Butterfly512

Anyone with Medicare? How is/was the approval process and coverage for the surgery? I have BCBS thru my husband's employer, and the coverage and benefits are excellent, but I'm wondering if the coverage requirements for the gastric sleeve surgery might be better with Medicare coverage so I don't have to wait so long. I can get my coverage back because I'm entitled to it with my SSDI, so I would just like to check my options. I only have part A right now, but I can get the other benefits back as well.
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So glad I came across this thread. Hopefully I can help.

Therapist, specialize in treating us, also complete evaluations, also have Bipolar I (and had surgery so...🤷🏼‍♀️).

According to the actual guidelines that we are supposed to follow regarding who has to be considered as not ready for surgery:
- actively psychotic
- recent (past year) inpatient hospitalization for mental health (suicidal/homicidal)
- drug/alcohol abuse within the past 6 months
- unstable mental health diagnosis (e.g. not actively in treatment, not keeping up with meds and appointments, etc.)

Now, the good news is, NONE of those things mean the person will NEVER be approved - they may just have to have a period of time that they show stability/treatment compliance BEFORE they get approved.

That info is straight from the ASMBS (American Society for Metabolic and Bariatric Surgery) guidelines. If the psychiatrist says otherwise, he can take it up with them! 🤣

I hope that helps.

~SW: 278 CW: 165~
RNY 1/5/2005
"What got you here won't get you there."

I'm sure I'm not the first one to post about this.
But I am really discouraged by the 6 month supervised diet requirements..or maybe I'm impatient, and just frustrated by another 6 months of the struggle and after making this decision I just want to move forward asap!
Does ANYONE know of a surgeon that will "work around those requirements" is there any way to omit that??
Any advice? BESIDES the whole lecture about how it's all worth it and the 6 months will be good for me.
I'm sure I might feel that way too if I'd already gone thru it, but I'm trying not to.
PM me with any help you can provide.
I'm in MI
Thanks
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Thanks the template was very helpful Butterfly512

Use the 6-month period for preparation and developing the necessary mind-set. This isn't a short-cut to weight loss. It is a long-term commitment. Have you addressed the reasons that you were not successful with lap-band? This is a major, irrevocable life-change. Unlike lap-band, you can't change your mind and have your stomach put back in. The surgery is the smallest part of success. Your brain isn't changed by the surgery and that's what will determine whether you're successful or not. Good luck.

Wanting to get started on a big change is very normal. It's just human nature. But, even if you had surgery in March, you'd still be dieting all summer! Even now, when I'm nearly at goal weight, my challenge is to not eat more than 1 cup of food at a time (which I am able to do, unfortunately) and to not drink during meals or for 30 minutes after. So, a year out, I am still very mindful of my meals, paying attention to both volume and calories.
Very few people are successful long-term without constant vigilance. Yes, there are a lucky few, but not the overwhelming majority.
Best of luck to you!

Try Dr Mark Pleatman, I think his location( if I recall right) is Bloomfield Hills, he is often on the Bariatric Pal pages as an highly approved surgeon, if his office will not work with you ( dollars to donuts they will) I'm sure they can recommend someone who will.
What's in it for me to to state this recommendation? Not a durn thing, never been his patient, his picture looks personable, I'm just a humble Buckeye. who found her miracle worker bariatric surgeon at Ohio State University, had her surgery September 5th, and just wants everybody to find a perfect fit. Oh and P.S. many insurance companies are dropping the 6 month requirements, oh that yours would join them! Best wishes from The Center of Ohio and ME!

Thank you for the response MKjohnson ????
I feel a lot better now knowing that, when I will have to start lifting my son today.
I don't know your situation, but Good Luck to you ????

I had the LB removal surgery Friday and I was told I could lift up to 30 lbs. Thank goodness, because my 2 year old wants to be carried constantly and needs help with the potty and stuff like that. My husband was only able to take off Friday (he was home this weekend but had to do car repairs so I was basically by myself today.) and I did ok. I think I'll be well enough by tomorrow to resume some of my daily chores but I'm doing freezer meals and saving heavy lifting for when he is home. I'm only on regular Tylenol now during the day, but I have been taking half of my Percocet dose at bedtime so I can rest.

That's got to be a physician decision and it would depend on how much trauma the band caused or causes as it's removed. If there's no large incisions or damage done to the stomach or esophagus I would imagine 28 lbs should be fine?
tmf

I believe so, I would think if it slipped you would be in pain & have other symptoms. The fact that you felt the need to stop is a good sign. Just eat really slow, chew chew chew don't drink anything with a meal.
When I 1st got my band I got sick & threw up all the time, it takes time to teach yourself

Chew, chew, chew your food to a Soup like consistency. Slow down, put your fork down between bites. Small bites, very small bites. It can take months and sometimes a year or two to get the hang of eating correctly with the band.

Try doing some Protein Shakes for 2-3 days only
Then try eating some chicken for dinner only on the 2nd or 3rd night, eat really slow, chew really well see how it does.
This gives your banded stomach time to settle down, the go get a fill but not as much as they took out. Take it slow.

