KarenLR75

You could take the same vitamind pre-op that you're going to need post-op. I take Calcium, Vitamin D, a multivitamin, and B12. I also take Biotin as a supplement to help with the Hair loss.

Preop I took Flintstones just to get in the habit of taking a multivitamin. I was also taking a very basic Calcium and Biotin supplement. Find a good biotin Shampoo as well as a dry shampoo for your hair. I use the dry shampoo to get me in-between washings, as it seemed like when I washed my hair I would lose more of it so I tried to go longer between washing. The dry shampoo also helps give it more volume. As far as I know no one has found the solution to the Hair loss thing.
I'm sure a lot of people like Bariatic Advantage and Bariatric Fusion for their multivitamins but my preference are the one a day options like ProCare Now and I just recently ordered BariatricPal One. I take the multi at night right before bed because of the nausea it causes and then I take my calcium chews at Breakfast, lunch, and with my afternoon snack or dinner.

Check out BariatricPal Multivitamin ONE "1 per Day!" Bariatric Multivitamins from https://store.bariatricpal.com/collections/bariatricpal-multivitamin-one!
With just ONE convenient & affordable BariatricPal Multivitamin ONE each day, you can get the bariatric Vitamins and minerals you need to stay healthy! BariatricPal Multivitamin ONE was designed and developed by a team of the world's leading Bariatric medical professionals.
Please take a Calcium supplement separately to prevent interference with absorption of Iron.

This book is a good place to start so you can understand the science.
The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable https://www.amazon.com/dp/B005CVV2AE/ref=cm_sw_r_cp_apa_Bus7ybP5P45SW

Just like WLS understanding the science behind it makes it easier to understand, follow and make the right choices.


/r/keto on reddit is a great place to start. I am just going to warn you. Keto is a commitment just like WLS. It isn't a diet it is a lifestyle and a way of eating. If you stop eating keto and go back to carbs the weight will pile on. Keto is not some fad diet you can follow for a little while drop weight and go back to eating trash. If you can't commit to it for life, there is no reason to even start.
Keto replaces carbs with fat to keep you satisfied and once you are keto adapted your body runs on fat.

@tiffany44641
I have been a low carber, Keto person off and on for about 16 years.
I would lose weight but plateau and I didn't understand stalls so I would quit. I also had a Portion Control issue. People in the keto community feel like you can eat without portion control as long as it is high fat.
Being sleeved helped me control my portions. In the beginning when I was healing I just followed a normal low carb diet.
Around 6 months when I was healed, I switched to keto. Personally I feel like if I didn't switch to Keto I would not have lost this much weight. I would have topped out at about 100 pounds lost and bounced around like most WLS people.
Just as importantly eating keto has allowed me to maintain my looks. I have lost 182 pounds and I look very young and healthy. I do not look sickly. My face looks amazing. Keto is great for women because the fat is great for your skin. If you look in keto groups the women that keto almost glow.
I am a strong advocate for Keto. If you can portion control you can lose a lot of weight on keto. If you can't portion control wls is a great option to help you with that. The sleeve has helped me with portion control and made making the right food choices easy.

I had surgery Monday. This particular plan through Cigna does not require any time period of medically managed visits for nutrition or weight loss and is accurate per the page I posted. I was approved first go within 3 days.

Thank you for responding, Frustr8. Guess there are not a lot of outstanding bariatric doctors in the dallas-fort worth area or everyone who may have had their surgery around here is just busy, which I understand.

