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Renew Bariatrics in Tijuana is where I ended up going. Dr Perez. Omg AMAZING! They have a very active FB group too. Love it!! On it all day every day lol anyway, stitches dissolve on their own. No need for follow-ups really. Pretty quick n ez procedure n I'm 3 weeks post op as of Saturday. I pulled the trigger shortly after making this post - down 23 lbs so far🎉

Hello everyone! I thought it would be helpful to have a detailed account of my experiences from first pre-op meeting through surgery (have a date but have not yet been sleeved) and perhaps beyond. These are my experiences which I think are fairly typical though yours may differ. Much of this same information is available here on bariatric pal but may take a bit more digging than I hope to lay it out here. So, let's begin. May of 2012: I began to seriously consider bariatric surgery and began hunting around for information and resources. It was then that I found Bariatric Pal. I thought my mind was made up about getting the lap band but after reading numerous posts here, I also began to consider gastric sleeve. The band seemed simplest and safest to me. After reading many, many posts here, I learned that that was not only untrue but that the band simply didn't work for most people. June of 2013: I finally got up the courage to see a surgeon about the surgery. After seeing him I was sold on the sleeve. It has a great long term success rate of an acerage of 60-70% (depending on the study) excess weight lost for five years or more. He highly discouraged the band and simply said it just doesn't have the success rate and he is not recommending them. August of 2013: I learned that my insurance at the time would not cover the sleeve, band or any other bariatric surgeries or weight loss programs. I was very upset but renewed my determination to lose weight "on my own". I did. I went from 385 lbs down to 305 and felt like a million bucks. I was absolutely positive I would shrink all the way down to my then goal weight of 225. Hah. Mid 2014: I ballooned back up to about 365/370 and began experiencing extreme knee pain, occasional chest pain, increased sleep apnea and rising blood pressure. My quality of life sucked. December 2014: I had a total right knee replacement. It was horrible. My weight prevented from attending the inpatient rehab clinics that I wanted to attend which had weight restrictions. I wound up in what was essentially an "old folks" convalescent home that made me feel old and invalid. I was ashamed to be there. February 2015: I severely injured my replaced knee while leaving physical therapy. I tore my hamstring and the tendon which attaches to the knee cap. It sucked and I know it was largely due to my weight. The injury still has not healed properly and I continue to feel very handicapped and I am only 48. I can not run at all and standing and walking long distances is out. I again renewed my efforts to lose weight. I went from about 375 to 345 by May and was feeling pretty good. May 2015: I learned I had a diaphragmatic hernia which is like a hiatal hernia but not as close to the esophagus. I had it repaired, which went well but developed an incisional hernia at the site of the laproscopic repair. My efforts at losing weight again turned around. It was at this time that I renewed my intention to get bariatric surgery. I came back to bariatric pal and researched Mexico. July 2015: I was just about set to go to Mexico. I did a skype consultation with Dr Altamirano in TJ and joined his FB group. I began putting the money aside in hopes of going in Mexico for surgery in December. I had strong reservations about Mexico at first but got over it after much reading on here, the consultation and the FB group. Still, I worried about follow up care if there were complications. I had new insurance at work but it still did not cover bariatric surgery. November 2015: I learned from some folks on here that they bought an insurance plan off the Obamacare insurance exchange and used it to cover their surgery right here in the U.S. Some of them even had it as a secondary insurance policy and it worked. My interest was piqued and I began exploring the exchange for an affordable policy that covered bariatric surgery. Some of the others I referred to had success with BC/BS of Illinois and I learned that Illinois requires companies participating in the exchange to cover bariatric surgery. Since I live in Illinois, this was great news! I found a policy that covered the surgery at 100% after a deductible of $3500. Steep but doable. The premium is $398 per month. January 2016: Now we're getting to the meat of the potato. I bought the plan off the exchange, receiving no discount, and it took effect on Feb 1st of 2016. It was the BC/BS IL PPO Silver Plan. Pretty good coverage after deductible. February 2016: I called the insurance company to verify benefits, and they were confirmed. I learned that they did not require a six month diet, or many of the other things that many insurance companies require. They simply said the require a "letter of pre-determination". I also learned that they do not cover the hospital or the surgeon that I initially consulted with. I researched their website and found out that Elmhurst Hospital, and their surgeons were covered. Hallelujah, I live in Elmhurst! I will pick up here later with details of my visits so far!

