???????

What's TPN? (sorry...I keep meaning to ask you)

Awesomeness! I'm stealing that word You say "snot"....really? Did you slime (whatever it's called)? All these crazy terms lol

My first surgeon visit in December 2018 also counted as a nutrition consult so my last consult should be in May. Monday, Jan 7th, I have the first true dietician consult in the evening. No idea what to expect yet so it'd be cool to keep up with other folks going through the same thing at the same time. Hollar at me!

What's "blarf"? Sounds like something I'd make up...I'm commonly use 'gnarf'...'gnarfle'...'gnarfed' LOLOL Sure hope you're doing ok!

LMAO! I'm just scared, man. After my daughter was born back in 2010 I had post-partum depression and they pumped me full of everything. It was the worst time of my life. I trusted doctors that turned me into an even more non-functional monster than I was before meds. As long as I arm myself with info instead of going in blind like I did before, I feel better because I know what questions to ask. We'll just see what happens...?

Turns out I can't take anything...phentermine, Belviq, Qsymia (which is the brand name for the phentermine+topamax combo)...they all severely interact with Trintellix. Basically combining any of them with Trintellix increases the risk of serotonin syndrome. That's some scary stuff so...no meds for me. Nope, nope, nope...

Yikes! To be honest, now I don't want to take anything after all these stories!

Noted. Was the phentermine addictive? This next appointment can't get here soon enough...looks like Contrave is bupropion+naltrexone. I tried Wellbutrin (which is bupropion) before I was given Trintellix. It messed me up. Mainly didn't work so they upped the dose. I found myself just sitting and staring, numb, but wanting to cry. NOPE! No thanks! LOL

Not second guessing anyone. I also have a hernia and can't deal with dense, heavy fiber type foods without pain and gas. I bloat up like a blimp when I eat grains. This is no different than a vegan or a vegetarian. I've been on a specific diet for a long time and I want them to know about it.

@mousecat88 Surgeon's office lady replied back and said "phentermine + topamax or Contrave", but to let the surgeon know I'm concerned about interaction with the Trintellix. Good to know...

Dude

Yes! I was given Topamax along with Lexapro many years ago. The Topamax effed me up! I was at work one day and all the sudden I couldn't speak. It was the scariest crap in the world so I quit all my meds cold turkey after that and Lexapro withdrawl was pretty awful. Brain zaps...not my idea of a fun time LOL

I bit the bullet and emailed the lady to ask what she thinks he has in mind so I'm sure she'll get back with me shortly. I've bothered the hell out of this poor woman But they DO work for me and I DO deserve an upfront answer. I'll report back once I have the deets LOL Weird is definitely right...I honestly don't want anything and the way you describe phentermine, I sure don't want any of that either! LOL I'm too old for that kinda junk now. My main concern is I already take my Trintellix anti-depressant. If anything were to interact negatively with that...oh man...it has helped me SO much.

Bahahaha "circling the drain" Girl, I have nothing figured out...at least not in the bariatric world LOL

Yep, here's what the surgeon's office lady said, "Insurance reviews what we send in based on the weight/BMI you were on your first visit. The only way that you would not be approved for losing weight is if your BMI ends up under 35 (and surgery wouldn't really be appropriate at that point any way). However, you are likely to lose about 25 pounds in those 6 months and insurance will look at this in a good way because it means you will be successful with surgery so they won't be wasting their money paying for it." So I doubt they expect me to lose too much on whatever meds they have in mind considering I'm so close to 40 BMI already.

Well, I won't say "disagree"...I do know that overeating protein can cause weight loss stalls (in the pre-op world). What's not used by the body during protein metabolism is converted to glucose by the liver. I don't work out or powerlift and I know once I reach about 100g of protein for the day, I've over done it and better chill out. I know fat satiates me, not just protein. The idea of a high protein, low fat diet (without having surgery) scares me. I don't believe in calories in/calories out (CICO). That's an antiquated method of achieving weightloss (for the pre-surgery people), it's not sustainable, doesn't work for everyone especially those with insulin resistance and it eventually ruins metabolism. Soo...that's the kind of stuff I'm afraid will bite me in the butt in conversations LOL However...I did email the dietician and let her know my eating habits. Hopefully she'll message back with some supportive words.

That's what I figured. I do that to much so I figured that was the case. I'm just so scared of sabotaging this process and not ending up getting surgery. Post-op will be a whole new world. Definitely aware of that. 80lbs in 6 months is awesome!!!!