I posted this in wrong forum! Moving it here:
Am in a tough situation, as most everyone is. While I've been morbidly obese now for over 12 yrs, I had been able to get around and was working on adopting a Keto way of life, not just as a diet as I truly feel physically better when I eat that way. Unfortunately while I've been working on losing weight, it's been much slower than expected (I've hit that female time of 'life' and everything seems to have slowed to a crawl) - I've only lost 46 lbs in the past 6 months.
I ended up tearing meniscus on 1 side of my right knee while exercising. I had surgery to trim part of meniscus that was hanging so it wouldn't get caught in knee when it bends. I also have history of throwing clots but I do NOT have a clotting disorder (like Factor V, etc.) I have a permanent IVC filter installed. My cardiologist recommended amount of Lovenox for me to bridge (for 1st knee surgery) to based on my body weight. Well, they don't make lovenox in that 'dosage'. The doctors decided to 'wing it' with the normal amount of Lovenox. Needless to say, I clotted again but I feel decision was made in error (i.e. cause & effect).
Since then I've torn meniscus on other side of right knee and my back has started to spasm (diagnosed with herniated disc). No big shock as I've put my body thru too much stress with weight. My issue is I REALLY wanted to avoid surgery & truly wanted Keto as my WOL. The problem is the pain my knee and back are causing is now so severe I cannot take it anymore. I thought I had a big pain tolerance but seems I cannot handle 'chronic pain' as well.
With my mobility limited until summer when pool is warm enough to swim in, I'm not losing weight fast enough to get to move on with my life and have the knee replacement my ortho is suggesting but will not do at my current weight..
So, I've been on these boards off & on for a few years, mostly researching & I feel that since I'm 50, I'm running out of time, especially with amount of pain I"m in. I truly want my life back more than I want food at this point and have felt that way the whole time I've been doing Keto. At 344 (down from 390), I'm ready for the pain to stop and I've researched until I'm blue in the face. I do know that I want to start down the road of interviewing doctors, my primary dr already was supervising my keto loss, I have a psych dr but am willing to do eval with another if they won't accept my own. I've discussed possibility of surgery with current docs for 2.5 years now.
I was also diagnosed with melanoma recently and after losing my best friend to brain cancer, I certainly feel a bit of concern that since we do not know how many days we will be on this earth, that surgery is definitely on the table. I looked for a Bariatric COE in DFW area and only come up with Baylor Hospital in Grapevine; however, when I look at bios & reviews of the 3 docs they have, none of them inspired me with confidence. Anyone have a dr to recommend who has a long history of performing both sleeve and bypass with great results?
I had considered combining lapband with my keto to see if that would help speed things up but looks like with my BMI, that may not be an option? I also have to carefully consider surgery options due to my clotting history. Ortho docs want to do knee replacement when my BMI is lower, until then, I just put up with pain.
Any input is appreciated!

FYI Cigna sent my approval today so we are correct on the no 6 month thing for our plans. :)

My surgeons nurse is way behind due to some fellow nurses being out sick so she said it would be several weeks until she gets to mine. Its KILLING ME lol.

I’m there with you too! It’s killing me! Should hopefully have everything submitted next week or the following Monday. I just want to know if it’s approved or not!
Fingers crossed you’ll hear good news soon!

Sooooo I'm done with EVERYTHING required for insurance and I'm just waiting on the nurse to submit it to them. Is anyone else playing the waiting game? I figured it would be a wonderful help to be there for each other while we wait patiently (or impatiently in my case lol).

Yes!!!! Sing it my sistah!!!! This surgery (both RNY and Sleeve) are largely what you make of them. But, the sleeve does carry a bigger risk of GERD and revision risks (IMHO). So if you have any reflux issues or asthma/upper respiratory issues, I'd sure choose RNY.

Here the deal in my view. A person can sabotage either procedure. However, read the medical journals that deal with obesity and look up the psychological studies after wls.

You have to prepare your Mind and body for long-term success. It's not just about the weight. Your life is going to change in multiple ways. Counseling can help throughout this process.

Sent from my SM-J727T1 using BariatricPal mobile app

Hey Orchids&Dragons,
Not sure if I recalled that you had CIGNA too. Sent you message after my meeting with Dr. Dyslin yesterday.
I'm stunned and confused by what they said Cigna requires for seeing a nutritionist for 6 months...back to back consecutive months with no break..not even sure they care about the 1 year supervised weight loss I had with primary. Am just devastated.
Am so confused by the differences I'm kind of seeing...did Cigna just change their policy?
sher0929 - did you have to see a nutritionist every months for 6 months BEFORE you were approved for surgery. To me I figured I'd have a partnership with nutritionist and see them BEFORE..a couple of visits and AFTER surgery. I NEVER EVER Expected such a long and confusing requirement.
Dr. Dyslin indicated there was never an 'appeal' that could be done with Cigna....but I thought I just read recently on someone else's post that they could appeal. SO VERY CONFUSED! AND MAJORLY DISAPPOINTED. Seems like 'hoop jumping'. I learned a ton about myself from the supervised weight loss that I initiated and all the work I've done and looked into the past FOUR years. Don't see the value of a nutritionist for SIX LONG MONTHS prior to SURGERY?!?! Don't mistake me...I know I need to meet with a nutritionist..it is the length of time and the fact that they don't factor in seeing one after as well...and that my supervised weight loss SEEMS like it means nothing.