Here's my saga. I posted this elsewhere in the forums and was kind of surprised at the negative response, so let me say, this is just my story. I'm not bashing the band, I'm very thankful for the success I had with it. I'm not bitter or angry, it just didn't work for me long term. I had a Realize band placed in February of 2009. My starting weight was 268. The band was fantastic and I lost weight steadily, with the exception of a few months when I realized how easy Cookies were to eat. In December of 2010, I hit the 100 pounds lost mark, I also found out I was pregnant that same week. At about 4 weeks pregnant I had a really nasty 3 day stomach flu. A few days after recovering from that, I started throwing up again. I could keep food down for a few hours, but it was all coming back up. I lost another 15 pounds in 2 weeks. I thought it was just severe morning sickness, even though in 5 previous pregnancies I'd never had morning sickness. I saw my Ob who told me to immediately get my band unfilled and if I was still throwing up the next day he'd have to admit me into the hospital. I got a complete unfill and immediately felt better, but with no restriction and absolutely no mental/physical/spiritual preparedness for no restriction, my love affair with all things bread and pastry renewed like we were never apart. I gained 40 pounds in the first 4 months of my pregnancy. I managed to gain back a little control, but ended up gaining about 60 pounds before I had my daughter in August of 2011. The weight gain took a great emotional toll on me, but I just knew that 6 weeks postpartum I'd get a fill and be right back on track... You know where this is going, right? In October of 2011 I got my band refilled. Pre-pregnancy, my fill level was at 7.2cc in an 11 cc band. We filled it to 3.5 cc and 3 weeks later filled it to 5 cc. I had very little restriction and it just didn't seem right. I'd also started getting heartburn. I went back a few weeks later and we filled it to 5.5. That lasted 24 hours, I had to go back in for an unfill and we went down to 5.2 so I could get Water down. I still didn't have much restriction, but I did have terrible heartburn and vomiting in the middle of the night. I lived with this for a few months until I couldn't stand it and went back in and had .5 cc removed. This made the heartburn manageable with daily meds and tums always at hand, but there was no restriction. I could eat all the bread, Pasta, rice that I wanted. I knew I had a slip, but didn't have insurance to cover bariatrics, so I lived with it. I tried eating less, exercise, weight watchers, even a juice fast but I've gained 20 more pounds on top of the baby weight. Fast forward to now and I finally have insurance to cover bariatrics. I went in a few weeks ago and had my upper GI. It showed a slip above the band, virtually my entire stomach is above the band, which is why there is no restriction felt, but the band was so tight that flow into the rest of my digestive tract was severely restricted. Food just sat there for a really long time, and the results of that we're just kind of gross. We unfilled the band completely to see if the slip would fix itself, although, we all knew what that result would be. The pregnancy hadn't caused the slip, the stomach flu had and 9 months of an empty band hadn't helped it unslip. I got that confirmation this week. My band is still slipped and the restriction is still severe even empty. I'm frustrated, but quite relieved that there has been a real issue this whole time and it wasn't just me. We're now going through the process of getting insurance approval to revise to a sleeve and I couldn't be happier.

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Hi all! I will be getting my VSG with Dr Jorge Green at Renew Bariatrics this July. Any past experiences or testimonials from patients would be greatly appreciated

I'm not sure if you will get any responses right now about Renew Bariatrics, but if you use the search tool here on BP you can find threads from the past, which might give you some insight about your topic... Best wishes. https://www.bariatricpal.com/search/?q=renew bariatrics

Thank you for responding! Yes, I was looking into dr Ariel Ortiz at occ. happy you had a positive experience. he has great reviews. a friend had it done with dr cueva at renewal bariatrics. Had a very good experience. When I called them the person I spoke to was much clearer than the person I spoke to at occ. also dr cueva is $2500 less. I would pay if necessary more money, but if I don’t need to why should I the only reviews I found about him were all positive but they were on renewal bariatrics Facebook page. I’m having a hard time making a decision.

Hi all Jes and Tam - Thanks for the early B'day wishes. I am taking tomorrow off to celebrate. Chrissy - you are doing so amazing. WoW - keep up the great work. I'm happy for you. Ali - you'll be there in no time. I got chicken noodle soup and strained it for the broth because I couldn't stand the regular chicken broth. The only bad thing is that it has a lot of sodium. During the full liquid stage when you can have creamed soups, I pureed Progresso's black bean soup flavored with bacon - it had more protein than the regular creamed soups and seemed to hold me better. Laurel - everyone's weight loss is different. I think you are doing great - just think about it in relation to how fast you lost weight before surgery - it is likely that losing that much in a month would never have happened. As long as it is going down you are doing fine. John - you are so funny - prison labor!! You are doing so well - I envy your 5lbs a week! Lee - you are also amazing and so positive. I will definately try to make the next Kaiser Richmond meeting. Jes - I think your spring renewal sounds great - I am glad it seems to have kicked the restriction back in. Donna - Happy 24 - wow! Congrats. Hope Tahoe is fun. CoCo - sorry you were not well, but I am also now going to try a 3 week challenge for my Dr. Park appt. This weekend my eating was a little better but not great - I need to go all the way back to being totally by the book - measuring and no snacking. Mo - glad you had a good active week. Riley - you left the meeting early and I didn't get to give you a hug. Why don't we get together next weekend for a walk? Candra - where are you? Are you OK? Don't stay away. Regarding fills, I went to the So. Co. Weight loss support group saturday and they have the local bariatric surgeon, Dr. Woodbury, who does a lot of WLS answer questions at the end of the meeting. I asked him about why there seems to be different philosophies about fills - fewer larger ones vs. many more frequent smaller one. He said there are some different schools of thought. He said he was trained by Dr. Obrien who is the founder of lap band surgery in Australia. He said that in order for your brain to receive the message from your stomach that you are full, you stomach walls needs to expand/stretch and it is that process that sends the signal to your brain. By gradually increasing the restriction, he said that your new pouch expands a little and sends that signal. He said if you overfill, then people tend to adopt maladjustive behaviors (eating softer foods, drinking liquids that don't expand the stomach walls and send that signal). He believes also that the overfilling can lead to the complications like the stretched esophagus, slipped band or the band eroding. He also said there is a school of thought that does the fills by doing a barium swallow and looking at the size of the opening that the liquid goes through. He doesn't subscribe to that because he doesn't think that is a better way and that learning to eat to fill the pouch to the right amount is very important to sending that full signal to the brain and he also says that doing that many xrays has negative effects as well. For those of you stuck on a plateau, there was another member there who is now a triathlete and he spoke about the importance of varying what you eat, the amount you eat and the type and intensity of your workout to move your plateau. He said your body adjusts to the lower calories and to the same exercise routine and what was once 'hard' becomes 'easy' for it. He suggested varying the food and the exercise. I think it is worth a try. Finally, I finished reading Coleen Cook's book the Successful Strategies of Weight Loss Surgery patients. It has a section on getting back on track. So here are some tid bits that struck a cord with me: Fearing Success -- "Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure." Maryanne Williamson -- " my entire life I have blamed everything on my weight. And if weight-loss surgery were to succeed, what would I blame my shortcomings on?" from a patient on the show Chicago Hope - Successful Failure -- "Obesity is a disease much like alcoholism; there is no 'cure.' Rather, there are habits one can develop to treat the disease through the remainder of life. I recognize now more than ever that I am not normal; my body is different than that of a thin person. It metalbolizes food differently; it requires constant monitoring of the calories in/calories out balance to maintain a healthy weight. While I had won the battle, the war was still going on and whenever I turned my back on it, I would be struck with another pound or two...Each success habit is important in its own right, but it is the constant adherence to ALL of them that fosters life-long change. One thing I know for sure is that weight-loss surgery patients are some of the strongest, most resilient, committed, never-say-never people I have ever met. We are well acquainted with failure. We know what it takes to pick ourselves up, dust ourselves off and do whatever it takes to meet out goals. But as experienced as we are with winning and losing, admitting and taking responsibility for our failures is never easy, but we must learn to becomes successful failures." "...I believe you undoubtedly have your own food obsession stories, hang ups and tempatations...May I encourage you to recognize your mistakes, take responsibility for them, own them, learn from them and do watever it takes to become a 'successful failure.'"Colleen Cook -- "For winning is no more than this: to rise each time you fall." from The Race by anonymous Love to all my surgery sisters and brother! Have a good Monday.

