Missouri-Lee's Summit

So why do patients face longer wait times to receive bariatric surgery compared with surgeries to treat other life-threatening conditions such as cancer and heart disease? . One big reason: Many insurance companies (including Medicaid) require those seeking bariatric surgery to lose weight before their surgery, even though there's no data or evidence to prove preoperative weight loss affects long-term success. Patients with complex medical histories enrolled in Medicaid experienced the longest delays. Nonwhite patients also waited longer... Smokers and patients with high cholesterol or psychological disorders also had longer wait times for bariatric surgery. https://www.sciencedaily.com/releases/2018/07/180730090141.htm How long did it take before you had your surgery? How long did you wait calculated from your first visit to your date of surgery? What requirements or obstacles did your insurance carrier impose? Supervised weight loss attempts? Were you told that you had to lose weight during those attempts… and that any weight gain would impede your path to surgery? Did you have to meet with a psychologist, nutritionist, and attend required bariatric surgery classes before your surgery was submitted to your insurance for surgery approval? For those who were self-pay… did you circumvent your insurance carrier because of the obstacles/delays imposed by your carrier, because your BMI or other insurance mandated requirements did not make you “eligible” or because you had no bariatric benefits?

You are correct. I did not know about his past. I tried (unsuccessfully) to read between the lines and give him the benefit of the doubt. It was a mistake on my part to make those assumptions. I feel empathy for the pain and hurt you experienced as a younger man. I'm sure it took a toll on your social confidence and self-esteem. Being a community of "fat people", we have all experienced different degrees of pain and self-imposed shame. Thank you for pointing out that I should not have made any assumptions about your friend when he was his younger self. I'm glad to hear that he has matured into a finer human being. Thank you for sharing your story.

Only I Can Change My Life, No One Can Do It For Me The Struggle You Are In Today Is Developing The Strength You Need for Tomorrow The Road May Be Bumpy But Stay Committed To The Process If You Are Tired Of Starting Over, Stop Giving Up Be The Best Version Of You Be Stronger Than Your Excuse It’s Not A Diet, It’s A Lifestyle Change Doubt Kills More Dreams Than Failure Ever Will Will Is A Skill Nothing Tastes As Good As Being Thin Feels Stressed Spelled Backwards Is Desserts An Active Mind Cannot Exist In An Inactive Body Strive For Progress, Not Perfection Success Is Never Certain, Failure Is Never Final No Amount Of Security Is Worth The Suffering Of A Life Chained To A Routine That Has Killed Your Dreams A Goal Without A Plan Is Just A Wish Success Is The Sum Of Small Efforts, Repeated Day In And Day Out You Can’t Cross The Sea Merely By Standing And Staring At The Water --(attributions unknown)

"Effort only fully releases its reward after a person refuses to quit.” --Napoleon Hill "Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, 'I will try again tomorrow.’" --Mary Anne Radmacher "It's hard to beat a person who never gives up.” --Babe Ruth "Patience, persistence, and perspiration make an unbeatable combination for success.” --Napoleon Hill "Energy and persistence conquer all things.” --Benjamin Franklin "Waiting for perfect is never as smart as making progress."--Seth Godin "Permanence, perseverance, and persistence in spite of all obstacles, discouragement, and impossibilities: It is this, that in all things distinguishes the strong soul from the weak.” --Thomas Carlyle

It sounds like your friend is a true friend. Your feelings of being ignored and that your friend didn't seem to take you seriously in the past, were your feelings; according to your story, he didn't go out of his way to make you feel like the "fat guy". Enjoy your moment of weighing less, but never forget how it felt. Not to say that you would! You sound like a good friend, too.

I had a huge hematoma on one side. Actually, my entire belly was black and blue. It was tender but it didn't hurt. I remember cushioning my belly with a soft pillow while sleeping on my side. I also found that sleeping somewhat upright (pillows piled high) was more comfortable than sleeping relatively "flat". I was tempted to sleep on my belly (something I was eager to do after giving birth), but I decided no.

Your username says it all. apositivelife4me . Keep being positive, keep sticking to your diet/exercise and more positive things will happen. I am genuinely happy for you and for anyone who is losing weight. It's something everyone here can understand and celebrate. Woo-hoo!

