Char

If I'm eating 3/4th of a sandwich, it's usually egg salad or just tomato on Whitewheat bread. Squishy food on regular-size, very soft bread with the crust cut off. It's something I treat myself with on occasion. It's kind of my new version of dessert. I generally stick to whole wheat and even then, I don't eat bread often. I can only eat half of a sandwich with meat when I actually make a real sandwich. Most times, it's just a piece of turkey or chicken lunch meat and some 2% cheese rolled up in a piece of lettuce. When asked about food volume during our orientation, my surgeon told us that after a year or two, most bariatric patients can eat the equivalent of a McDonald's regular hamburger, the one you find in the kid's meals, more if they over eat and stretch out their pouches. Personally, I'm not into that kind of pain and I'd like to keep my tooth enamel, so I eat until I know my stomach is almost, but not full. It takes a while to figure out what that feels like. It's taken me as long as an hour and a half to eat a meal.

I actually do better sticking to my diet plan when I weigh myself daily. I know several other people that do better that way, too. It's an individual preference, but you do have to know and understand the plateaus and even a little weight gain now and then. Water weight gain can be 5 lbs or more. It can happen if you eat too much salt, because of hot weather, as a warning sign that mother nature is about to come calling, or because someone in Thailand sneezed while you were putting on your shoes for that matter. : ) You just have to keep in mind that kind of weight gain will come right back off if you stick to the plan. My scale helps me keep on track. I almost always gain weight when I don't weigh every day.

From what I understand, they're not supposed to cancel your insurance without offering you the opportunity to sign up for temporary insurance under the COBRA laws. You may want to check into that. COBRA insurance isn't the cheapest in the world, but it may allow you to get your surgery sooner. I'd find out what the deductibles will be if you were able to do that. Waiting may be the cheaper option.

The drain line is really long and could still have been the source of your pain. They place the end of it right under the internal incisions made in your stomach because that's where the most drainage occurs. Freakiest feeling in the world having that tube removed. I couldn't believe how long it took to get to the end of the drain line!

Be prepared to experience hunger during the liquid phases of your post-surgical diet. It took a while for me to stop feeling hunger, I assume because my body had to deplete it's grehlin levels and I got more used to the smaller stomach. After a while, you may have trouble making sure you eat enough because you don't get hungry unless you haven't eating for most of the day. It took me a few weeks to get there. If you get all your protien, Vitamins and fluids in, the hunger issue won't be as bad, but you may have trouble getting them all in. A year post-surgery and I still have trouble eating and drinking enough unless I eat and drink practically all day. Don't try to eat solid foods until your doctor says you can or you can cause a leak in the staple line. Hang in there, it will be over soon enough. Pay attention to how you feel when you're eating. If you eat slowly and put some thought into the new sensations in your mouth, sinuses and chest when you're eating, you'll learn when you need to stop eating to keep from vomiting. It goes for both liquid and solid food phases, but especially when you start eating solids. I get a sensation almost like I'm going to sneeze, my gums feel like they're tightening around my teeth, and my mouth, nose and eyes will start watering when I eat too much. Now that I know the warning signs, I know when to stop. You can get those sensations if you eat or drink too fast, too. I get the hiccups when I do that. Hiccups are a good signal to slow down or stop eating or drinking. Most of the time, it doesn't happen immediately after swallowing, it can take a few seconds or more, so pause between bites and sips. You'll learn your cues faster if you pause and take a moment to pay attention to what your body is telling you. Sometimes I'll be chewing another bite when I get my fullness clues. When that happens, I will spit out what's in my mouth, so keep a napkin handy when you're eating until you learn what your intake limit is. If you swallow another bite after your body's told you it's full, you will end up running to the bathroom or the nearest trash can. You definitely don't want that to happen while your staple line is still healing. It will also take a while to figure out how long you have to wait to drink after eating. It hurts like crazy if you drink too soon after eating, even more than if you take one more bite than you should.

I guess that explains why almost a year out from my surgery date, I still can't eat but a half or 3/4 of a small sandwich...even less if there's lots of meat on it. Cool beans!