I just had a nice surprise. My husband and I are going to Italy and Greece for 2 weeks in June. I don't know what made us start talking about our passports but we did. So he goes and pulls mine out of our lockbox. We got it renewed in March of 2008. Here is where I digress a bit... so, my 'ah ha' moment was in november of 2006 while at my moms house. I didn't own a scale and she had one in her guest bathroom. I jumped on it and saw 267 pop up and realized I can't do this anymore (at 5'2", I was easily 140lbs overweight). It was right there that I decided to do whatever it took to take the weight off. If someone told me shooting horse pee into myself would work, I'd do it. Luckily for me my answer wasn't as gross. I scheduled a consult at the mayo clinic to get the lapband. Mayo has an extensive bariatric program and requires six months of appointments prior to surgery. I jumped in full force. By March of 2008 I was 25 lbs down, tracking my food religiously and exercising regularly. So when I had that picture it wasn't even my 'come to Jesus' moment but wow five years makes such a difference. As many of you know the band didn't work for me. I had it placed in June 2008 and did well the first 2 years. Then I started having terrible reflux and playing what I referred to as my food games ( waiting until 2 or 3 in the afternoon to eat, get stuck, throw up, look longingly as others ate around you knowing darn well you can't even swallow Water but you are starving). In December of 2012 I couldn't ignore it anymore. I made an appointment with mayo again to get an EGD and find out what was going on. I found oyt later that week that the two years of vomiting, reflux and heartburn had manifested itself into intestinal metaplasia. It was then I decided the band has to come out and I wanted converted. Having a friend die from Barrets several years ago, I knew I was done playing. June 2013 (almost five years to the day from my lapband) my band was taken out and I was converted to RNY. I was 220 on the day of surgery and am 160 this week. I am confident I will reach my goal if it takes me another 20 years. God willing horse pee won't factor in. So back to my NSV.. Seeing that picture was a great visual reminder of my journey to this point and reminded me how every step along the way helped me get here. My relationship with food is better than it has ever been, I feel healthy and while I have the all too damiliar freakouts from stalls I never take my eye off of the prize. Me and my worth to achieve anything I desire.

Today marks 3 months since I was re-born into this brave new world! And since that day, I cannot even begin to enumerate the exponential feelings of wellness and hopefulness that have begun to saturate my life. My goodness, I knew I needed help, but I had no idea how much of an addict to food I really was, and how every aspect of my life was somehow either tied around food, or mitigated by food, most of the time in negative nonsensical self-harming ways! Never in my wildest dreams could I have imagined, or even supposed in my defeated mind, that I could come so far in so little time! But here I stand, 3 months later, half way there, 54lb’s lighter, working out north of 1 hour every day (no excuses and I love it, and actually look forward to it!), no longer prediabetic, experiencing wellness, dancing around with my kiddos with giddy abandonment, full of energy, wanting to take pictures again, with a renewed sense of self-worth, with a focused mind, doing a double take at that lady in the mirror, being more in control and feeling so positive about most of my food choices. Friends, there is a brand new energy that I oscillate with these days, and there is an inner joy about me that I forgot I was even capable of experiencing. I have spent today with a heart full of gratitude to God, I think that is most of what I feel today. Grateful that I have been rescued from what was not only a miserable, but a horribly unhealthy, sunken life. That I came through surgery and could see the faces of my kiddos again! For the amazing friendships I have made along the way on Bariatric Pals, without whom this journey would have been an infinitely lonelier one. You know who you are…thank you!!! All this…and I’m only half way there!!! I’m more motivated and pumped than ever before. So I wanted to share this with you, thank you all for your love, encourage you in your journey (especially if you were like me, so torn about the decision to do or not to do!) and invite you to let me know where you are in your journey, your thoughts and laments around 3 months, or before or after! Just a collective pause to savor the goodness J Sending you Sunshine! Ellie

If you know for certain that bariatric surgery isn't covered by your company's health insurance policy you can write to HR and ask them to get it covered at the next renewal. There was a letter I saw on these boards that someone created just for that purpose. I'm pretty sure he said it could be copied and pasted. You might want to search for it. Your other option is self-pay. There are a lot of doctors who do this surgery and the rates vary in different parts of the country. There is always the Mexico option. Again - there are a lot of people on these boards who have self-paid and you could search for that info on these boards. Can you switch health insurance next year? Is there a policy you can get at work that covers WLS? The only other option is finding a new job with insurance that you know covers it. Best of luck.

