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Oh man, I'm so sorry that anxiety is sitting with you right now - it stinks. I too have heard that mood swings can be part of the early stage post-surgery for a variety of reasons, including hormonal fluctuation, sleep disturbance, or loss of food as a comfort and coping tool. During my pre-surgery phase, I got more aware of how I have used food to manage and numb anxiety. Post-surgery, as my hunger/food desire has started to return I've had some unpleasant reminders of this old habit. I also really and truly get having fear around moving from one food stage to the next. with each food stage "graduation" I have been so afraid of what might happen. Go figure that by following my program I have been fine. Like catwomen said complications are rare, and even rarer if you're following the recommendations of a reputable program. Not to go into advice mode too much, and knowing our experiences might be different (maybe you are having panic attacks rather than generalized anxiety?), I will say that I have found therapy to be a big help. With my therapist I know I can unload my anxious build-up. saying my fears out loud to someone else helps me put them in perspective. Therapy also gives me a non-food outlet that instead of numbing helps me identify what might be contributing to anxiousness and give it less power by helping me to put it in perspective. Not all therapists are skilled, so it can take some shopping around, but might be worth it.

He Hey guys !my insurance said they cover all the bariatic services my PA asked me to ask them. The requirements I believe they said there was no required supervised diet however I do have some history with phertamine. My bmi is right at 40.4. I’m gonna ass a screen shot of the blue home plan for bariatic ! I think it should be an easy process as far as what they’re asking for. I hope to have my surgery by June fingers crossed. Anyone have experience with novant ? In Nc Pasted what the picture has in case visibility is hard.  A thorough preoperative evaluation for bariatric surgery must include all of the following: 1. Evaluation of the patient's understanding of the procedure to be performed, including the procedure's risks and benefits, length of stay in the hospital, behavioral changes required prior to Page 8 of 21 An Independent Licensee of the Blue Cross and Blue Shield Association Bariatric Surgery and after the surgical procedure (including dietary and exercise requirements), follow up requirements with the performing surgeon, and anticipated psychological changes. 2. 3. Evaluation of the patient's family/caregivers support and understanding of the information in #1. Within 12 months prior to surgery, a thorough nutritional evaluation by a physician, registered dietician, or other licensed professional experienced in the issues of bariatric surgery, who has had a meaningful conversation with the individual regarding the dietary and lifestyle changes required to ensure a successful outcome over time. Nutritional assessment must follow American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines. Pre-operative assessment must document that the patient has a good understanding of the diet and nutritional changes that are associated with bariatric surgery and has the capacity to comply with these changes. Per the ASMBS guidelines, " *..it is essential to determine any preexisting nutritional deficiencies, develop appropriate dietary interventions for correction, and create a plan for postoperative dietary intake that will enhance the likelihood of success. Not only should the practitioner review the standard assessment components (i.e., medical co-morbidities, weight history, laboratory values, and nutritional intake), it is also important to evaluate other issues that could affect nutrient status, including readiness for change, realistic goal setting, general nutrition knowledge, as well as behavioral, cultural, psychosocial, and economic issues." 2019 guidelines for perioperative nutrition, metabolic and nonsurgical support are available at: 4. https://journals.aace.com/doi/pdf/10.4158/GL-2019-0406 Within 12 months prior to surgery, a formal psychosocial-behavioral evaluation performed by a qualified behavioral health professional (i.e., licensed in a recognized behavioral health discipline, such as psychology, social work, psychiatry, psychiatric nursing, etc., with specialized knowledge and training relevant to obesity, eating disorders, and/or bariatric procedures), which assesses environmental, familial, and behavioral factors, as well as risk for suicide. Any patient considered for a bariatric procedure with a known or suspected psychiatric illness, or substance abuse or dependence, should undergo a formal mental health evaluation before the procedure. 2019 guidelines for perioperative nutrition, metabolic and nonsurgical support are available at https://journals.aace.com/doi/pdf/10.4158/GL-2019-0406 5. Appropriate medical work up may include a chest x-ray, upper gastrointestinal series, endoscopy, appropriate pre-op labs and ECG. A complete physical examination by the attending surgeon and an assessment of thyroid levels is required. If the patient has comorbid conditions (e.g. diabetes or 6. cardiovascular disease) the patient must be capable of undergoing the procedure. Anesthesia clearance for surgery. The first five criteria must be met before seeking prior plan approval for adults and adolescents; the sixth must be met prior to surgery. Surgical procedures must be performed at a facility capable of providing gastrointestinal and biliary surgery (preferably JCAHO accredited), AND that has equipment and staff capable of managing a morbidly obese patient (appropriate instruments, beds, lifts, monitoring equipment) AND that can manage short and long term complications of bariatric surgery.