Boston-based medical researchers published an article in 2017 ( https://jamanetwork.com/journals/jamafacialplasticsurgery/article-abstract/2688763 ) warning of Snapchat dysmorphia. The pervasiveness of filtered images of unattainably perfect pictures on apps like Snapchat can take a toll on one’s self-esteem, make one feel inadequate for not looking a certain way in the real world, and may even act as a trigger and lead to body dysmorphic disorder (BDD). Classified in 1987, BDD is an obsessive-compulsive preoccupation with perceived flaws in one’s appearance, impairing one’s functioning and often leading to repeated plastic surgery. Dysmorphia literally means ‘bad form’ in Greek. https://www.independent.co.uk/life-style/cosmetic-surgery-snapchat-instagram-filters-demand-celebrities-doctor-dr-esho-london-a8197001.html

This advice was directed at Bootscraper's case. It wasn't meant for the VirginiaRN's PA/staff case. Two different scenarios. I saw absolutely no point in confronting the PA/staff. They needed the "guidance" of a higher up. Confronting them would have done about the same as confronting the elevators.

Three-quarters of severely obese patients had unhealthy, not very diverse gut microbes (low microbial gene diversity). This unbalance was associated with a greater tendency to have a high-fat mass in the trunk of the body and an increased likelihood of having type 2 diabetes, hypertension, or more severe versions of these comorbidities. According to the researchers, more work is needed to determine "whether specific interventions (specialized diets, prebiotics/probiotics, or gut microbiota [fecal] transfers) may be useful to consider prior, or post, bariatric surgery in severely obese individuals." "This is "an exciting field" of research… one day we'll probably have the perfect combination of gut organisms in a fecal pill form.”--Samer G. Mattar, MD, president of the American Society for Metabolic and Bariatric Surgery (ASMBS). https://www.medscape.com/viewarticle/899158

That worst part of this is that you have to keep reliving the impact of their comments and kicking yourself for not saying anything. The lesson everyone on this forum should be hearing is SPEAK UP. Don't let the comments slide. Report, confront... but "do" something. When we do nothing, we essentially are telling ourselves that we don't matter. That our feelings don't matter. And that others are free to speak about us as they please. I am looking forward to future posts here in which someone was so moved by the stories and advice here that they spoke up. Everyone: be a self-advocate. You matter.

You are a classy lady. I have not been moved by another story on this board as much as this one. You have a gift of speaking from your heart, which gave everybody here a front-row seat to your pain. I applaud you for that courage. It's not easy to put your hurt on display. Your son learned more that day about you and your strength than you realize. Your restraint in reverse-shaming your PA/and staff was not a weakness in my view. You are a consummate professional. You behave as a professional with your patients and in your everyday life. Lucky are the patients who have you as their care-guide. It's easy to admire people who do "great things", but it's people that go through everyday struggles, survive them, and keep moving in a positive direction that I look to for inspiration. Being big (and former big) people, we've all tasted some of the pain that was unceremoniously dished out to you that day. We've all had to figure out how to process that pain. By sharing your story, I believe you gave those (here) who are not as gifted at expressing their inner feelings, a voice. You mentioned the idea of writing a letter to the head of practice. I would start drafting a letter now while your thoughts are still fresh in your mind. Composing such a letter in itself would be therapeutic for you. Whether you decide to send it is another matter for you to consider. If you do send the letter, however, I would NOT send it anonymously. As a self-advocate and a role model for your children, it is important for you to stand behind your words. It would be too easy for the head of practice to dismiss a letter written anonymously. The PA/staff would not be able to deny the words that came from an actual person as easily as words coming from a ghost. By signing your name, you also leave the door open for a response. If one receives a letter like this from an actual person, there is an obligation to follow up. If you send it anonymously, you will always wonder whether it was intercepted and destroyed before reaching the head of practice, whether it was read and acted on, etc. Just as you were placed in the position of having to process the hurt they caused, let them now defend their unprofessional patient-shaming. By writing this letter, you are not only helping to correct a wrong done to you, but to future patients who would be at their mercy. This PA is young. She obviously still has some important lessons to learn about being a compassionate caregiver. While it might have felt good to lambaste that PA/staff directly (in front of your son), I think being shamed professionally by her superior is a far better lesson. Just my two jellybeans....

Great tip, Kitty.