OMG...the dr's office called back and said they called CIGNA and were told that I had to do the 6 months, ,consecutive, yada, yada, yada and this is why it is best to 'let them handle these things' as I don't know the right people to 'talk to'.
EXCUSE ME? I don't know the right ppl to talk to? I didn't call for 'basic coverage'. I called for the legally binding policy COVERING what their REQUIREMENTS ARE. Like you, I think/feel that these people should be very experienced with making these calls but the way she tried to read back policy 0051, I could tell she was very very very very confused!
And she's saying to cancel the appt with the nutritionist for this month and 'just go' next month. She wants me to go back to my primary and get more 'notes' even though he wrote a letter detailing everything!
I SO do not want to have a bad relationship with my doctor's staff! I never want anything like this. I just DO NOT BELIEVE this one person is truly comprehending how crazy all of this is..not even saying 'hey, this doesn't make sense...we should be hearing the same thing...let's do a conference call (which I suggested). I feel like I'm alienating them and I'm just at my wit's end here.
I also feel bad for them and us as this is obviously something VERY VERY STRANGE related to CIGNA so we are all having to go through extra struggle and frustration because BOTH of us have had this same..."interpretation issue".
I can't wait to hear how yours goes! I'm rooting for you. I also need to think how to...let my dr's office know..this is NOT personal and I'm not trying to argue. I am genuinely confused and I have dealt with Cigna so much in the past decade plus I work in a software industry that deals with healthcare, insurance..so I'm not a complete newbie.
Am worried they now think I'm some desperate person that doesn't want to do what is required. All I have ever wanted to do was 1) Do what was required but more importantly 2) ensure that this decision was right for me and that I was 'right' for it. Right as in ready. Right in my head space, right in my willingness to work hard, right to meet and EXCEED the requirements from CIGNA as this was not an easy decision and I"ve spent 4 yrs exploring all options and am at peace with the work I've put in, where I'm at emotionally and mentally and the agreement and research with other specialists and doctors I've seen.

1 You reacted to this × Quote KarenLR75
Intermediate Member Pre Op 5 24 posts Location:TX Height:5 feet 6 inches Report post Posted just now Just got off phone with CIGNA. They reviewed MY specific coverage and stated that this Is NOT one of their requirements.
We stepped through ALL of the requirements for their current policy which is effective thru 7/15/19.
I have a downloaded copy of the specific and current policy regarding bariatric surgery. The CIGNA rep on the phone was mystified as to how the dr's office feels that the 'six months with a nutritionist' is a requirement.
I called Dr. Dyslin's office staff back and was chided a bit for 'calling the insurance' which honestly upsets me. The young lady was nice but she is NOT proficient with reading/understanding medical verbiage and what it means. She said she and her office manager are confused YET they are looking at the same policy (policy 0051 for me) and they don't understand IT!!!! Said they will call insurance to check again but advised that I NOT CALL the insurance to 'get things confused'!! CONFUSED??!! I've been studying this for four years and since I am end up hospitalized every other years for the past several years I've become very INSURANCE PROFICIENT.
I like Dr. Dyslin but if his staff is so GREEN they can't interpret to me what is CLEAR AS DAY to both myself AND CIGNA....I'm a bit concerned I may need a different office..and I really liked the doc!!
HERE is the part they are hung up on which CIGNA said doesn't mean 6 back to back meetings with a nutritionist and I AGREE
A thorough multidisciplinary evaluation within the previous six months which includes ALL of the following: 
a description of the proposed procedure(s) 
a separate medical evaluation and/or a recommendation for bariatric surgery from a physician/ physician’s assistant/nurse practitioner other than the requesting surgeon or associated staff 
unequivocal clearance for bariatric surgery by a mental health provider 
a nutritional evaluation by a physician or registered dietician
surgery

How did things turn out for your sister? I have bipolar 2, and I’m just starting my pre-op journey.

Side note: when I told the NP I’m bipolar, she asked 1 or 2 and if I had “the one with multiple personalities” 😬

I’m hoping to see their psychologist ASAP to settle my nerves.