Yes, I am pre-op. The weight I've lost was a result of 2 years strict keto....you probably saw that in my other post. I don't believe there's a set expectation for weight loss. The lady at my surgeon's office said with the meds, they expect me to lose approx. 25lbs which should put my BMI around 38.5. I gained a good 5lbs during the holidays which they're unaware of. I can lose 13.5lbs at this point and be right at a BMI of 40. I just need to get to that appointment and find out what they're wanting me to take. I'm guessing it's phentermine which I highly doubt will effect me since I used to pop Adderall like Skittles. No matter what, I'm going to make sure this surgery happens...

Yes, I am in the very beginning of pre-op. It sounds like you've definitely gone through it all! I have tracked my food in an app on my phone for the past 1 1/2 years fairly consistently to make sure I'm staying within my macros, so that data is definitely there for the dietician. I don't eat sugar, don't drink soda/carbonated stuff aside an occasional La Croix and use stevia sparingly in coffee. For drinks, I switch between Propel and Powerade Zero and plain water. Don't eat bread, no pasta, no grains, no beans/legumes, nothing inflammatory like certain oils and other ingredients. For the most part, I eat fatty meats, nuts, leafy greens, high fat dairy (sparingly) and I consume a lot of MCT oil - about 4tbsp + a day. My protein macros are set at 60g a day (which I sometimes exceed accidentally), because I'm not a powerlifter and I don't work out. During protein metabolism, unused protein amino acids can convert to glucose which causes weight loss stalls so that macro is important to not blow. Keto is very strict and I've done well, but not well enough. My job changed insurance plans unexpectedly which happened to include bariatric for the first time ever so I'm jumping on to take advantage of it. In 2017 I had a bad car wreck and nearly lost my foot and broke a ton of other bones so I haven't dared to exercise. Things still hurts from time to time, but I can walk. Even before the wreck I wasn't actively working out so pretty much all I can do is walk. I expect dietary changes post-op, that's a given. I just don't want to sabotage everything I've done on my own so far just because the dietician doesn't believe in Keto/LCHF. I might just be overthinking and assuming too much which is why I was curious about other people's experiences with their dieticians.

Well, that's refreshing to know! I've always found myself having to fight to back up my way of eating so I guess I'm going into this too much on the defensive.

My doctor scheduled me to visit Jan 14th and I was unsure why. I asked my contact person over there and she stated it's an appointment with the doctor because he's going to be prescribing me some weight loss meds to get me losing a little during the next 5 months of nutrition visits I have to complete. That was kind of shocking. I didn't expect to be given meds. Anyone know what they might give me? I had an addiction problem with Adderall for some years that I finally overcame and this kind of scares me. I don't want anything that'll make me speedy to remind me of the Adderall days. I'm already taking Trintellix for depression which has been AMAZINGGGG. Thoughts?

So I've arranged my first dietician consult, which is interestingly done remotely via WebEx video conference (not relevant to this post, but just interesting). Any who...I was given a lengthy PDF packet to read through regarding general nutrition and as I read it, I find I don't agree with some of the information. I've been living relatively strict keto, High Fat/Moderate Protein/Low Carb for nearly 2 years and I'm afraid I'm going to get into this consult and butt heads with the poor person. Not on purpose, but I really don't want to change the way I eat because I know what happens when I eat the stuff that is considered OK. I get bloated, I gain weight, my face gets puffy, my feet get swollen...etc. My body likes keto and most "health professionals" aren't on that bandwagon. Any words of advice from anyone that's gone through their diet consults would be awesome. I know the best thing is to just smile and nod, but I know this girl is going to want active participation.

Sadly, I've confirmed that my insurance, Anthem Blue Cross (California), still requires dietician consults for 6 months. So I guess my Blue Cross plan is just not the same type of plan discussed in this article

Finally got my Anthem Blue Cross policy requirements confirmed. Standard 6 months of nutrition visits (should be done in May), psych evaluation in April and a $3500 out of pocket maximum which I have no idea what that exactly means. Google describes OOP max as the maximum amount you have to pay out of pocket (copays/deductibles/coinsurance) before everything is covered at 100%...which makes sense. Benefits lady has me confused and they won’t be back in the office until next week. In her email she made it sound like I have to pay all that before surgery. Anyone have any insight and/or tips on this? Do I need to start saving $$$? ?

Awesome!!! I have a new Anthem BC California policy but live in Texas. What were your requirements?