Assuming I read you correctly that case manager works for the insurance company? If so, I would ask for everything in writing first and foremost. Secondly, ask if you have to use a Bariatric Center of Excellence and/or do they have someone in your area they would refer you to. Regarding the timing, not sure when your insurance renews, but if it is on a calendar year (i.e. renews 12/31), then you might consider trying to get it done this year. If the policy changes when it renews at 1/1 (and there are no guarantees it won't), then anything they tell you now could be completely different.

Both sleeve and rny remove that grehlin secretions...however and vets will tell you many, maybe most get it back down the road. It is why developing good habits are important during the honeymoon phase when it is gone. Our bodies are smart and figure out how to renew those connections, my advice to anyone contemplating bariatric surgery is to go on YouTube and watch every video dr. Matthew weiner has produced. Very informative and research based.

Hey, BariatricPal Members! It’s that time again…the time when we get to connect with you, BariatricPal members, via our newsletter. We hope that the coming of spring is inspiring you to take another look at your weight loss and health. With warmer weather, longer days, and fresh seasonal produce coming in, staying active and eating nutritiously is easier than it was in winter. To keep you motivated and focused, here is what we have for you in this letter. Member Poll: How Do You Plan Your Meals? Member Spotlight: Meet ajtexas! From Spring into Summer! Hidden Gem? Check Out BariatricPal’s Weight Loss Surgery Library! Ready to get started? Take a look at the newsletter, go enjoy a walk in the fresh air, and then log on to BariatricPal and talk about the newsletter and anything else that you’ve been thinking about. Thanks for your support! Sincerely, Alex Brecher Founder, BariatricPal Member Poll: How Do You Plan Your Meals? Meal planning can be an important factor in success after weight loss surgery. You need to get enough Protein and other nutrients and limit your calories while you stick to the allowed food choices on your weight loss surgery diet. Meal planning can be challenging, though. How do you plan your meals? I meet regularly with a nutritionist or dietitian to plan my menus. I sit down on the weekends and plan my meals for the upcoming week. Each morning or evening, Ifigure out what I will eat in the coming day. I don’t plan specific meals. I just make sure to have plenty of protein and fill in the rest with vegetables, fruits, and whole grains. I don’t plan, but I know I should. I just eat what looks healthiest at the time. Other – Read my answer in the discussion! Go to BariatricPal to select the answer that best describes you, and then tell us about it in the discussion! Exciting News – We're welcoming unjury and Opurity to BariatricPal! BariatricPal is proud and excited to announce two new sponsors for our newsletters. The new sponsors are Unjury, a supplier of innovative protein supplements, and Opurity, maker of dietary supplements for bariatric surgery patients. Their support lets us keep BariatricPal newsletters coming to you each month. Unjury is part of ProSynthesis Laboratories, Inc, a company founded by a dietitian and committed to your health. You know the importance of getting enough protein after weight loss surgery, but you also know that meeting your protein goals can be challenging. Unjury makes your task easier. Product flavors include chocolate Splendor, Chooclate Classic, Protein’d cheese Sauce, strawberry Sorbet, vanilla, chicken Soup, and Unflavored. These ready-to-use protein powders come in single-serve and multi-serve containers, and contain high-quality whey protein to keep you full and nourished. They are sugar-free. Founded in 2007, Opurity is dedicated to using the purest ingredients in its supplements. Opurity nutritional supplements are designed specifically for bariatric surgery patients. Choose from chewable orange-berry Multivitamins for lap-band patients or for gastric bypass and gastric sleeve patients. Opurity also sells chewable Calcium, Vitamin D and folic acid/vitamin B-12 chewables. All supplements come with a money-back guarantee. Support from Unjury and Opurity helps us continue to bring you the services you enjoy on BariatricPal, so please support these two companies! When looking for your bariatric surgery supplements, first visit Unjury and Opurity online. Purchasing from these companies helps support BariatricPal. Thanks to Unjury and Opurity for your generous sponsorship, and thanks to BariatricPal members who support our partnership! Insure Nutrition We are always thrilled to welcome a new newsletter sponsor into the BariatricPal family, and this month, Insure Nutrition is giving us the pleasure of doing just that. Our latest sponsor, Insure Nutrition, is an online company that specializes in getting health insurance coverage for nutritional supplements. Its Post-Bariatric Surgery Nutrition products includes Premier Protein shakes in chocolate, vanilla, and strawberry flavors and OptiSource High Protein drinks in caramel and strawberry flavors. Checking if you are eligible is easy. Insure Nutrition encourages you to use its online form to find out if you qualify. Our sponsors help make BariatricPal newsletters and other services possible. We encourage you show your thanks by considering them first for your bariatric needs. Member Spotlight: Meet ajtexas! Our spotlight this month is on Amanda, but you may already know her as AJ! Before surgery, AJ weighed 250 pounds and had high blood pressure, pre-diabetes and pain in her feet. She got winded walking up a flight of stairs, and says she was miserable! This 47-year-old got her gastric band in February of 2012, and ajtexas lovingly calls her band the Yellow Band of Texas. It has helped her lose 80 pounds to a goal weight of 170 pounds and a normal BMI of 24.4. Although she is a self-proclaimed boredom eater and she struggled with head hunger, AJ says that now she truly loves herself and can smile when she looks in the mirror. She can do chores all day long on her farm in Texas, and loves it! She also likes her new clothes and the fun of trying on small, fashionable outfits like tailored tops and skinny jeans. AJ uses BariatricPal for support and tough love. She says the friends she has on the boards are friends for life. She also realizes the value of paying it forward, and takes care to support new members when she feels that she can help them in their journeys. Her advice to members who are struggling with weight loss is to allow yourself to succeed, and to be persistent. Don’t give up! She also cautions that maintenance can be as hard as losing the weight. AJ, thank you for sharing your story and advice! You look fantastic, and we appreciate your presence on the boards! If there is anyone you would like to meet in our Member Spotlight or you would like to be featured, please let us know! Tell us in the Member Spotlight forum or send Alex Brecher a PM. From Spring into Summer! Spring is a time for growth and renewal. Signs of spring can be all around us in the form of melting snow, muddy fields, new leaves, and singing birds. Let these energizing signs inspire your own revitalization. Whether you are just thinking about surgery or are already at goal weight, there is always something that you can work on to lose more weight or be healthier. Now that spring has begun, it’s time to set some new goals to keep you focused or get you back on track if you slipped up during the winter. Summer is a few months away, so why not base your goals on being able to have more fun this summer? These are some sample goals for each phase of weight loss surgery. You can reach them by the time summer starts. If you are pre-surgery: Aim to finalize your research on weight loss surgery. Once you are sure you want surgery, figure out which type and choose a surgeon. Set a date for your procedure. If you are shortly post-surgery: Aim to hit the ground running when it is time to focus on weight loss. That means carefully following the post-surgery diet progression to speed recovery from surgery, and also learning all you can about the solid foods diet you will be eating for the long term. If you are in the middle of losing weight steadily: Aim to lose a certain amount of weight or fit into a certain goal outfit. If you are at goal weight: Aim to participate in a challenging summer activity, such as a kayaking trip or a 5K road race. These require serious training and healthy eating. Follow these tips when you are setting your goals. Keep them realistic. If you have averaged a loss of 2 pounds per week (8 pounds per month), a goal of losing 24 pounds in three months is realistic. A goal of 50 pounds is not realistic! Make an action plan. If your goal is to go on an overnight hiking trip, you not only need to keep eating well, but also need to train for it. Map out a training plan that includes walking during the week and hiking on the weekends when you have more time. Make your goal specific. If you have a vague goal, you won’t know whether you are making progress toward it or whether you achieve it. Instead of vowing to lose weight, get into shape, and eat better, specify goals such as losing 20 pounds, running 2 miles without stopping, or meeting your protein needs each day. Take advantage of spring to give yourself a new start. Regardless of where you are in your weight loss journey, some hard work and dedication can help you can achieve remarkable goals by the time summer comes! Hidden Gem? Check Out BariatricPal’s Weight Loss Surgery Library! You already know that BariatricPal is the world’s top online weight loss surgery community. Did you also know that BariatricPal has an entire section filled with credible information on weight loss surgery? These science-based facts can help you plan your weight loss surgery, lose more weight, and adjust to life after weight loss surgery. Information on the major types of weight loss surgery, including the lap-band, vertical sleeve gastrectomy, gastric bypass, sleeve plication, and duodenal switch. The post-surgery diet progression from liquid to solid foods All about the weight loss surgery diet, from food lists to meal plans and beyond Strategies for succeeding after surgery And much more! You already log in for the tips and encouragement on the boards. Next time you’re on BariatricPal, stop by our information center. You never know what you might discover! That is all we have for this month’s newsletter. Thanks for reading it, and we’ll see you on the boards!