So. I am still in the middle of this process. My surgeon's office is also telling me i have a 6 month nutrition visits, but I've spoken to cigna THREE times in the past two months, and they have continually assured me that the specifications i've been given (above) are correct, and there's no 6 month requirement. my surgeon's office basically said that they'd submit the paperwork and we'd see what happens. I figure if they deny and we have to appeal, it's pretty obvious that the plan does not outline that this is a requirement. the only thing that says 6 months is that we have to have all of the requirements done within a 6 month period. the insurance coordinator at my surgeon's office is adamant about the 6 month thing, but i've spoken to a few people on bariatric forums that have said their cigna also did not have the requirement, so between that and my talking to cigna multiple times, i feel OK (but not 100%) about being approved. I will let you know once I find out, I'm guessing it'll take a week or two to get an answer back from them. My theory is that if cigna wants me to meet with a nutritionist for 6 months it should be clearly listed in the bariatric surgery requirements for my plan. it is not. and they have confirmed. sigh. i feel you. i would suggest that you call cigna, they will tell you the same thing as i just did, and then tell your office that you've spoken to them.

Might be, might not be.
I personally think you can't be prepared for "after surgery". There is no realistic simulation of post-op life. And there will always be people who won't feel "prepared". However, I fear a lot of them won't even feel "prepared" after going through supervised diet for 6 years instead of 6 months.
This feeling of "lack of being prepared" reminds me of residents who're diving head first into their first on-duty-night alone. They almost never feel "prepared". I didn't feel prepared for many things on the job as well - and I mastered things anyway. Just like (most of) the residents that are now in fear of their first on-duty-night will master them.
Not that unrealistic I fear. However, enough people are already gaining back their weight and some more on top of it, despite the waiting and preparation period.
Of course one can draw two entirely different conclusions out of the fact that many people are gaining back weight:
1) patients need longer preparation time so results will be better
2) preparation time is wasted time, there will always be people who're going to gain back the weight, no therapy works for 100% of the patients
For me it was length of time. We have wasted so much time already on stuff that didn't work long term, why waste more? Look at the studies on morbid obesity and conservative treatment. Not one seems to come to the conclusion that non-surgical treatment is successful.

Hey Orchids&Dragons,
Not sure if I recalled that you had CIGNA too. Sent you message after my meeting with Dr. Dyslin yesterday.
I'm stunned and confused by what they said Cigna requires for seeing a nutritionist for 6 months...back to back consecutive months with no break..not even sure they care about the 1 year supervised weight loss I had with primary. Am just devastated.
Am so confused by the differences I'm kind of seeing...did Cigna just change their policy?
sher0929 - did you have to see a nutritionist every months for 6 months BEFORE you were approved for surgery. To me I figured I'd have a partnership with nutritionist and see them BEFORE..a couple of visits and AFTER surgery. I NEVER EVER Expected such a long and confusing requirement.
Dr. Dyslin indicated there was never an 'appeal' that could be done with Cigna....but I thought I just read recently on someone else's post that they could appeal. SO VERY CONFUSED! AND MAJORLY DISAPPOINTED. Seems like 'hoop jumping'. I learned a ton about myself from the supervised weight loss that I initiated and all the work I've done and looked into the past FOUR years. Don't see the value of a nutritionist for SIX LONG MONTHS prior to SURGERY?!?! Don't mistake me...I know I need to meet with a nutritionist..it is the length of time and the fact that they don't factor in seeing one after as well...and that my supervised weight loss SEEMS like it means nothing.

Don't worry! I am fortunate my insurance turned around the approval within 3-4 days, but those 4 days were scary and nerve-wracking. And for no reason. Insurances I think are getting the hint that it's better to pay for this surgery than to pay for years of prescriptions and doctor visits, etc.

I had two wls with cigna last year. No problems, quick approval.

Anyone approved by Cigna recently? My surgeon's coordinator just submitted my info to Cigna today and I'm SO nervous! She told me that denials don't happen often and they are usually able to overturn them if they do. She even gave me a surgery date already. April 24th! I met all of the requirements and I know the team knows what insurance companies look for. Just can't help but freak out a little! The last few months have been crazy and it would suck to be denied when I'm finally almost at the finish line.
I'm curious to hear recent experiences with Cigna. It seems most of the topics I find on here about Cigna are from a while ago.

And you can talk to us, even when you feel like hitting your head against something, even when they build walls of brick that you feel like you can't surmount. We're here, many of us have battled against the many tentacled beast that is for-profit insurance in the USA in 2019. And quite a few have managed to win!

That sucks you had to fight that hard but I’m glad you finally got approved! I’m hoping he does. He seemed confident but you never know until that approval!