Don't know your situation, but this is what I know....
First, after a fill, you need to stay off foods for a period of time...it can be inflamed mimicking a overfilled band. Also, continuing to eat only prolongs the situation never giving it a chance to rest and heal....
The same is true after an significant stuck episode....continuing to eat can and will cause dilation.
Stay with liquids for a day or two then ease back into eat, keeping in mind what you did before that created problems.
It took me a few times before I realized Rice was a problem...and that is only one example.
There is a fine balance between band adjustments, what types of foods we eat, and how we eat them.
With the way my band is adjusted, there are certain foods I no longer eat..just too risky..and when I am eating I have to be very mindful how I am eating...can't rush it, can't take too big of swallows, need to chew adequately, etc.
Eventually it all became 2nd nature without giving it much thought.
Before surgery I was doing everything wrong..eating WAY too much, too fast, not to mention an insatiable appetite and hunger....
But that is what surgery did for me...it was a major behavior modification....the hard way in the beginning.
I understand some people choose to have their bands less adjusted, letting them eat more unrestricted, less behavior changes...
But agaion, everyone is different, the band is adjustable and people themselves are different.

He did go to the first consultation and has a clear understanding of the surgery, etc., from me explaining it and bringing brochures and sending him info from online, he just doesn't understand the problems I have with emotional eating, appetite control, weight gain from my meds..and everything else that causes my failing on every diet.
And whether he is fine with how I am or not ..this is for me and will make me happy & complete.
I am sure he won't mind though when I am thinner and looking hot lol

Went out for lunch yesterday with the fella and we were both pretty hungry. Everything looked yummy but I suggested we have two items, and see how hungry we still were and to go from there. So we shared a pitcher of white sangria, a small guoc, and nachos appetizer. Turns out that was enough. Never even bothered ordering anything else. Plus...it turned out to satisfy well into the evening when we had some fruit and cheese to nibble on rather than a full dinner.
I really do prefer eating this way. Haven't been uncomfortably full in quite some time and I have learned to enjoy not feeling the heaviness or the guilt that comes from overeating.

Maybe some people can eat slow, not drink right after meals, and follow a low calorie diet perfectly right after getting banded, but as my posts clearly show ???? I really don't think I can stick to those rules or changes in my eating habits until I am forced to after having enough fills.
I am at 5cc now after 3 fills and definitely not in the green zone yet, I start off doing good after each adjustment but then as I realize I can eat how much and whatever I want still, etc. Its hard not too.. Obviously or I wouldn't have a weight problem in the first place.
Is there Anyone here that didn't adhere to the rules of the band until they had to? Until they had enough fills to have no choice but to?
I am waiting to get to that point! Because until then the struggle of dieting and trying to follow the rules is so tough for me!

Every one is different, of course, but sometimes I think every day is different, too. I have a lot of variation. Some days I'm really not hungry at all until evening, while other days hunger arrives at 11:30 or so (that's about the earliest for me -- I do not eat Breakfast because I am not hungry in the mornings). I try to listen to my hunger and respond to it appropriately (good food, protein). I have to resist old wiring in my head that tells me to hold off or restrict myself in some way. All those years of dieting! I have not logged in a long time and that might be helpful to me for a little while, but I know I won't be a regular My Fitness Pal person again. I just want to "be" -- be normal, I guess. Normal weight, normal relationship with food. We all have to do whatever we need to do to achieve our goals. Best wishes to you -- it is so much easier in the zone and you are getting there!

I just need someone to tell me that once I get to the green zone..and just with the band in general, that it's not a diet.. I am so tired of struggling with diets, counting calories, trying to follow certain meal plans, etc.
I want the stress and the struggle to be done!
I just want to be able to eat less and be active and lose the weight, then maintain it

@@Butterfly512 let me start by saying no one does this thing perfectly even with the right amount of fills. It's more about finding the balance works for you more then it is striving for perfection. The band should not be used to FORCE you to make the right choices or to follow the rules, that is something you have to take control over and make your mind up that this is what you're going to do for your overall health and the bands optimal effectiveness and longevity. If you're using the band as a restrictive tool I just worry that you'll run into troubles down the road. It's a tool to help you but the mindset has to be there. You can't drink with your meals, it defeats the purpose of having the band it just washes everything you eat right through never giving you that satiety feeling even if you're at your sweet spot, how will you know?. If you wait until you're unable to drink with your meals, well in my opinion that means you're possibly too tight and being too tight hinders your weight loss more than not having enough Fluid in my opinion. Not being able to drink with my meals was one of my biggest fears when I opted for this surgery but I just didn't give myself a choice. I drink right up until I take my first bite, sit at the table with no glass in front of me finish and then wait 1 hour before resuming. It really hasn't been as hard for me as I thought it would be. Regarding your portion amounts, did your surgeon give you any guidelines? Here's what mine said 3-4 oz of Protein, 1/2c veggies and 1/4 c or starch. I eat my Protein first, then my veggies and very rarely do I even have room to eat my starch. This is ALL of the food I allow on my plate if I eat it all great, if I don't great. If I'm still hungry afterwards then I will get up and do something, anything, because I know that it's head hunger not real hunger. Once my hour has past I follow it by drinking fluids and 9 times out of 10 that does the trick to help that hunger "feeling" go away. Not always but most of the time. Keep in mind this is only if you're in the green zone but even if you're not you still have to follow the same guidelines until you get there, yes it will be a little harder, but the rewards are so much sweeter than anything you can put in your mouth! Best of wishes throughout your journey. You'll get there!!!!