I had the VSG in Mexico in August of 2015 because my relatively low BMI disqualified from me receiving any coverage from my insurance, and it would have cost a small fortune to have the surgery in California where I reside. My total cost was $4200, which included a hotel stay at the Marriott and local transportation. I had a very positive experience there, no complications, and consider the surgery to be a tremendous success. My reproductive endocrinologist had recommended the surgery to me for my PCOS, and has done the follow-up blood work. I was initially very skeptical about going out of country for the surgery, but after researching it felt confident about the decision. "Medical tourism" has become an increasingly popular option for Americans and Canadians, and many of the facilities and surgeons outside of the US are equal to or even superior, but of course it's imperative to do thorough research before proceeding.

Hi All, Just wanted to know what others have experienced. For some reason I am having daily anxiety. I absolutely can't stand it as it hits out of nowhere at all. I am only 17 days Post-Op, take my vitamins daily, and still taking my Metformin until I am blood tested again. I do not want to go on an anti anxiety medication. I had been on Lexapro for 4 years at which point I put on a lot of weight going from a size 4 to 1-2X. I lost all motivation on working out as well. I went off the Lexapro completely 2 months before surgery and started actually caring about myself which is why I decided to do this surgery so I could get my health back on track. Following my weight gain, I developed diabetes, Apnea (now using a C-Pap for a year) and NASH of the liver. I notice exercise helps with the anxiety for sure but I cant seem to get a decent response from the medical community to help me feel better about this. I asked my surgeon why this sudden onset of anxiety that hits for what seems like no reason at all and his response was if I am eating right and exercising that this could be the cause because of sudden change and that maybe people are treating me differently and all of this is causing anxiety. I then told him no - people are not treating me differently. My family is amazing with all of this and I am working out of the house so have not been around others for them to treat me differently. In my case this is absolutely not the case at all. I pressed on asking if chemical changes in the body could be happening due to the surgery that may be causing this and he said yes. Wondering why I had to keep poking to get that response at all and yet because that was not the first response I am even doubting that. Why not just tell me that since I made it clear I am having these spikes out of nowhere and can't figure out why. I am finding myself overthinking everything right now honestly. Wondering how I will tolerate eating anything at this point or will I ever be able to. My doctor keeps his patients on a 5 week post-op liquid diet before you go on to a pureed / soft food diet for another 3 weeks. So unsure of myself right now and considered I made a huge mistake and so very much want to get passed this feeling more than anything in the world. Part of me is happy I did the surgery for my health and the results of weight loss I have seen thus far but another part wonders why I could not get back on track on my own and worried about long term complications. Like once I start eating will I have a sudden stomach leak, will I have no ability to hold down food or end up on liquids for the rest of my life? Will I ever be able to enjoy a glass of wine again and comfortably get on with life in a better more healthy way. Will I end up with Gallstones that cause another surgery or will I have stomach blockage in the future and how will I know if I do? I want to celebrate my choice to have done this and enjoy the weight loss but instead I am having so much self doubt and it's making me miserable. My liver health alone was cause to do this along with the diabetes so what is my damn problem? It is really hard to deal with this and I'm frankly pissed at myself for letting the anxiety get to me. I am considering going back on a lower dose of Lexapro again at least until this simmers down as I am hoping this is a chemical change in my body due to part of the stomach being removed and all the dietary changes just concerned it will make me not give a crap again and go lazy. IDK, if I knew factually this was all going to be a temporary reality then I would do it until the body goes back to normal.

