Tiffykins

I didn't have trouble losing 20-60lbs. My issue was keeping it off, and being hungry all the time. I ate healthy, I just ate a lot when I wasn't dieting.

For me, the sleeve gave me the best of both worlds, 3 years out, I still never experience physical hunger, and satiety off smaller meals within a decent caloric intake.

I could do it on my own, lose it, but there's no way I could keep it off without my sleeve.

And you know all too well it's because of you that I quit coming here............have a good life..

If you can't comprehend how shady this situation appears that is totally on you. It's sad because so many could be helped rather than shuffling people to just this particular surgeon.

Why the drama ?

I questioned how her surgeon was getting a non-covered procedure covered with Tricare after years of it being denied. Our bariatric program has been shut down at our MTF where I had my revision. Every spouse is getting referred off base and the band or bypass are the only allowable surgeries. Congressional complaints, appeals, and all the hoops have been filed and jumped through with zero approvals. We went round and round about it via private message some time last year. I should have recalled the screen name when she posted, but because I quit frequenting this forum, my memory lapsed. And, I was truly hoping it wouldn't be turned into a drama fest of my surgeon got it approved.

Other military wives are struggling to get this surgery. It's cloak and dagger stuff, and it saddens me that others have struggled for years, postponed surgery, or had to self-pay because the codes used won't get disclosed. It's all secretive and in my opinion unfair if there is a way to get it covered, yet the information can not be shared unless you go through this particular surgeon. Out of the hundreds of denials, how in the heck is this ONE surgeon getting approvals and getting paid by a government ran insurance program.

It really saddens me that this surgeon is not willing to help others in other states get approval. The rules of our insurance is strict enough as it is. IF there is a legal and legitimate way to get VSG covered with a civilian surgeon, it would help 1000s of other military wives/dependents who deserve to have the surgery they need.

Like I said, Medicare has approved it, Tricare will follow, hopefully sooner than later.

Here is a product that has insure that I get the Protein I ned without having to drink a bunch of drinks that taste horrible~~MusclePharm Gel pack~~22 grams of protien, 90 calories sugarfree and there's about a full tablespoon of product to ingest. And no, I don't know that insurance code nor will I ask my Dr for it. He's got better things to do than to divulge that Tiff

Luckily, Medicare picked it up so hopefully VSG will be covered by Tricare. It'd be nice for this surgeon to share, but I think we've had this conversation before and I'll just quit asking for others to get help.

This is why I quit coming here, because of the posts like this. No consideration for anyone else, cloak and dagger when others are out here struggling to get coverage.

I am in NC and have tricare standard~~Dr T. Ryan Heider in Mooresville did my VSG~~Tricare approved~~I know I will get somme haters remarks on this, but those are the facts..I have nothing to gain sharing this with you~~Good Luck

Can you share how you got it covered and what code he used to get it covered since you're in the South region of Tricare as well?

The reason I'm asking is because our MTF is no longer offering bariatrics as the surgeons have both been PCS'd. So, now everyone is getting referred off base, and getting denied since Tricare has NOT picked it up here.

They've gone through the requirements, they meet the guidelines and they are still getting denied and ONLY approved for the band or bypass.

No hate, just if it's getting approved, it would be helpful to other dependents if you could share some details to help others.

did you have any out of pocket expenses when it was done at an MTF?

No out of pocket expense at all.

YOU LOOK AMAZING!!! Congratulations!

I can't wait til my surgery day on July 25th!

Thanks so very much ! ! ! You'll love the sleeve!

I also have PCOS and I have 4 kids. My last one I was 293 when I found out I was pregnant so obese women CAN have a "normal" pregnancy.

I agree 100%. Grant it, I had surgery to avoid setting myself and the baby up for possible complications and pre-disposing the baby to being obese as studies are now showing obese mothers have a higher incidence of obese children.

The main reason doctors advise patients to wait an XX amount of months post-op is because it gives the body to stabilize at a specific weight, BUT there are hundreds of women who get pregnant before even 1 year post-op and have perfectly healthy, full term babies.