You're more than welcome. It was such a pain in the tush to get through the Tricare maze, I figured I should share what I discovered so people trying to get a VSG at an MTF can jump through the hoops without the flames I had to endure. I felt quite singed by the time I had my surgery. It's kind of confusing if you don't understand that Tricare has two components, an on base MTF budget and an off-base civilian budget. Basically the VSG is covered by the on-base MTF budget and not covered by the off-base civilian hospital system budget. Both active duty and retired people have access to both Tricare budgets. Both also have to go through the approval process to aquire a referral from their doctors. Neither can have the procedure done at a civilian hospital, both must go to an MTF, so you're not dealing at all with the off-base Tricare people who only approve services paid through the off-base budget. A civilian doctor can do the referral for both active duty and civilian family members. I'm not sure if active duty family members have to have their civilian doctor send the referral to a military doctor or not, but after physician approval, both active duty and civilians seeking a VSG should apply directly through the on-base Tricare system, not the off-base system the civilian doctors access through thier Tricare referral/approval website. Just find out the contact information for the on-base Tricare office (Benefits Management), get the specialty services fax number and contact name and have your civilian doctor fax the referral to the specialty services team for approval. Maybe it will all start making sense to everyone who reads this thread so they know how to work the system and avoid a stress-induced breakdown.

My husband and I call them Tri-2-Care reps.

The Patient Advocacy office is either where you need to go or can tell you where the Benefits Management office is located. Just call them. I did everything over the phone. Of course it took from September 2010 to February 2011 to get a straight answer and figure out exactly who to call. Don't have your civilian PCM send referrals through regular channels. Find out where the Benefits Management team is located and find the people who approve specialty services. I was asked by the Benefits Management team to fax my information directly to the Specialty Services office at Ft. Gordon. If you go through regular civilian channels (the Tricare system the civilian docs enter their referral requests), all you'll get back from Tricare is the MTF isn't taking new patients, which is hogwash. The 1-800# Tricare reps do not know anything about how to get you on base for bariatric surgery they don't cover. Trust me. They don't know. I had to nag my way way up the chain to get someone who knew that their system had an automated response for certain procedural requests and that the auto reject answer from the civilian Tricare system is" the MTF is not accepting new patients." They don't even contact the hospital, it is an automatied, computer-generated response. No humans are involved. You're fighting a machine. Go to the people on base. Patient Advocacy should be able to direct you to the right people if they aren't the ones who process that base's treatment requests.

Just to clarity something in my earlier post, while you do not have to go through the regular retired Tricare system (that crazy 1-800# and a bunch of cluelessness regarding the VSG), you still have to go through the on-base Tricare office. The Benefits Management office on base is the active duty Tricare office. The funding for the base Tricare for services through an MTF is a different pool of funds than the fund pool which pays out for services obtained through a civilian hospital or physician.

I had two bands removed and had horrible scar tissue. My band surgeon said he'd never seen anyone build up scar tissue as much and as fast as I did. It took him a couple of hours to remove and replace my first band as opposed to the 45 minutes to put the first band in. The only thing you'll want to do is make absolutely sure the MTF's surgical team knows you have been warned about your scarring issue. Try and convince them (it should be easy) that you'll need the surgeon with the highest successful number of VSG procedures to perform your surgery because of the scar tissue. I not only had significant internal scarring, I had a deformed upper stomach because of it and still had no problem with sleeve formation. The only complication I experienced was a small bleeder (they missed or improperly sealed off a small blood vessel when they removed my lower stomach). It's a complication that can be experienced with any form of surgery and not specifically associated with bariatric surgery or my scarring issue. I had a 6-day stay in the hospital and a transfusion, but I was well cared for. They did not release me until they knew the internal bleeding had stopped. Just make sure the facility you choose has a good bariatric program that has been in place for a while.

When you said you read you didn't have to go through Tricare to get a VSG, you were probably reading my post. I did not mean you didn't have to go through one of the Tricare systems, only that you didn't have to go through your regular local channels if you are retired and the MTF is outside of your 99-mile zone of treatment. There are two separate and distinct divisions within Tricare's funding sources. One serves the active-duty, MTF hospital system and the other serves anyone seeking treatment via civilian channels. It's a budget issue. The military hospital system operates on funds the government allots to the military defense budget. Tricare insurance coverage for services off base through civilian facilities reimburses hospitals and physicians is paid out from government funds allotted solely for the purpose of insurance coverage in a non-military environment. So while you do not have to go through the normal Tricare channels if you are retired, you still have to go through the active-duty, on-base Tricare office. Instead of sending your referral to the civilian system you're used to going through, take it directly to the on-base Tricare office. Anyone wanting bariatric surgery at an MTF, active-duty or retired has to go through the Benefits Management's (Tricare) Specialty Services department office on base. The only people you bypass are the people you get stuck talking to on that 1-800# that are pretty much clueless regarding bariatric surgery, especially when it comes to the VSG. Here's how I did it: http://www.verticalsleevetalk.com/topic/12138-tricare-prime-anyone/page__st__40__p__366787#entry366787

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.