I had my band removed at the same time as I was sleeved. I had wanted an RNY, but my surgeon said that he would only do that if it was safe to (depending on scar tissue after the band, etc.). When he removed the band, it was a total mess in there--no surprise, given the complications I've had over the past 2 years. But, although he wasn't able to do the RNY, he was able to do the VSG. I'm only 2 weeks out now, just starting on pureed foods, so I can't really tell you how it compares. But I hated that feeling with the band! So I really hope it's not like that with the sleeve.....

i did not have your doctor - but just to let you know-i had severe complications (recently learning that i really almost died)....surgery in TJ. my kaiser here was great- no issues with taking care of me- surgeries, diagnotstics, outpatient follow up (still have j tube feeding tube).....so i have no concerns with my post op care and i am a nurse so i have high expectations of care even though i do not recall a lot of my time spent in the hospital which is a blessing i am told! so focus on the positive - you are likely not to be the 1%!!!! happy journey!

Okay so, I thought I was doing really well. I was even discharged the day after surgery. I'm lucky enough to say I don't have any of the major medical complications that are associated with obesity. Here I am post op day 4 and I'm having a terrible time getting enough Water, nevermind Protein and "full liquids." The foods that process the easiest are those that have the least to offer - sugar free pudding and Jello...and a very small amount of light Greek yogurt. I have a lot of nausea, almost constant, and the gas pains are better but still NEARLY constant. I have no energy because I'm taking in so little and terrible headaches. On the plus side I'm sleeping better and for longer periods of time and I'm down to 2-4 pain pills a day. I'm so not a sit around and do nothing type person; having so much soreness and feeling so blah, I'm just feeling stuck. Because I've been having such a hard time getting some type of protein, my husband suggested I try a little Peanut Butter. I mixed 2 tbsps of peanut butter with 4oz of fat-free milk and blended it in my food processor. That was 9 grams of sugar (supposed to keep it under 10) and 11.5 grams of protein. It wasn't bad and it settled pretty well. I had a little cramping but nothing I'm not already experiencing. I'm handling my Calcium chews, multi-vitamin, and Pepcid well...and I'm grateful for that! My potassium crushed in applesauce (or yogurt or pudding) isn't going well. Not only does it taste terribly BUT I get a lot of cramping and gas pains shortly after. My husband is picking up some light vanilla Greek yogurts and some peaches (packed in water) now for me to try blending to get more protein. Ladies...any suggestions or tips for these early stages? Thanks so much!

I was one of the 10%. I was in the hospital 8 days 5 longer than I was suppose to be. I got an infection somehow somewhere still don't know what from. I had a temp, white blood count was high, Fluid in my longs had trouble taking deep breathes which is what they want you to constantly try to do. Went in for a second surgery to look for a leak and didn't have one. They put in drains and got on antibiotics and I started to get better. It was rough the first 3 weeks of recovery. My body went through something traumatic. Low calories trouble drinking, diarrhea, extreme weakness. I did not ever end up back in the ER. I took it day by day and realized that first week or so liquid is the most important thing. My dr even told me that he didn't care about the protein or the Vitamins he cared about hydration first which was very true. I was faint a few times. But I focused on the fluids over food. Then eventually around week 4 it got a lot better and I was back to work week 4. I have never tracked anything. I refuse to live that way. I do however consciously make the right choices knowing in my head what is high carb versus more protein. I limit my carbs just by making good choices. Now that I can have a salad or a piece of fruit or a handful of nuts and be full and satisfied, making the choices are much easier now. Before I would never be satisfied on just that. Now I am so I actually want it. It's amazing. After eating the same things or getting in a routine you know what u should and shouldn't have or how much so I mentally keep the numbers in check. I refuse right now to write it down. And so far just making the right choices is working. I am 4 months out today and I have consistently lost every week with the exception of a stall for 2 1/2 to 3 weeks. But that's ok. I'm down 42 since may 8th and 57 all together since I started my journey. Good luck to you. Even with my complication I have no regrets. It's a risk but a risk I was willing and ready to take to feel better. The recovery is only temporary everyday gets a ill easy and u feel a little better. Then one day you wake up and feel 100% back to normal except u eat a lot less now. And somehow you have energy again. It's a blessing and a freedom I can't describe until you go through it yourself.