1) Your swelling has subsided.

2) Liquids in, liquids out

3) Acid mimics hunger. However, not all "acid medications" are created equally. If you are on an H2 blocker, you will not get the full effect of acid reduction. An H2 blocker treats the symptoms, H2 blockers are Zantac, Pepcid. Proton Pump Inhibitors/PPIs actually stop the acid from producing in your stomach and those are Dexilant, Prilosec, Nexium, Protonix, or any generic of those drugs. These drugs need to be taken on an empty stomach and some require a full hour wait time before eating, Nexium requires 30 minutes. OR, you can eat and take them 2-3 hours after eating. I choose to take mine first thing in the morning and wait an hour. Sometimes, you need to double up on the dose. Zantac, Pepcid never does anything for me.

broth counts as a liquid. There is absolutely no reason to be alarmed with liquids. It's the sheer mechanics of your pyloric valve opening. Be grateful that you can get in that much liquid. It took me an hour to 8oz at 6 weeks post-op. We do not have pouches like RNY patients, there is no stoma. We have normal functioning stomachs, just smaller in size.

Easy mental picture when you start progressing through the stages and learning about eating post-VSG:

Think of your sleeve like a kitchen sink:

Liquids : Dump liquids in, they slide right on down, empty into the drain. NO stopping

Full liquids/thick liquids: Dump 3ounces of yogurt, cottage cheese, pudding down the drain; It will slide down the drain opening a bit slower, but you don't have to stir it around, or mush it through the sink drain.

Mushy/puree: (this is where your teeth come in extra handy) you can dump some puree chicken salad/chili/egg salad down the drain and it's gonna sit there for a bit, it'll leak through, right? but it's going to take some time. So you might have to get a spoon to stir it around to get it to go down the drain.

Soft Solids: Oh chewing is essential. You can toss some ground beef in the sink and it's not going down without some mushing down/stirring it around with the spoon to get it through the drain opening. . The stomach after surgery still isn't sure what to do with those soft protein/solids, so it's slow to work properly, and all the stomach really does is break down, mush down the food. 85% of Absorption of nutrients/calories etc etc occur in the intestine. Anyways, the meat is going to need some help to get down the drain. Gastric fluids, the mechanical work of the stomach, and chewing helps this process. This is when you really get the restriction.

Measuring your mushy/purees and onto soft solids and Protein will keep you from overeating and puking or being in pain. Once you get to full liquids, still be cautious and measure out. Once you're on mushy/purees, always, always measure. Don't eat until full, eat the measured, prescribed portion and that will help you stay within your caloric intake for the day.

The pyloric valve is what regulates how and when the food dumps into the intestines. That's why liquids don't offer restriction. Sip away, enjoy hydration so many of us struggled with being able to get in fluids.

As time progresses, your stomach works better, transit time speeds up and you can eat a bit more. This is where the "sleeve stretching" posts come up. People think they've stretched something, when it really boils down to the stomach is just working properly.

I had the lap band and after that procedure, I can confidently say that I would never have a band at the bottom of my sleeve. Even if it's not filled/unfilled it's still something that could possibly have the same side effects of a band - erosion, etc.

If the sleeve is hard to stretch to begin with (not that it can't be stretched) I really don't see much of a benefit.

Amen, you couldn't pay me to have any sort of band around my stomach. NEVER.

Yes, it's extremely true. That is why it is recommended that if you are going to use a hormonal bc method to use a back up method as well. Many early out WLS patients end up pregnant because of the hormone flux, and increased fertility and unpredictable cycles. I was never diagnosed with PCOS and we never TTC'd before I lost weight. Therefore, I have no idea if my weight decreased my chances of pregnancy. I simply refused to get pregnant fat.

Now at 3 years post-op, I'm 21.5 weeks into my 2nd post-VSG pregnancy. Delivered a beautiful, healthy, full term baby girl last October, and this October we will welcome a new little brother to the family.