My insurance company approved my band removal and request for a sleeve in July. When my removal was scheduled, I received a letter from them saying the surgery hadn't been authorized. I spoke with the insurance coordinator at my surgeon's office, and she said the authorization had expired and simply needed to be renewed. She didn't think it was a big deal until I told her as of September, BCN had changed its contract to read bariatric surgery is a once-in-a-lifetime benefit and asked her under which contract the renewal would be considered. She said she didn't know. A couple of weeks later, I called her back and she told me BCN had once again approved both surgeries. I had the band removed yesterday, but have to wait until February for the sleeve. Admittedly, I'm concerned the insurance company is going to change its mind again, and I'll end up tens-of-thousands of dollars in debt. Does anyone know the origins of the once-in-a-lifetime benefit regulation and if it applies to any other surgery? Just seems punitive.

I was denied by cigna because the Memorial hermann hospital I chose didn't renew their contract to be a Bariatric center of excellence. How dumb is that? Then I'm told anyone who applys in the houston area through cigna will get denied if they dont go to two hospitals in northwest houston. There is a huge selection of surgeons in houston that accept cigna. To me this doesnt make sense. Then conveniently one would think the surgeons office had prepared for something like this but no. Okay so then I called all the doctors that work at the two hospitals mentioned. None of those doctors have openings till sept/oct. I know there are going to be road blocks but I can honestly say the last few days I was being positive till this came up. I really feel like after a total of 2.5yrs trying to get this done, I want to give up. The average person will have "road blocks" I'm sure but not this many. *then i get a call from the surgeons office saying it was a misunderstanding and they will correct it and submit for reconsideration. I'm so confused. I hate cigna

I have BCBSNC (State Health Plan)...and I have to do to the 6-month medically supervised weight loss visits, too. I called BCBSNC yesterday and they stated that all BCBSNC policies that support bariatric surgery have went to that rule due to Medicare changing their rules (NC changed with them). I'll most likely be going to Duke Raleigh Hospital for mine, and my surgeon said he hopes that when the plans come up for renewal on 12/31 that the policy will change back and the 6 months of visits will no longer be required. *fingers crossed* I've actually thought of having the surgery down in Mexico due to the wait and the cost being about the same. Still considering it, actually.