I love him! I don't see him that much, but he's a sweet guy who will listen and answer questions. I like his staff too. I've had no complications from the surgery whatsoever. I hope you like him too... Sent from my iPad using the BariatricPal App

Much of what you are feeling is happening because of the significant change in hormones, it will get better with time. That being said, you should not be having significant pain at this stage. Most people are completely off pain medications within a few days post op. What kind of pain are you having at this point? You might be having a complication such as a stricture. Have you called your surgeons office?

I think you've made the right choice. A friend of mine is a medical resident and she's currently taking care of a woman who developed pretty serious malnutrition-related complications from her bypass - TWENTY YEARS LATER. And the woman's still obese! My friend is not sure whether she used to be heavier, but she was clearly unable to reach a healthy weight OR be healthy in other aspects with the bypass. I would've never gone for a bypass (if I was 500 lbs - maybe, because the rewards would then be worth the risks, but not at my original size).

I did like him but hated the drive for aftercare, and, and complications. The drive was bad from Eugene, but to Bend no way. Dr Hughes was wonderful in taking on my fills when we moved here, and just continued my care when I had further complications and revision.

First off, I just want to say how wonderful a forum like this is. Everyone is so supportive. I am Lisa, I am 40 year old who weighs 306 pounds. (That looks awful, over 300+ and I am admitting it, I guess I am in fat denial or something ) I have been married for 11 years and have a 5 year old son. I have been visiting this site for a little while now and finally have decided to get this ball rolling. I go tomorrow to a seminar. I live in a small rural town and they do not offer WLS so I have to travel about 1 1/2 hours away to have the surgery. I have been contemplating WLS for a while and finally came to realization that my weight is not getting any better, in fact worse. I have comorbid conditions of diabetes, hypertension, and obstructive sleep apnea and I also have asthma. I do have the support of my husband with this, but my family is not so much on target along with some of my friends. I don't know what to think about that. I am glad though I have talked my husband in to going with me to the seminar so he knows what I will be up against. I have Federal BCBS and hope that the approval process goes fast. I am so excited about this, but then again I am very nervous, which is pretty normal I think. I really think that is going to give me the fighting chance I need to get this weight off. I am so sick of being tired, hurting and etc.... One of the most important reasons why I am doing this is that my mother and father both died too young, my father died when I was 18 and he had complications of diabetes and mother died when I was 29 because of breast cancer. I want to be there for my son when he grows up. I will post soon to let you know how the seminar goes and see if I get an appointment with the surgeon. I also hope that I can be of help to anybody else who is like me and have been contemplating WLS for a long time.