Most reproductive endocrinologist highly recommend losing weight, especially by doing low carb to increase fertility. We struggled for our first year of TTC, I endured 2 chemical pregnancies, and then conceived Tatum without medical intervention, had a completely uneventful, uncomplicated pregnancy due to VSG with her, 2.5 months later, I popped positive again with Nugget. AND, we were preventing with a barrier method, and were not trying to conceive so quickly after delivery.

Tricare coverage for the VSG will continue to be a hot topic until Tricare approves coverage. I'll share my story again to perhaps make it easier for active and retired military personnel and family members to get a VSG.

I'd like to mention first that current coverage refers to vertical banded/sleeve gastroPLASTY, which is entirely different than vertical (or longitudinal) sleeve gastrECTOMY. The difference is with gastroplasty, they are simply stapling off part of your stomach as opposed to gastrectomy, where the majority of the lower portion of the stomach is removed from your body. Gastroplasty is reversible if necessary. Gastrectomy is not. Once your tummy is gone, it's gone, tossed in the bio-hazard bin and burned. As far as I'm concerned, burn, baby, burn! I love my sleeve.

The reason you can obtain a VSG on base and can't through an outside surgeon is the MTF's Tricare coverage comes from an entirely different pool of funds than the Tricare coverage paid to outside providers. It's a budgeting issue. The MTF's operate on funds granted to the active military hospital system. Insurance coverage through an outside source operates on funds designated solely for insurance coverage via civilian systems. When it comes to reimbursing for services provided, the two systems do not overlap.

OK, so what now?

Step 1.) Get your referral.

It took months to figure out the maze of retired military vs active military insurance, hospitals, referral processes, etc., but once I did, it's not that difficult. The hardest part is getting the doctors to approve the need for bariatric surgery and getting past the pre-surgical psych evaluation. That's step one. So get started on that if you haven't already. Doesn't matter if it's your civilian or military doctor, although I think it's easier to obtain permission from a civilian doctor. Military doctors can be real snooty about weight management through diet and exercise only. Raspberries....

Once you obtain a referral, you will have to get your VSG at a military facility until Tricare approves the procedure. Since it's new, they want to see the long-term statistics compared to other available options now that the VSG is may be on the way to becoming the procedure of choice for both patients and surgeons.

Step 2.) Find an MTF with a surgical bariatric weight-loss program.

Some facilities have had bariatric programs for several years now. Others are just starting to perform bariatric surgery. Ask how many bariatric procedures have been performed at that facility and how many the surgeon doing your surgery has done. Ask about their complication rate and if any fatalities have occured. The only one my surgeon experienced was death by Whopper. One of his patients upon discharge had someone drive her from the hospital straight to Burger King, ordered and ate a Whopper, ripped out her staple line and bled out before getting back to the hospital. Please follow your post-bariatric liquid diet. Be prepared to experience hunger and know you're going to have to tough it out...yes, I'm digressing.

You may have to do a lot of driving at first, but if you play it smart and get them to combine some of your appointments on the same day, you can cut the expense. We combined my EGD with one of my pre-surgical nutrition sessions and my psych eval with my first meeting with the surgeon.

If you are active duty and are traveling outside of your 99 mile treatment zone, you can get reimbursed for travel expenses if your military doctor has approved your surgery. If you are retired military, you're SOL. Start stashing some cash. FYI, obtaining my VSG took 6 or 7 trips to Ft. Gordon.

Step 3.) Contact the Benefits Management office at the base where you want to have your surgery. You will need to send your referral directly to that base's Specialty Services department within the Benefits Management office. The names of the offices will probably be different within the various services. The BM/SS office is the Army version of the on-base Tricare management team. The Specialty Services office has to approve your referral before you can see a surgeon on that base.

Don't bother trying to go through your normal, local Tricare channels once you get your referral. After 5 months and hours of phone calls, talking to people who had no clue as to what I was trying to do, discovering that the different departments within Tricare have no idea what the other departments do, someone finally admitted that Tricare automatically responds with "this MTF is not accepting new patients at this time" if you are trying to get your surgery done at an MTF outside of your 99-mile treatment zone. I spent weeks calling back and forth with the hospital telling me I have no idea why Tricare is saying we're not accepting patients because we are, then calling Tricare and asking them why they're saying the hospital isn't accepting patients. I'm lucky they didn't cause me to stroke out or rip out all my hair.