@@briefs199 I definitely feel once you find your green zone that the diet mentality slowly dissipates. With that said I think how you maintain that weight loss is a very personal choice. For me I have to log my food and I'm two years post op but I don't have the I'm on a diet perspective I have the perspective that this is what I have to do to keep my self honest and mindful of my choices for life long success. Will this one day become a thing of the past? Who knows only time will tell but for now logging food is no biggie for me it brings me comfort it's all about what works for you as an individual. Don't be afraid to try different ways of doing things until you find what works best for you. You'll get there and things will definitely become easier once you find that sweet spot. Good luck to you on your journey!

When I got to the Green Zone, a few things started to happen...
First, my hunger, cravings, tastes, and interest in food altogether changed...
Second, I discovered that there are certain foods that did not go easy with my band..so I started to avoid them until I now stay away from them altogether,,,just so happens, most of them are high in carbs anyway.
Third, my portions became very small...very small!....Some people call it getting full faster, or satiety...whatever, I simply could not and still cannot over eat.
So saying all that, since the above was taking place, I concentrated on what I could eat. Concentrated on High Protein, high nutritious foods ...since I eat so little at a given meal, I'll not blow it on junk...like the rule says, do the Protein first. Then go for the extras, if you're able.
Call it a diet if you like, but I call it a new lifestyle. I eat wholesome, nutritious foods...nothing processed, etc.
I compare notes with friends who are into it also and did not have WLS....
I should add, when I reached the Green Zone, say 4 months after surgery....things really turned upside down! It was not easy, and I was tempted to get Fluid taken out of my band thinking I went too far.
It took a full 12 months until things began to smooth out and get easy, as I continued to learn new things about eating.
And today, (I still study new foods) it is 2nd nature, no calorie counting, etc.....
I just eat less (a lot less) and eat good....protein, Water and exercise.
And with all that, I am not afraid to have Desserts, etc from time to time....enjoy myself and life's little pleasures....
But all this did take time....I read posts here every day from people banded a few weeks to a few months wanting results!
This is a lifetime change...have to think about the big picture.
Remember...The band is adjustable ...Get It Adjusted!!!
I read posts where people are struggling, and I want to shout..."What about The Band" Is the band doing anything???? Because they sure talk like it is not even there.

At 7 weeks your body is still healing. Your band isn't providing restriction yet so unfortunately it all falls on your choices right now. If your doc has u on solids already try more Protein at lunch. I would be starving if I just had a yogurt. I usually need a 3:00 snack of some kind Try not to go over 4 hours without some sort of protein..maybe this will help the starvation monster until you get restriction.....plan, plan, plan. Everything you will eat that dat including snacks...that helps me. Chin up You can do this!!

I was banded in 2011 but if memory serves me right, 7 weeks post op, I was still on a restricted diet at that time...certain harder foods were not allowed yet and I most certainly did not a fill yet...I remember by first fill, and even the second...the NP asked how I was doing and my response was HUNGRY! I was not at proper restriction yet, but still trying to be good! Between surgery and recovery, restricted diet for a while, I lost about 25 lbs. The rest I did have to work for, and one of the biggest things I learned to do was have something healthy around for when I was starving. It happens! Don't beat yourself up! Cottage cheese is my go to, it always hits the spot, it's a good consistency for sitting in the pouch, and it's high in Protein. But if you are not feeling restricted yet at all, I feel for you! But hold on! You're not a failure, the best is yet to come! Keep your appointments and even if you gain, it's ok, but it's not ok to give up! You can do this

Hi there ! Hope you're doing better today, but 1st , slow down a little ! I may be wrong , as everyone s a little different, but 1st and foremost you're supposed to focus on healing at 7 weeks, not losing weight. Follow the rules as much as you can and the weight loss will follow. 2nd , you're not in the green zone yet, so of course you're hungry alot ! You cant control the hunger, but you can control whether you eat a cheeseburger and nachos. Your choices are to eat those foods when you're hungry, or eat some protien and fruit or veggies. Once your stomach is filled with food ( healthy or unhealthy) the hunger goes away until you feel hungry again, right ? . So, plan ahead, pack small amounts of healthy foods in tupperware or baggies, and when you're too busy with your child to cook you'll have something healthy already to go. Hope this helps ! Good luck !!
eat a cheeseburger and nachos.