Like pretty much everything else in your life, the holidays are a whole new ballgame after weight loss surgery. Your weight loss surgery diet is strict. It doesn’t include fatty foods and sugary desserts. Going off your weight loss surgery diet can stall weight loss and also cause complications. You could be prone to dumping syndrome if you have the gastric sleeve or gastric bypass, and lap-banders can face obstructions and acid reflux with the wrong foods or too much. If you let your guard down for the rest of November and December, you can find yourself slipping off of your diet and feeling pretty unhealthy. But by keeping your eyes open and planning ahead, you can keep yourself on track and get through the holiday season feeling proud of yourself. Watch Carefully to Avoid Extra Calories Calories show up everywhere at this time of year. Sometimes they don’t even seem that bad, but they add up quickly. Have a bite here and a handful there without paying much attention, and you might be disappointed when you weigh in on New Year’s Day. Don’t let calories slip into your diet. First, be aware of the extra calories that are around. They can include any of the following. Lunch or dinner out when a friend or family member comes to town. Chocolate truffles on the secretary’s desk or the break room at work. Cookies from well-meaning friends and family who want you to taste-test their creations. Sweetened, pumpkin-spice coffee instead of calorie-free regular coffee. Food court fare when you’re holiday shopping at the mall. Holiday parties, potlucks, and dinners. Stick to Your Good WLS Habits The first line of defense is to stick to your regular good everyday weight loss surgery habits. Log every bite of food you take to keep from getting in hundreds of extra calories from sneaking in a taste here and there. Even if you have to estimate the calories in some of your food, especially if you eat out or at a party, you can keep more discipline if you log your food. Also, think about your other healthy habits. Keep drinking water between meals. And, protein is still all-important. Make sure you have some at each meal and snack. Focusing on finding lean protein can keep you focused when you’re faced with all kinds of other unhealthy choices. Arm Yourself Against Temptation If you’re starving and you’re face-to-face with a basket of chocolate-covered pretzels, you might opt for the sugary, high-carb snack. Unless that is, you have your own weapon. Keep some high-protein and low-calorie choices with you at all times so you never need to go for the junk food in desperation. We have many health snack options at the BariatricPal Store! Take them with you to work, or in your car, purse, or pocket. You can have them if you’re stuck in traffic or at the mall at mealtimes. Almonds packed in 1-ounce portions. Beef jerky (not fatty beef sticks). Apples Cheese sticks Roasted soybeans or garbanzo beans Tuna pouch Work around Your Cravings You don’t need to deprive yourself completely at holiday time. If there’s a particular taste you want, there’s a good chance you can satisfy your craving with a healthier alternative. For example, you can have lean ham and turkey breast instead of brisket and turkey with the skin on it. Roast green beans with onions, rosemary, and balsamic vinegar instead of having green bean casserole, bake sweet potatoes instead of having candied ones, and puree cauliflower or carrot instead of making mashed potatoes. Use the same strategy for desserts. Go for sugar-free cocoa mix instead of chocolate fudge when you’re craving chocolate. Munch on plain popcorn while your friends are passing around the caramel corn. For breakfast, make high-protein oatmeal pumpkin pancakes instead of regular pumpkin pancakes. Plan for a Few Treats Almost everyone has a few holiday treats that are irresistible. There may be some family recipe that you’ve had at every Christmas for as long as you can remember, or maybe a coworker brings in her cinnamon rolls made from a secret recipe. Whatever it is, you feel as though the holidays are incomplete without it. There’s no reason not to plan for one or two key treats. Just be sure you plan for them and stick to a single serving. Savor it, and concentrate on the flavors and on the memories and feelings it brings up. Then get right back on your regular diet. There are a couple of reasons why some weight loss surgery patients might be better off skipping even the occasional special holiday treat. First, don’t start if you’re not sure you can stop. If you’re not confident that you can stick to a single serving, it’s best not to start eating. Second, some weight loss surgery patients can’t tolerate all kinds of junk food. Fried and doughy foods are risky for lap-band patients, since they can obstruct the band. Gastric bypass and vertical sleeve gastrectomy patients are at risk for dumping syndrome from eating too much sugar or fat at once. And, no weight loss surgery patient should eat too much, since that can stretch the pouch or sleeve. The holiday season is a happy time, but it’s a struggle if you’re trying to lose weight and get healthy. You can prevent it from sneaking up on you and interfering with your weight loss by staying alert and having a plan.

I feel you. I argued that the sleeve take longer to perform about an hour shorter. I mentioned with people over a 50 bmi it is best to not keep us under too long. Mine was stubborn and said he could do it and it would be safe and it would be best for me. I just looked at him like... shit..... that was my ace lol. Only positive on rny is it almost cures diabetes, more weight loss and it can be reversed. Sleeve is faster, less complicated, you can eat more... 4 Oz instead of 2oz and you don't have dumping syndrome. Correct me if I'm wrong Sent from my SM-G900T using the BariatricPal App

So I am 99.9 % self pay. My concern is what would happen if something went wrong. Like if I had to stay in the hospital as a result of a complication... Would Cigna pay for the stay even though it was related to something I didn't go through them for? Or what if 5 years from now my gallbladder is removed... Do I have to pay bc I paid for the surgery? Just wondering how that might work.

Thank you all for the feedback, I am very greatful to you all...a lot of important questions have been answered...I guess I have more research to do...plication vs sleeve!?!?!?! My biggest concern with the plication is the dying of stomach tissue and the fact as stated above, how do u check for ulcers/cancer. Very important argument. Only read about these complications from one patient on the web. Also the fact that the plication surgery is fairly new and there are no long term statistics. Long-term statistics are what have kept me from doing any surgery up til now, been waiting to see what happens with lap-band and then I waited to see with what happens with the sleeve and here I am still waiting! LOL! Arghhhhh!