Another snafu I ran into was my DEERS information was not registered on the Ft. Gordon list of personnel and family members assigned to or being served by the base. I had to contact the I.D. card office and have them register me into the base system. If you are not in that system, the base BM/SS office nor the hospital can access your Tricare eligibility information online. If your information is not accessible on the base internet system, the hospital can't schedule an appointment until they can register you on their online system. This goes for both military and retired personnel and family.

Step 4.) At this time, you can contact the nurse in charge of the MTF's bariatric surgery schedule and make your first appointment. Standard procedure will most likely be attending the next informational seminar at that base. After that, you're off and running.

Just want to quote it for future reference and easy for me to pull. You wrote it all out so eloquently and precise. Thanks for taking the time for those trying to get VSG.

I seriously have zero food restrictions. Early out chicken was the most difficult to eat, it needs to be moist, but by 5-6 months out, food was easy. The only foods that sit heavy in my stomach to this day is brown rice, pork chops and scrambled eggs. Steak, scallops, chicken, turkey, roast, all veggies work just fine. I eat lettuce wraps weekly, ya know meat with a romaine lettuce leaf wrapped around it. Nothing fancy.

Food just works. There's no pouch/stomach, just a regular stomach that functions the same as before. Healing varies, and food tolerances vary for each patient, but most report zero food restrictions. I can eat those foods listed above, but they "sit" heavier than other foods.

I'm 3 years post-op today. Have absolutely zero regrets, and I'm a band to vsg revisioner as well. I live a very normal life in maintenance, and currently into my 2nd pregnancy post-VSG. The sleeve is the complete opposite of the band. It's pretty awesome to be honest. I enjoy a varied diet in maintenance, but I ate low carb, high Protein through my entire losing phase (6.5 months). I started at 263lbs at 5'2", and got to goal of 150lbs in 6.5 months, lost an additional 23-25lbs over another 4.5 months getting me into maintenance.

I delivered my daughter Tatum 30 October 2011, and I'm due with Nugget (a boy, we can't decide on a name) on 17 October 2012.

I'm 20 and a half weeks into my 2nd post VSG pregnancy and as of today, I'm 3 years post-VSG. If you get pregnant early out, nothing happens to your stomach staples. The standard recommendation is to wait 1 year after achieving goal. This recommendation has become more lax with some surgeons over the years because more and more women get pregnant before that time frame. Some surgeons say 6 months, some say to wait 2 years. It really varies on each individual patient. It's best to wait until you've at least achieved goal, and can consume enough food to support your body. The baby steals everything from you. Getting pregnant while still obese is just as dangerous to you and the baby, and can complicate the pregnancy. Plus, the hormone flux and rapid weight loss, heavier restriction during those first few months out make it more difficult for some women. Not to mention all the other pregnancy stuff, like morning or all day sickness, food aversions, cravings, increased hormones and other fun pregnancy stuff.

I was personally cleared at 8 months post-VSG for TTC. I was below goal, able to consume enough calories to support my body and a developing baby plus my labs were great. It took us a year to conceive Tatum. I delivered her on October 30, 2011. The year of trying to conceive I endured 2 chemical pregnancies and had already been referred to a reproductive endocrinologist because we had not been successful without medical intervention. Then, BAM, a sticky baby.

My pregnancy was uncomplicated due to VSG. I was high risk for other reasons, my age of 34, and the fact I have a rare clotting disorder.

This pregnancy has not been complicated by VSG either. I am due October 17th with this baby boy.

At this point, don't squeeze anything in especially if you're feeling full. There is a reason behind not eating until full.

If you are logging your food intake, and hitting your Protein and Fluid goals at this stage, you are doing fine.