I am sorry to hear your frustrations as well. It doesn't sound like your doctor is giving you a lot of information to work with. I would strongly recommend you meeting with a nutritionist or dietician that is familiar with lapband surgery and get some ideas on meal plans. I will tell you that potatoes and Pasta don't work well for many of us. I am able to eat almost anything except those things and scrambled eggs. I feel like if you had specific ideas of what you can eat, etc you may feel less frustrated. There are also books on the band and recipe books. If there is a nutritionist you could see through your surgeons office they would have insight into the band. My bariatric center has them on staff and they have given me a lot of great ideas and even on how to eat overall. I am able to eat steak, ground meat (love chili), chicken, ham, etc. I feel like I can pretty much eat anything except starchy foods (incl. doughy bread) and the scrambled eggs. I really don't feel deprived at all. Truly. I hope the New Year brings renewed success w/ the band. You have done a great job so far.

PATCHES!!! <3 I have been taking the Patches for 6 weeks now and I can’t say enough about them. No pills, no chalky flavor, no getting full on them before I even get to eat my Breakfast. They are so simple. I ordered them from Bariatric Pal’s online store. They auto-renew and come in the mail every couple of weeks and cost me $19.00 a month. I take one patch and put it on my shoulder before bed and when I wake up, I take it off. You only have to wear it for 8 hours. I just leave them on my nightstand and it is the last thing I do before bed. They really work, because I went away for the weekend, and forgot to pack them (before and after that, I have been wearing them religiously) and I way felt a difference. The list of the Vitamins is great and I love that it has a lot of Biotin in them to help keep your skins, nails and hair in good form since that is one of the number one negative responses from people who have underwent WLS is the thin hair and terrible skin. I have also not experience any issues with the adhesive. I have before with other “patch” products but so far nothing with these. Great product! Hope you find something that works for you!

Here's more than you probably wanted to know: The Latest on Nutrition and hair Loss in the Bariatric Patient by Jacqueline Jacques, ND Nutrition and Hair Loss A common fear and complaint of bariatric surgery patients is postoperative hair loss. While for most of us as people, our hair is important as part of our self-image and body image, it is not very important to our bodies. For this reason, nutrition can have a great impact on hair health because when forced to make a choice, the body will shift nutritional stores to vital organs like the brain and heart and away from hair. Hair loss has many causes. The most common type of hair loss after weight loss surgery is a diffuse loss known medically as telogen effluvium, which can have both nutritional and non-nutritional causes. Whether you are aware of it or not, for most of your life you are always in the process of both growing and losing hair. Human hair follicles have two states: anagen, a growth phase, and telogen, a dormant or resting stage. All hairs begin their life in the anagen phase, grow for some period of time, and then shift into the telogen phase,which lasts for approximately 100 to 120 days. Following this, the hair will fall out. Typically, about 90 percent of hairs are anagen and 10 percent are telogen at any give time—meaning that we are usually losing a lot less hair than we are growing, so the hair loss is not noticeable. But sometimes this can change. Specific types of stress can result in a shift of a much greater percentage of hairs into the telogen phase. The stressors known to result in this shift, or telogen effluvium, include the following: high fever, severe infection, major surgery, acute physical trauma, chronic debilitating illness (such as cancer or end-stage liver disease), hormonal disruption (such as pregnancy, childbirth, or discontinuation of estrogen therapy), acute weight loss, crash dieting, anorexia, low Protein intake, Iron or zinc deficiency, heavy metal toxicity, and some medications (such as beta-blockers, anticoagulants, retinoids, and immunizations). Nutritional issues aside, bariatric surgery patients already have two major risks of major surgery and rapid weight loss. These alone are likely to account for much of the hair loss seen after surgery. In the absence of a nutritional issue, hair loss will continue until all hairs that have shifted into telogen phase have fallen out. There is no way of switching them back to the anagen phase. Hair loss will rarely last for more than six months in the absence of a dietary cause. Because hair follicles are not damaged in telogen effluvium, hair should then regrow. For this reason, most doctors can assure their weight loss surgery patients that with time and patience, and keeping up good nutritional intake, their hair will grow back. Discrete nutritional deficiencies are known to cause and contribute to telogen effluvium. One should be more suspicious of a nutritional contribution to post-bariatric surgery hair loss if any of the following occurred: 1. Hair loss continued more than one year after surgery 2. Hair loss started more than six months after surgery 3. Patient has had difficulty eating and/or has not complied with supplementation 4. Patient has demonstrated low values of ferritin, zinc, or protein 5. Patient has had more rapid than expected weight loss 6. Other symptoms of deficiency are present. Iron Iron is the single nutrient most highly correlated with hair loss. The correlation between non-anemic iron deficiency and hair loss was first described in the early 1960s, although little to no follow-up research was conducted until this decade. While new research is conflicted as to the significance of ferritin as a diagnostic tool in hair loss, it has still been found that a significant number of people with telogen effluvium respond to iron therapy. Optimal iron levels for hair health have not been established, although there is some good evidence that a ferritin level below 40mg/L is highly associated with hair loss in women.1 It is worth noting that this is well above the level that is considered to be anemic, so doctors would not be expected to see this as a deficiency. Zinc Zinc deficiency has been tied to hair loss in both animal studies and human cases. There is data linking zinc deficiency in humans to both telogen effluvium and immune-mediated hair loss. Zinc deficiency is a well-recognized problem after biliopancreatic diversion/duodenal switch, and there is some indication that it may occur with other procedures such as gastric bypass and adjustable gastric banding. In 1996, a group of researchers chose to study high-dose zinc supplementation as a therapeutic agent for related hair loss2 in patients who had undergone vertical banded gastroplasty. The study administered 200mg of zinc sulfate (45mg elemental zinc) three times daily to postoperative patients with hair loss. This was in addition to the Multivitamin and iron supplements that patients were already taking. No labs for zinc or other nutrients were conducted. Researchers found that in patients taking the zinc, 100 percent had cessation of hair loss after six months. They then stopped the zinc. In five patients, hair loss resumed after zinc was stopped, and was arrested again with renewed supplementation. It is important to note that in telogen effluvium of non-nutritional origin, hair loss would be expected to stop normally within six months. Since the researchers conducted no laboratory studies and there was no control group, the only patients of interest here are those who began to lose hair again after stopping zinc. Thus, we cannot definitively say that zinc would prevent hair loss after weight loss surgery, and further study would definitely be needed to make this connection. A further note: The tolerable upper intake level (UL) for zinc is set at 40mg in adults. This study utilized a daily dose of more than three times that level. Not only can these levels cause gastrointestinal distress, but chronic toxicity (mostly associated with copper depletion) can start at levels of 60mg/day. Information related to this study has made its way to many a support group and chat room—even to doctor’s offices—with the message that “high-dose zinc will prevent hair loss after weight loss surgery.” Patients should be advised that high-dose zinc therapy is unproven and should only be done under supervision due to the associated risks of toxicity. A lab test to check for zinc deficiency would be best before giving a high dose such as this. Protein Low protein intake is associated with hair loss. Protein malnutrition has been reported with duodenal switch, and in gastric bypass to a much lesser degree. Little is known about incidence, as only around eight percent of surgeons track labs such as total protein, albumen, or prealbumen.3 Limited studies suggest that patients with the most rapid or greatest amounts of weight loss are at greatest risk.4 With surgical reduction of the stomach, hydrochloric acid,5 pepsinogen, and normal churning are all significantly reduced or eliminated. Furthermore, pancreatic enzymes that would also aid in protein digestion are redirected to a lower part of the small intestine. It is thus likely that maldigestion rather than malabsorption is responsible for many cases. Some studies have also implicated low protein intake.6 Research also indicates that low levels of the amino acid l-lysine can contribute to hair loss and that repletion of lysine stores may both improve iron status and hair regrowth. In a study of anemic patients with hair loss who were supplemented with 1.5 to 2g of l-lysine in addition to their iron therapy, ferritin levels increased more substantially over iron therapy alone.1 Biotin Many individuals believe that supplementing with, or topically applying, the nutrient biotin will either help to prevent hair loss or will improve hair regrowth. To date, there is no science that would support either of these presumptions. While biotin deficiency can cause dermatitis, hair loss is only known to occur in experimentally induced states in animal models or in extreme cases of prolonged diets composed exclusively of egg whites.7 Other Other nutrients associated with hair health include Vitamin A, inositol, folate, B6, and essential fatty acids. Hair loss can also be caused by systemic diseases, including thyroid disease and polycystic ovarian syndrome (PCOS), and is influenced by genetics. Conclusions Hair loss can be distressing to bariatric surgery patients, and many will try nutrition themselves to see if they can prevent it. Unfortunately, there is little evidence that early hair loss is preventable because it is most likely caused by surgery and rapid weight loss. Later hair loss, however, can be indicative of a nutritional problem, especially iron deficiency, and may be a clinically useful sign. Educating patients about the potential for hair loss and possible underlying causes can help them to make informed choices and avoid wasting money on gimmicks that may have little real value. References 1. Rushton DH. Clin Exp Dermatol. 2002;27(5):396–404. 2. Neve H, Bhatti W, Soulsby C, et al. Reversal of hair loss following vertical gastroplasty when treated with zinc sulphate. Obes Surg. 199;6(1):63–65. 3. Updegraff TA, Neufeld NJ. Protein, iron, and folate status of patients prior to and following surgery for morbid obesity. J Am Diet Assoc. 1981;78(2):135–140. 4. Segal A, Kinoshita Kussunoki D, Larino MA. Postsurgical refusal to eat: anorexia nervosa, bulimia nervosa or a new eating disorder? A case series. Obes Surg. 2004;14(3):353–360. 5. Behrns KE, Smith CD, Sarr MG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity.Dig Dis Sci. 1994;39(2):315–20. 6. Moize V, Geliebter A, Gluck ME, et al. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg. 2003;13(1):23–28. 7. Mock DM. Biotin. In: Shils M, Olson JA, Shike M, Ross AC, eds. Nutrition in Health and Disease. 9th ed. Baltimore: Williams & Wilkins; 1999:459–466.

