summerset

@@WLSResources/ClothingExch In Germany the insurance companies require all of this stuff. The thing that makes me mad about this is, that insurance companies can deny coverage even though the patient did as required. Like I said: it's like playing the lottery here. The worst about it (IMO) seems to be the emotional turmoil the patient ist in when doing this program. The patient might be denied coverage if he/she doesn't lose enough weight on it and the patient might be denied coverage because he/she loses too much weight on it ("see, it works without surgery" which is of course BS because what is a time span of 6 months when it comes to weight loss and maintenance?).

That's worth a full quote.

Only if the behaviors persists. Behaviors (or maybe "habits" would be more correct) only have an impact when done on a regular basis (well, unless you do something really dangerous). You could compare it with consuming alcohol maybe. If you drink a larger amount of alcohol daily, not good. If you drink a glass of wine now and then, it's most likely not causing a problem. Yes. If. I mean there are patients participating in a 6 months long multimodal concept (PTs and NUTs and counsellors and whatnot) and they don't lose weight or only a few lbs. How can that be if these programs are supposed to be the cream of the crop? I'm no longer sure it really works this way. Sometimes I think some people have what it takes to succeed, fancy programs and behavior modifications or not, and others don't. But maybe that is too much fatalistic thinking though.

Of course not. However, what would it take to really prepare people for WLS? Is that even possible? To be eligible for surgery you should already have gone through everything else that is available to lose weight so you should be quite educated about all the theory regarding lifestyle changes (nutrition, exercise, therapy etc.) - you would have to self-pay to come around all of this stuff. Maybe I'm underestimating the number of self-payers in the US. In Germany people have to go through months long so called "multimodal concepts" since a whole while that might last from 3 months up to 9 months, depending on the insurance company and/or WLS center, to get approved for surgery (and even then it feels like playing the lottery and patients can be denied coverage). Yet patients still have problems losing all of the excess weight or struggle with major regain. Would be interesting to compare failure/success rates though with patients who got minimal counseling before surgery.

I would like to have known exactly all of that and more - however, there aren't surefire answers to these questions as it all varies a great deal from patient to patient. I now think that maybe these not-really-answerable questions have been the reason I postponed revision for over a year. I couldn't even know for sure if it would really solve the problem I was getting revision for in the first place (reflux). There was a good chance, yes, but no guarantee.

Damn, it really is like getting a driver's license! I think quite a few drivers should never have gotten permission to drive a car at all. All jokes aside - there is no way you can tell if someone is going to "mess up" after surgery or not. You'll never know for sure. There are people getting heart surgery and don't stop smoking or start smoking again, there are people who start drinking again after getting a new liver, even though they stopped drinking long enough to be able to get that liver etc. - and how many times before surgery (being on the umpteenth diet - oops, I mean lifestyle change of course) did we think This Is Finally It! This Time It Will Be Different! This Time I Will Succeed! - and yet we didn't. About that "lifestyle change": obviously we all needed surgery to be able to do that change and we all messed up a great deal before surgery when it comes to "lifestyle changes", otherwise we wouldn't have been eligible for surgery in the first place.

Reminds me of getting a driver's license somehow. Interestingly enough there are many shitty drivers out there anyway - and all of them have passed their tests.

What I thought.

Would be interesting to know.

With an energy intake that low of course you can't.

I think meal planning is easiest when you're alone/only preparing for yourself. No need to pay attention to any likes or dislikes except your own. tupperware like stuff and the microwave are my best kitchen friends since a long time because I don't like to spend a lot of time for meal preparing. I steam batches of mixed vegetables and cook rice in the microwave and can store it in the containers I used for cooking in the fridge. I buy prepared mixed salad greens so I don't need to do the chopping and cleaning.

Don't get me wrong. I just wanted to point out that it's that uncommon in Germany that patients are not even asking for it if it's not offered.

@@Djmohr Seems to be different in Germany. I never even had a patient who asked for a local injection before an IV stick.

Me, too.

Never have seen this. I mean like - never. We use Xylocain before we insert sheaths of course but not IV sticks to administer contrast agents. I also never seen it at another hospital so far. Sometimes when it comes to little children they put a kind of cream on the skin that is supposed to dull the pain a bit. Don't know how good that works.

Yes, I don't like the AC myself that much when it comes to injections. The veins do (usually) not blow but the automatic injector regulates down the pressure rate and flow rate when the needle doesn't work properly. However, for cardio scans and PE scans the AC is a good place. The patient mustn't bend the arm though. In my experience the veins on the soft inside of the forearm seem to be more prone to blowing when it comes to higher flow rates but maybe I'm making things up in my mind, lol. In general I have to take what veins are left anyway. Usually the patients have already been sticked multiple times (several IV lines over the course of the hospital stay, multiple blood drawing).

Ok, I'm dumb and clueless here - what's this about lidocaine and IV starts?

Yes, our radiographers are usually only placing needles into the AC - and most of them need to see the vein to place the needle. Most of them also fear the hand and the bigger needles that are needed for higher flows and would never use the forearm. I always shake my head when they get one of the radiologists because the patient said "I'm getting chemotherapy", I get there and I see veins in which you could throw a needle into while still standing at the door of the room. They assume that all patients getting chemotherapy automatically have bad veins without even looking. Ugh.

Ah yes, placing needles (usually for administering contrast agents)- I could sing a song or two (or more) about this issue.

To make it even more complicated, it depends on the approach a nutritionist or RD follows if a certain food is considered healthy or not.

But if your abdominal muscles are still weak and can't contact properly (remember, there are several incisions there), the lower back has to do more work and that might be causing back problems.

What does "little weight loss" mean? I'm sometimes surprised at what people call "too little weight loss". WLS does not magically create turbo-fast metabolisms. To burn 1 lbs of body fat a certain amount of energy has to be expended, surgery or not.

Is the pain in your lower back? When doing e. g. squats you usually use your abs to stabilize. When your abs don't work properly yet, your lower back takes over.

I focus on the immediate outcome. Endorphins and/or relaxation. And if the day was really hard (especially on top of an awful being on-call shift the night before) the best exercise may be going to bed early.

Nothing wrong there. 33 lbs in 6 weeks means a weight loss of 5.5 lbs a week.