I'm 3 years out, and pregnant so what I'm eating today is no where close to what you would be eating in your losing stage. During my losing stage, I ate 600-800 calories, 640z of clear fluids, 60+grams of Protein and no more than 30-40grams of carbs per day. I ate 4 meals per day, no Snacks, no Protein drinks, every meal had to have a minimum of 15grams of protein to ensure I hit that 60grams of protein. Keeping that regimen gave me two things; 1) It kept me satisfied because I was eating protein 2) kept me in my caloric and carb guideline for optimal results.

For me, my "worry" obsessiveness didn't go away until I was over a year out, and then I had to realize I was below goal, maintaining that I had to start living life as normal as possible.

I lost 130+ pounds, and honestly before pregnancy, I had zero medical need for plastic surgery anywhere on my body. I had this little baby fat roll/excess skin on my lower abdomen that could have been removed, but there wasn't a true need for it. That first year of maintenance really showed great improvements to my skin. It rebounded nicely, and I had zero need for Spanx or other compression garments. I wasn't having to shove excess skin into my size 2 jeans. At 19 months post-op, I got pregnant. Gained 35lbs in the pregnancy, and all my weight came back to my "trouble areas", my stomach mainly. My skin stretched out, way out, good thing though is that I didn't gain one additional stretchmark. I lost 25lbs within 4-5 weeks after delivery, and even though I was only 10lbs from my maintenance weight, I couldn't get back into my jeans. The skin was way too much, and I was having to wear 8/10s. Low and behold, just 2 months after delivery of my daughter on October 30th last year, I popped pregnant again. I wore small maternity clothes through my entire last pregnancy, and now that I'm at the halfway point of this pregnancy, I'm having to wear size medium to large maternity clothes because I've already "popped out" and I'm showing big time this time around.

I did have some wound healing issues with my csection incision because the skin in that region is so fragile. I had a csection 14 years ago with my first son. I have 2 large stretch marks that go through that region and the skin is super thin and fragile that they had issues closing the incision. I've qualified for a Tummy Tuck, and will be having it done sometime next year. My son is due on 17 October of this year. I will wait a minimum of 9 months to do the tummy tuck because I know the skin needs time to rebound.

Genetics, how long we've been obese, how long we've punished our skin, and age does play a role in how our skin rebounds. More than anything, time is your best friend in the skin department. I know people who are three years+ post-op and their skin is still tightening up and changing.

Thank you all so very much ! ! !

Many of you all know that I have been absent from VST for several month and with good reason. I delivered Tatum on 30 October 2011. Having an infant is tough work, no matter how prepared, old, or well-versed you , sleep deprivation sucks. Of course, now we have moved onto major growth spurts and teething, but hey I'm getting to sleep at least!

Here is my newest update, I do apologize for my absence from here and I am working to reply to all my private messages, Please know that it is nothing personal, I just needed a break, and I can't promise I'll be back regularly, BUT I am here. I will reply, I am on Facebook way more than I am, but I have stopped adding friends there as well. I am however always open to answer any questions anyone may have.

I am 20 weeks pregnant again, as I've posted before, I popped positive on another pregnancy test and this baby is due just 2 weeks before Tatum's 1st birthday. Least to say, this pregnancy is vastly different and way more difficult.

BOY! ! ! !

Even more importantly, Nugget is thriving. We had the big anatomy scan today, along with full detailed U/S of the heart, lungs, brain, bones and ALL are measuring normal and with zero defect or abnormalities ! ! ! Big sigh relief, and eternally grateful.

Some not so great news for me;

4 weeks ago, had a bad case of food poisoing, E. Coli was found in my urine culture. I've struggled significantly through this pregnancy with what a lot of women refer to as "all day sickness". I went off my Celebrate multi and switched over an RX prenatal. First mistake was switching, when something works, DO NOT change it. The prenatal induced the "all day sickness" for weeks until I put 2 and 2 together. Yes, it took awhile, pregnancy mush brain along with dealing with Tatum 24/7 with my husband gone for the last 6 weeks has been hell to say the least. So, anyways, I switched over to a chewable Centrum Complete, 2 weeks on that and the nausea returned. All in all, my Iron is tanking, not severe enough for me to have to do extra supplements and my platelet count is already down in the 90k range. So, more labs, ordered my Celebrate Vitamins back and they'll be here this week, and the platelet count is being monitored every 2 weeks. This all explains my chronic fatigue and need for a daily nap even though I'm 20 weeks out.