Hi Nancy, greetings from another Nancy! It is entirely normal to feel doubts, even when you have been so focused on jumping those hoops. I had my surgery on April 22 and I can tell you that I felt those doubts too. Throughout this process I pursued my goal of having the surgery in a very proactive way: researched it about a year ago, found my insurance had an iron-clad "NO bariatric" clause, waited patiently till last fall when the policy renewal came out, found it had changed, starting attending seminars and reading everything I could get my paws on, etc etc. You know the details: psych eval, nutritionist, more insurance hoops, etc. Then when I got the approval I had about a day of "YAY!!!" before the "...ulp..." set in. Although this sounds corny, it did help me. I made a list of the pros and cons. I found my pro's included some things that were obvious, like enjoying clothing shopping again and getting my pernicious blood pressure down, but there were other things, too. For me, it is getting OFF the diet merrygoround. I have been so very focused on my weight for 20 years, so very absorbed in dieting, so very frustrated at failing in my diets, so much guilt and even shame. I look forward to ending this cycle! I am starting my second career, in the health care field, and being obese is not a plus in my work. Interestingly, these are the things that help me when I am struggling. Hang in there, Nancy! although my surgery is still so recent, and I haven't yet gotten the full benefit of the fills and the major weight loss, I AM glad that I am being proactive and taking charge. Kudos to you for doing the same! Nancy

