Natasha Estrada

Good to know. Though BlueCrossBlueShield is not the same as Blue Shield. Each state is differnent. My friend found this out the hard way because she has BCBS issued out of CT and assumed she could use any BlueCross of California doctor. Not so much. Had to send her this video. I should clarify I'm not intending to keep anything from my pcp I just dont want to have to make an appointment just to discuss it

This is what Blue Shield of California requires so far as documentation goes. Initial Bariatric Surgical Requests:  History and physical including prior weight loss attempts and responses, and comorbidities* (see below)  Description of non-surgical weight-reduction program (e.g., physician supervised, organized weight-reduction program, or combination), initial weight, duration, and end weight  Description of exercise program and duration or medical contraindication to an exercise program (if applicable)  Monthly documentation of weight, dietary regimen, physical exercise, and behavior modification/behavior health interventions for six consecutive months occurring within the last 18 months prior to the request for bariatric surgery (e.g., medical records, and/or diet or weight-loss logs)  Nutritional consultation  Weight over the past six months  Psychological consultation, that includes that patient has been cleared for surgery  Medical doctor (MD) order for surgery that includes current height, weight, and body mass index (BMI), surgery requested and recommendation  Comorbidities* (when BMI >/= 35.0 kg/m. and <40.0 kg/m.): If diagnosed with coronary artery disease: Submit documentation from cardiologist that includes all previous and current treatments, as well as, member’s current status If diagnosed with diabetes: Submit documentation from primary care provideror endocrinologist that includes all previous and current treatments, as well as,type of diabetes If diagnosed with hypertension: Submit documentation from primary careprovider that includes all previous and current treatments, as well as, member’scurrent status If diagnosed with obstructive sleep apnea: Submit official sleep study report interpreted by a sleep disorders specialist MD or Doctor of Osteopathic (DO)medicine and documentation So I'm not sure if "Medical doctor (MD) order for surgery that includes current height, weight, and body mass index (BMI), surgery requested and recommendation" automatically = PCP

Oh I'll definitely tell her I just didn't know if I needed to make a special trip. I think she'll understand I had a colonoscopy earlier this year that found 4 precancerous polyps at the age of 34. My situation is more like Gingersnaps. My insurance didn't need her to refer me so I just referred myself. But for years I've had *** so I guess I'm used to the gatekeeper system. Is Heathcare Management Organization a dirty word because it keeps on getting bleeped

Honestly I wasn't plan on packing anything to bring apart from my purse. This is probably because I can see my apartment from the hospital but every other time I'm been inpatient I haven't needed anything. I don't need many creature comforts and if I do hubby can dash to get it. So a purse with my phone and a kindle should be fine. Hospital gown technology has changed a lot. I went for my upper GI and the gown covered everything from neck to ankle quite well. Side my house robe covers barely anything anymore.

I'm pretty sure they do. I've noticed from people watching at my surgeon's office. (the bariatric patients have a separate waiting area) that everyone seems pretty high strung and anxious. My program does about 400 surgeries a year. Thats a lot of nail biting patients

I love the Muscle Milk powder also. They have many flavors to choose from include red velvet cake.

As for the Lovenox. I also have a lithium induced tremor and I used to work as a nurse despite shaky hands. Lovenox is prepackaged and pretty darn easy to give. It's a subQ injection with a tiny needle so angle is not so critical. Practice poking yourself with a pen where you hand hits your belly before the point does. The needle will be at a 45 degree angle which for subQ is ok. (45-90) That makes it much easier to keep it steady. Its a big barrel syringe too with an auto retracting needle.

Well there is some benefit to pushing your tsh to the euthyroid level i.e close to zero versus just being "in range" but that's something a physician should do.

I had a friend who had her own diet. The Mountain Dew diet. It included 2L of regular mountain dew a day. I remember getting magazines from Singapore that had all kinds of weird ultra low calorie diets.

I'm not a dietician yet but to become a registered dietician you need to complete both the theory portion and the internship. Or you could take a coordinated dietetics program. Not sure about the online options but definitely the clinical hours are in person. Sometimes the online degrees have you arrange your own clinical experience which can be difficult. I know this is the case for some nurse practioner programs. The prereqs involve a lot of chemistry and A&P with lab components so IDK if they can be taken online or not. Check the eatright.org for more info. http://www.eatright.org/BecomeanRDorDTR/content.aspx?id=8092

Both fat and Protein promote satiety. Carbs if not used get stored very very quickly. If it's playing in your city Fed Up is a great film to see.

In general there is nothing in a carb your body needs other than energy. Simple energy. Protein and fat how ever have amino acids and essential fatty acids. Tryptophan is the precursor to serotonin. Tryptophan is an amino acid, a less common one. Ingesting carbs allows tryptophan to be taken up in the body faster but you could get a similar effect from ingesting more tryptophan. Carbs are seductive I'll give you that. I used to feel awesome when I used to eat about 20g a day. ​Very complication explanation of the above if your into biochem http://www.psychologytoday.com/blog/evolutionary-psychiatry/201105/sunlight-sugar-and-serotonin "Having obscene amounts of sugar and carbohydrate over long periods of time can max out our serotonin machinery, leaving us unhappy, carb-craving, and depressed."

Always the brentwood campus is within walking distance of many eateries and probably a trader joes and whole foods. http://asucla.ucla.edu/restaurants/

Don't worry there will be plenty for you to eat in Los Angeles. This is the city of weird dietary requests. Worse comes to worse you could always hit a juice bar. I seem to recall the UCLA campus having a variety of food choices.

"Now, personally, my friend was completely oblivious to how her actions could effect me at all. I chalk this up to pure self-centeredness" Wow she has no idea that the self centeredness she refers to is her own. Why should a decision as big as WLS be based on your friend's feelings. Honestly all these tirades are not about you but about how the change your making is making her feel. There is not a lot you can do about it.

Part of the issue is they only hire people who have lost weight and maintained on weight watchers which usually means leaders that have only lost about 20-30lbs. It makes sense of course business wise. Also the system is constantly changing. The support part does help but when it comes down to it is still is about will power and the spend your points on what you like mentality doesn't really encourage balanced eating

Sounds like you might benefit from cognitive behavioral therapy. In the book they give us to read preop with my program there is a section on grieving the loss of being able eat the way we used to. A therapist might help with that.

I would tell you but then I'd have to eat you.

Accountant

Think about the preop process this way. It's like a train once you're on you have to stay on until you get to your destination. If you jump off you just end up at the side of the tracks and you don't know when the next train is coming. Take your family and spouse to a support group.

i've never heard of such a thing. A good part of the risk in the operation is from cutting you open and the anesthesia. I can't believe any surgeon would open you up and then not try and complete it. The insurance won't pay him for opening and then just looking.

I have a consult for the endoscopy on 7/1. I had a colonoscopy a few months ago but I had to have it at the hospital because of my BMI (55). I would prefer to have it at their own endoscopy center because it ends up being a lot cheaper after insurance. My colonoscopy ended up costing me $400 when outpatient it would have been about $60

I would think so. I was on CA SDI for a few weeks after my gallbladder surgery this really would be no different as long as the MD signed it and they are usually happy too. Two caveats though. It takes them 6-10 weeks sometimes to start paying out the claim and then they put it on a debit card for you instead of a check. Also it is best to ask for more time than you need as extensions also take a long time to process.

Yes that's one of the complications I would not be happy with: reflux

I'm presurgery but I like Muscle Milk powder. Might be worth looking at for a little variety since they have the widest range of flavors I've seen. Latte, bananas and creme and even red velvet cake.