@Sosewsue61 Let's keep each other in the loop. Our symptom overlap is striking. I'm most intrigued by your scar-tissue supposition. I'm thinking that my reason is probably mechanical rather than a deficiency. As far as I know, keloids and hypertrophic scars don't occur under the skin. I know when I had an umbilical hernia repair, though, the scar tissue that formed under my bellybutton has been uncomfortable at times.

I'm not looking forward to Bony-Butt Syndrome. I don't even want to think about not having enough booty to cushion my body. The idea of my tailbone being compressed while seated is not what I signed up for!

The hardware and the way my knees were configured has to be of some relevance... yes?

I've made a conscientious effort to avoid using the word "love" when talking about food. "I love chicken wings. I love French fries. I love tacos. I love spaghetti." No more! I'm breaking off my love affair with food. We're just good friends now. But food keeps trying to win me back. "Give me another chance!" "No, Food. I'm moving on. There's someone else in my life now. Someone that I love more than I ever loved you -- myself, my health, my life." - What word will I use in place of "love"? Probably good ol' "like". "I like okra. I like shrimp. I like garden-fresh tomatoes. I like pecans." I'm also going to avoid using the word "hate". Hate gives Food more importance than it deserves. "I don't like pineapple. I dislike Brussels sprouts. I don't care for liver." - For me, it's easier to give up the word "love" rather than "hate". Not sure why.

@likehasjustbegun If you like cauliflower, I think it's more important for you to have it, particularly since you are craving it. Why deprive yourself of something that is healthy? The important thing is that you are eating it according to your stage (pureed). I believe that your dietitian's recommendation is based on the idea that some people have a problem with cruciferous vegetables so they make a blanket recommendation to avoid all vegetables in this family (cabbage, collard greens, kale, Brussels sprouts, kohlrabi, broccoli, and cauliflower). \ I am post-op. I barely get 250 calories a day, very little protein, fluid intake way below optimal. I think it's great that you are doing so well. If after trying cauliflower and only if it is uncomfortable to eat, would I eliminate it from my diet.

No matter what part of the body is undergoing surgery, the process of healing is the same. Surgically “traumatized tissue” (skin, muscle, bones, cartilage, tendons, etc.) does not just magically heal; rather, the body has to rebuild and repair tissue on the cellular level. This involves energy and nutritional building blocks to support the healing process. Healing efforts surround the rebuilding of collagen, the main component in many tissues — such as skin, muscle, blood vessels, and bone. Improperly-formed collagen is associated with healing disturbances. Healing occurs in three overlapping phases. Most of one's healing occurs in the first few weeks. Inflammatory phase (up to 5 days): The body’s first response to injury involves forming a localized blood clot to stop bleeding. Infection-fighting cells (neutrophils) and debris cleaning cells (macrophages) are recruited to the traumatized area. Proliferative phase (2 days - 3 weeks): The body starts building tissue with specialized collagen-forming cells called fibroblasts. This new tissue is called granulation tissue and special growth factors to stimulate skin formation (epithelialization). Remodeling phase (3 weeks - years): The body transforms and replaces the collagen that was placed during the proliferative phase into a stronger collagen to support structure and function over the long term. It is a good idea to be as healthy as possible and nutritionally balanced before surgery to support healing. Certain vitamins and minerals are known to support the normal response to healing, and to support the normal immune system response to infection. Vitamin C: Necessary to build and rebuild collagen throughout the body. Vitamin C is also a powerful antioxidant that supports the immune response. Vitamin A: Supports immune system functioning and aids collagen strength. Also required for bone development. Zinc: An essential trace mineral used in enzymatic reactions involved in tissue and wound healing, regeneration, and repair. Vitamin K: Aids the natural blood clotting response and is important for bone health. B-Vitamins: Cellular metabolism, tissue repair and immune support. Vitamin D and Calcium: Important for bone health. Magnesium: Mineral involved in approximately 300 biochemical reactions. Amino Acids (L-Arginine, L-Glutamine): Two key amino acids for wound repair and immune function. Dietary Supplements to avoid before surgery: Vitamin E and surgery do not mix because Vitamin E is associated with increased bleeding, and this can lead to a collection of blood (called a hematoma) that could result in serious complications. The Vitamin E applied to scars is different from the Vitamin E taken orally. Vitamin E for the skin is okay. Herbal supplements, in general, should be avoided before surgery because they can cause bleeding or other operative complications. Some herbal supplements to avoid: Ginko Biloba, Garlic, Ginseng, Ginger, Dong Quai, Ephedra, Feverfew, St. John’s Wort and/or Omega 3 fatty acids. http://www.surgerysupplements.com/pre-operative-supplements-recommended-supplements-before-surgery/

@gully90 From your photo, it's evident that some of the most beautiful women still come from Texas!