Hi all -- love the threads! So much good information and conversation. My name is Amanda. I'm a 37yo homeschooling mom to six kiddos, and I'm hoping to be a December sleever. Having been overweight since late childhood, I've been hoping for bariatric surgery since seeing a documentary about RNY fourteen years ago. I've not had insurance coverage for bariatric surgery before last year, and even then, it came as a surprise. I would check at the beginning of each year when we'd renew our benefits, and my husband's company would not only not cover it, they would specifically exclude it. The surgeons I'd call would tell me that exclusion would make an appeal impossible. Anyway, last January I didn't bother checking because I assumed after years of exclusions, there would be no change. I've been looking at the VSG for about a year now and lurking here on these boards, and I began exploring cash-pay options with surgeons in the U.S. and abroad. At the end of last summer, just as I was making a plan to go to Mexico for surgery, my husband double-checked our benefits, and LO AND BEHOLD, our insurance now covered bariatric surgery just like any other surgery -- standard deductible and 20% copay with a few other minor costs here and there up to a $5000 max. Thrilled, at the end of September I made an appointment with a bariatric surgery group just down the highway from our house. I then cancelled in early October because we discovered I was pregnant with my sixth babe. I was told to call back after six weeks of post-delivery recovery, and for those weeks after baby, I wrestled with the choice to call the WLS. Maybe this would be the time I could get the weight off. Forget the fact that I've been over 100 pounds overweight since middle school and have tried every single diet and pill and plan under the sun -- maybe this would be the year. In retrospect, I was terrified of seeing the doctor because I was afraid he'd reject me for WLS. It had always been the option in my pocket, the secret bullet for the day when I realized I really couldn't do it on my own. If the doctor rejected me, I would truly be without options and hope for real weight loss and health. Despite being severely overweight, I felt like I was in pretty decent health and would be rejected because of a lack of serious comorbidities. I have prediabetes and have had gestational diabetes when pregnant -- both of which increase my chances of Type 2, a disease that killed my grandmother. My mom died of cancer last year, and my obesity increases the risk of my developing cancer. My dad had high cholesterol and HBP. Stroke and heart disease run in my family. I also have Hashimoto's Thyroiditis, and while that's not caused by my obesity, it complicates any effort at weight loss. Other than that, I have neuropathy in my feet and weight-bearing bone problems in my feet. I'm prone to injury and have to see the podiatrist several times a year for medical care. I also have numbness in my arms and hands, and I'm concerned it's moving towards a total loss of feeling like my feet. My knees and back ache, and getting up and down and moving around a lot is exhausting -- a real problem when you're with six kiddos all the time! So, while I don't have a large number of documented medical comorbidities, I'm feeling the chronic effects of a lifetime of obesity beginning to creep up on me, and I just don't like it. Additionally, my mom died from a type of cancer she could have avoided (lung cancer specific to smokers), and her grief was complicated by the fact that she could have made different choices all the years she smoked and maybe lived longer. I don't want that to be me. I don't mind dying at 56 like she did, but I'd rather die from falling off a mountain I've just climbed or because the chute didn't open when I went skydiving, not because I chose a habit that destroyed me, and I never got a handle on it. After that brief post-baby wrestling period, I decided to pursue surgery, and if by some miraculous chance I lose 100 pounds between now and my surgery date (ha!), I'll call off my surgery. I saw the surgeon on August 5 -- my 13th wedding anniversary -- and not only did he not reject me, he said I was the perfect candidate. (He probably says that to all the girls. *wink*) I weighed 262 at the appointment, and I'm now 5'7" (was 5'10" before my weight began destroying the bones in my feet -- sigh.) My BMI was 41.1, thanks to my new shorter stature. I'm still very new to all of this, and while I have a few hoops to jump through, they don't seem all that complicated to me. Maybe I'm missing something. My insurance (Cigna) requires a 3 month diet with the nutritionist (4 total meetings), and I see her this coming Tuesday -- just a week after my first appointment. I also attend my first support group at that time. I'll have three more nutrition meetings and one or two more monthly support group. I've already had initial labs drawn, and I'll see my PCP on Monday for a physical (per his request) to have him write the letter of recommendation my insurance requires. The surgeon requires a physical therapy evaluation, which I also already have scheduled on Tuesday. Besides that, I'll do an EGD and a psych evaluation, and that's it. It doesn't seem like a lot to me, and the fact that half of the requirements will be completed within a month of my initial meeting with the surgeon blows my mind. It's impossible for me to believe that after 25+ years of obesity and 14+ years of researching bariatric surgery, MY day is coming.

I honestly think that this is where that support team that is part of many bariatric groups comes in. We need help seeing our selves as who we have become as much as we need that help in transitioning into who we are becoming as we lose the weight some of us have had for most of our lives. I was worried about the sunken in face, and the jowls that might come and the wrinkles that might suddenly appear as the weight came off. Sure I see the sag, and I see the wrinkles and yet I feel amazing! I am not 20 years old anymore, but I feel once again like I have a renewed vigor for life. I have lost a small child, it's no longer on my back and the load is lighter. I am moving around more and getting out more and feeling better then I have in years. I earned the sag and the wrinkles, they came from living. If they bother me enough I'm going to fix them since we live in a world where that is possible, why not? I didn't start this Quest with perfection in mind, just health and happiness!! I hope you all are finding that today as well!

Hi. I was scheduled in OCC with dr Ariel Ortiz in July. They’ve been closed throughout the pandemic. Now that they’re re opening in July they came out with a tremendous amount of new requirements that are making it very difficult for me. (For example need to be there 2 days before surgery) I’m strongly considering switching to Tijuana bariatrics with dr Garcia or renew with one of their doctors. what are your thoughts? I’m so confused. 🤦‍♀️ I just want this done already!

How to get reliable information whether or not Gastric Bypass Surgery is the best surgery for me? Does anyone have any information about Renew Bariatrics? Does anyone have Gastric Sleeve Surgery done in Renew Bariatrics? Would you recommend it to me? Does anyone know any reviews on Renew Bariatrics? Appreciating with thanks any replies to my questions.