Oh and another perk/benefit to the pre-op diet... Is the weight loss! Nothing like jump starting your slimming process! And anything I can do to lower the risk factor and make the surgery less complicated for my doc the better. (Shrink that liver!)

I'm having a horrible time with my protein! I'm 6 weeks out and on full food. whey Protein makes me sick, so I have not had a shake in quite a while. I'm running about 40-50g protein per day. My NUT wanted me at 85g/day. I read somewhere yesterday that taking in too little protein could result in a stall/slow-down, and I'm worried about that. Has anyone heard of that? Last night I sat and worked out a schedule for meals/snacks, but I'm not sure I'll get all my Water in with the 30/30 rule and eating so often. This is no longer as easy as I have been making it!..... or am I making the eating plan too complicate?

I choose Dr Aceves due to his zero leak complication rate. I did not want to fly back to Canada and then find out I had a leak and begin a long process here of trying to fix it. Another smaller factor was staying in a hospital the entire time (minus the first night at the hotel because surgery is the next day). I felt the paying the extra money was worth it to me. FYI you fly into San Diego also for Dr. Aceves so that should not affect your flights. Just your deposit if you so choose to change your mind.

Hi all. I am scheduled for lap band surgery on May 21st. I have Aetna and it is covered by insurance. Apparently fills aren't but the dr's office said they have ways of getting around that. My question is- I'm looking for a new job this summer and I'm concerned about getting new health coverage and not be covered in case of a band slip, revision, complications or future fills. Any advice? Thanks in advance...

I chose my surgeon Dr Kelly based on the comparisons I did with my top choices, which were Dr Kelly, Dr Alvarez, Dr Aceves, and Dr Rodriquez. I looked at education, training, experience, and complication/mortality rate. A hospital with ICU was important to me, the trauma training Dr Kelly had was a big plus for me. I liked that he over sews the staple line, I liked that he uses a 34fr bougie because of problems I had seen others have with getting fluid in immediately post op and strictures with a smaller size bougie, and he also does a technique in which he does extra wrapping at the part of the esophagus where a lot of leaks can and do occur. I also wanted at least 2 nights in the Hospital. The complication rate/# of sleeves done ratio was something I considered. I used the search feature on this website as well as OH, and went back 7 yrs. I also went by which MX border was the safest at the time I was going, according to the News and what I found googling. Even if Dr Kelly was the same price as the other surgeons, I would have chosen him, but I found nothing in my research that warranted paying an extra $3k to any other surgeon after I did all this research and read all the reviews. I have already shared my experience, and as you said in your post, you aren't really looking for that. But if anyone has any questions, I will be happy to answer.

Well to cut a long story short today (almost 2 years post op) I was admitted to hospital due to abdominal pains (GP was worried it might be vsg complication?!?). It was a long, and inconclusive day, but because I don't have a follow up package with my surgeon today was the first time I have been weighed by a medic since my surgery, which was my silver lining. Last time a doctor weighed me I was deliberately wearing very little and had a BMI of 36, today I wasn't expecting to be weighed, so was wearing jeans, two jumpers and my sturdy shoes I could have kissed the dr when she announced my BMI was 23. I knew that's about what it was, but my official weight on my medical records is now not obese!

My surgeon never gave me a pre-op diet, just directions to lower the carbs, go high protein, and try to lose 10-15 pounds before surgery. He said the most important thing is to shrink the liver to allow better access to the stomach and reduce chances of complications. It's also a chance to practice what you'll have to do more stringently after surgery, so that you don't go into emotional shock in the first two phases after surgery (liquids and full liquids). So I just dieted like normal with salads, veggies, no soda, cut out sugary stuff, ate lots of chicken, tried out a few protein shakes. But I still made time to have some of my favorites, just in very small bites. Then of course, clears 24 hours before surgery for anesthesia reasons.

Thank you very much for ur words Shelly!! Yes I know there's risks of complications. But I also know that If I do it I will be a happier person. And that's what I'm aiming for!!????