This pregnancy is much more difficult. I've already gained 14lbs and with the Prednisone therapy looking like it's going to happen a lot sooner than last time, my high risk ob told me today to brace for an additional 25-30lbs gained. Least to say, mentally I'm prepared this time for it. Physically, it's going to kick my butt!

Overall, I am elated with the news on gender and Nugget's overall health and development. I am working on me, my BP is running extremely low, today it was 83/50, super low even for me so I have to drink even more fluids (I already drink 90-100ounces per day), and try to rest more.

Thank you all for your continuous support, encouragement, love and prayers. We're halfway home on this pregnancy, and while my pregnancies post-VSG have been pretty awesome, this is my LAST pregnancy. Definitely doing the snip snip dance during the csection.

Cheers everyone ! ! !

This is the most recent 2012 Sleeve Gastrectomy information from TRICARE:

http://www.humana-mi...ull-i1-2012.pdf

It says it does cover the surgery and has conditions on what your BMI needs to be to cover the surgery.

Hope this helps everyone.

Medicare denied covering it just yet, so Tricare isn't either.

So, you are correct, it is STILL a non-approved, non-covered, procedure with Tricare unless performed at an MTF then Tricare really isn't paying the claim as they do to civilian doctors.

I have tricare prime and I'm getting it approved. I have a PCM at an Air Force base who has referred me to a civilian surgeon. He says no prob!

When you get the approval, let us know because I've just had 2 more friends denied after jumping through the 6 month pre-op requirements, the psych eval, the nutrition class and the letter came down last week that ONLY Bypass and the band are approved.

From the ingredients listed, it is collagen base Protein as the #1 ingredient:

Purified Water, Proprietary Protein Blend [Hydrolyzed Collagenic Protein Isolate, Whey Protein Isolate And Casein Protein Isolate], Malic Acid, Natural Flavors, Branch Chain Amino Acids (Leucine, Isoleucine, Valine), Acefulmate-Potassium, Sucralose, FD&C Blue #1 Contains: Milk Contains No Preservatives.

From the ASMBS guidelines: Page S93 starts the protein talk and it warns against collagen protein consumption considering it's not a complete protein:

http://s3.amazonaws.com/publicASMBS/GuidelinesStatements/Guidelines/bgs_final.pdf

This medical documentation also proves that there is ZERO scientific evidence that we can not absorb a specific amount of protein per serving/per meal. Our bodies absorb ALL the protein we eat, how it is assimilated and broken down by the body thus how it used by the body is more important. The XX amount of protein per meal/per sitting is complete myth with zero medical or scientific evidence to support that theory. Our bodies simply need a higher quality of protein than what collagen can offer for recovery purposes, and to protect our lean muscle mass and organs after major surgery and extremely limited capacity for nutrient and protein dense foods.

I only had to do low carb/high Protein for both my band and my revision.

There's no scientific evidence to prove that the "liquids" only diet does anything more than low carb for a pre-op diet.

Nor, did I have do the 6 month wait, or lose any specified amount of weight before either surgery.

I take a multi with Iron (once daily right now because I'm taking a RX prenatal since I'm pregnant)1

1 2500mcg B12 sublingual 4-5 days a week

calcium citrate chewables by Celebrate Vitamins -2 chewables per day 500mg per chewable

I've taken this regimen for 18 months apart from the prenatal. In my last pregnancy, I stayed on Celebrate Complete Multi- 2 chewables per day.

It's actually no more than what any other woman in my age group should take on a daily basis apart from the b12.

Because tissue needs adequate blood flow, tying off a large portion of the organ, and/or even just suturing and pleating it as in the plication is not giving the results as once promised.

Also, scar tissue forms, adhesions line damaged tissue, you can wrap a rubberband around your finger for a year and then take it off and not have any damage.