@James Marusek Weather history, pattern mathematics, why cats naturally like to be petted, the log cabin playhouse for your grandkids, how pneumonia was the real killer during the 1918-19 flu pandemic, etc. So much to enjoy on your site. I was able to relate to your battles with your insurance carrier. In all fairness, though, I eventually received help from someone from our university system (of Missouri) who was able to jump over various gatekeepers and talk directly to the higher-ups and resolve everything in a day. Also and, of course, thank you for your service.

I wonder if strength training on my upper body or the lower body while seated is something I can do. I just need to avoid weight-bearing pressure on my right ankle. Did you mention that you have a physical therapy background once?

@Roxine. You didn't scare me... and like you said, it's only temporary. I've been taking collagen peptides (for skin, hair, nail, and joint support) for about a couple of weeks. It might help; it might not. My guess is that I'm a good deal older than you, so I'm used to my body heading South. I looked up Viviscal... I wonder what horsetail extract does? I'll ask my daughter about it; she's a pharmacist. Just curious, but did you grow up sitting on your hair? I did. Super long, super thick and straight. I've worn it shoulder length for several years now. I've never had it any shorter. I'm happy for you regarding all the weight you've lost. Your remaining weight is the about the same as the weight I've lost so far. Since my pregnancies already scared the becheezits outta me when my hair was falling out in handfuls, I'm sort of prepared. I hope it doesn't happen, but I think I'll do okay. Also, and due to my thyroid, I have very little body hair. Never have to shave my legs. No hair! If you decide to get a wig, let me know. If you get one, are you planning to go drastically different or more or less the same as your hair now?

I wasn't specific enough in my previous post. MarinaGirl is correct about taking iron and calcium at separate times. Here's information from one of the handouts from my surgeon's office: Gastric bypass patients need to take more vitamins than lap band patients or vertical sleeve gastrectomy patients because, in addition to only being able to eat a limited amount of food, part of their small intestines have been bypassed. People absorb most vitamins and minerals in our small intestines and with part of them bypassed, they end up absorbing fewer nutrients from the food they eat and the supplements they take. The vitamins you need may vary based on your individual needs and the results of your blood tests, but here's what the American Society for Metabolic and Bariatric Surgery (ASMBS) recommends you should start with: *An adult multivitamin, containing 100% of the recommended daily allowances (RDA) of at least 2/3 of all nutrients, including 18mg iron and minerals like zinc, copper, and selenium, twice daily. *1500mg to 2000mg calcium citrate (not calcium carbonate or tricalcium phosphate) divided into three to four doses of about 500mg each, taken at least two hours apart. RNY patients don't have enough stomach acid to break down calcium carbonate or tricalcium phosphate for absorption. That means supplements like Viactiv, Tums, Caltrate, and Citracal gummies aren't good choices. *An additional 18mg to 27mg iron for menstruating women *350mcg to 500mcg sublingual B12 daily or 1000mcg B12 injections once a month *B-50 complex is optional Note that the ASMBS recommends an adult multivitamin. While some surgeons and dieticians recommend children's chewable vitamins to patients, these are usually missing some key nutrients that gastric bypass patients need. Read the label of any multivitamin you are considering carefully and make sure it has 100% of the RDA of most ingredients and that it has minerals like copper, zinc, and selenium. ---- I take a multivitamin, calcium citrate, magnesium citrate, iron, Vit D-2 (doctor's prescription), and sublingual B12.

One of the concerns with any multivitamin is whether it contains all the vitamins and minerals that a bariatric patient can absorb. If the calcium in the multivitamin is calcium carbonate, it's not bioavailable (easy absorbed) for you because of the changes to your body. You need calcium citrate. The type of iron is also important. Some forms of iron are no longer bioavailable for you. B12 is also a problem. It has to be sublingual (dissolves "under the tongue") or you need to take injections from your doctor. Also, does the multivitamin contain certain micronutrients such as zinc, copper, and selenium? NEVER, ever, ever, ever use a GUMMY vitamin. They are a waste of your money because they are the worst at bioavailability. Write to me privately if you have any more questions.