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Help Center -Department of Managed Care This I my appeal letter to ask that you reconsider and approve the Sleeve Gastrectomy Weight Loss Surgery that was denied by Anthem Blue Cross because they consider the procedure investigational. I believe this surgery is exactly the tool I need to improve my health and the quality of the rest of my life. I have been told by several of Anthem Blue Cross customer service representatives that 43775 is a covered procedure and that as long as my HMO approved they would pay for the surgery. This is not what I am being told now. I have been getting the runaround on this for two months. I received a letter from my HMO dated 2/6/10(copy enclosed) stating this is not a denial of service but Anthem considers this procedure experimental and has to go to the Utilization Dept for a decision. The number to call this department was on the letter. I called this Dept. a minimum of 5 times and was told they don’t know what I am talking about, this dept. doesn’t handle HMO. So I call my HMO and they say “oh you have to appeal” so I send my appeal letter to Anthem on 2/16 and wait the 30 days for a decision. On the 28th day they inform me that I cannot appeal because I haven’t been denied, oh and the people in the Utilization Dept. don’t know that their department handles this?? So they send it back to the Utilization Dept and now I have officially been denied. This part of this process has taken two months, very frustrating. I. PATIENT BACKGROUND My name is Jeani Xxxxxxx and I am insured under group plan xxxxxxxxxx. My member ID # xxxxxxxxxxxxx. I am now 59 years old. I am 5/5 tall and at this time I weigh 233 lbs. I am seeking approval for weight loss surgery. I have been overweight to one degree or another since I was a young child and was advised by my pediatrician to diet at age 10. I have made numerous efforts at weight loss throughout my teenage years and adult life. I dieted frequently as a teenager and young adult. Numerous times I have lost 40-80 pounds or more but eventually the weight returns. Weight loss programs I tried include juice fasts, traditional calorie counting on quite a few occasions, Weight Watchers, Slim Fast, Nurti-system, the Atkins diet, Cabbage soup, Mayo Clinic diet, the Zone, gym membership, lap swimming, weight training, water aerobics, walking programs, various buddy-system diets and individual, self hypnosis, ”Think yourself Thin” “ Think yourself Thin Automatically, tape you listen to in the car” Dexatrim, Metabalite, Hoodia, Green Tea Extract, and numerous other fad diets. In all cases I lost weight but each time the weight crept back, usually with a little more. Eventually I realized that traditional dieting seemed to actually cause weight gain due to increased hunger that seems to occur after significant weight loss. I believe science is only now beginning to understand the reasons for this phenomenon which is consistently reported by clinically obese people. Studies also show that genetics plays a larger role than once thought and there are morbidly obese people in my family as well as slim people. My co-morbidities include high blood pressure, high triglycerides, low good cholesterol, have had abnormal EKGs, borderline diabetes, and osteoarthritis in my hip, which my doctor said weight loss would help significantly. I have also had sever back pain most of my life. I take hydrochlorothiazide and verapamil for high blood pressure which is effective. I take medicine, Niacin for high triglycerides. I have a family history of cancer as well as strokes, heart disease and severe arthritis. I take nabumetone almost daily and ibuprofen to help with severe leg pain related to arthritis in my hip. I have taken ibuprofin for back pain that i have had most of my life even when I was not overweight. I believe I will need NSAIDS even after WLS which is why I need the sleeve as this is the only WLS that you can still take anti-inflammatory medications. I buy over the counter ibuprofen as I can get 500-200mg pills for $10.00 which last over 6 months, whereas when getting prescription I only get 30 -800 milligrams for a co-payment of $10 which only last a month. My excess weight and other health issues makes everyday activities difficult including housework, shopping, standing, walking significant distances, working and recreation. It effectively makes my world smaller limiting the number of things I can do each day. I have lived with obesity for years and strongly wish to change this aspect of my life. I fear the consequences of my high triglycerides especially considering the family history i have of heart disease. Many members of my family died of heart attack and stroke. I was stunned to learn that my weight is in the obese category but heartened to learn of this newer treatment with fewer side effects and shorter recovery. I am highly motivated to succeed with VSG and understand that food intake will be significantly limited for the rest of my life and that I must continue to exercise to be successful. Before I found out about the arthritis, which is the result of a subtle fracture at some point in my life that affected the curvature and angle of my right hip bone (this was found by an MRI that was done after pain medication didn’t help and physical therapy made the pain worst), I used to walk a minimum of 30-60 minutes a day at least 5 days a week. Since this pain in my leg as a result of the hip arthritis I no longer can do that and I am afraid that the weight will just continue to creep up on me. My particular problem is in volume eating. I eat good food, lots of chicken and turkey, lots of fruits and vegetables, the thing is I am always hungry and I eat until I am full. Having a smaller stomach and feeling full sooner seems like exactly the kind of help I need. I had given up on traditional dieting as it always resulted in failure and am pleased to have found the VSG surgical option which appears to be the only tool offering a realistic possibility of lifelong weight control for me. I believe VSG is the best surgery for me because it offers restriction like the lap-band and the RNY but without the malabsorption of the RNY. The RNY is not an option because I very much need regular doses of nabumetone and ibuprofen for the leg pain related to my hip pain and even once I lose the weight believe I will still need ibuprofen for my back pain which I have suffered with most of my adult life. Tylenol is not effective for me. I am allergic to codeine, vicodin, any pain medication of that type I cannot take. Narcotic pain relievers make my head seem fuzzy but do not help with pain. I have the same concern about the lap band. I also understand that as many as 27 percent of lap band patients require band removal and weight loss is often unsatisfactory (I think the number is even higher now). Most importantly, the VSG removal of a large portion of the stomach removes many of the cells that produce the hormone ghrelin which is known to cause hunger and appetite. The RNY and lap band don’t have this advantage. At age 59 I am concerned about the side effects of the RNY and do not want to spend 6 or more months with dumping syndrome and feeling rotten. I also worry about the ability to take and absorb other medications I might need in the future as I age. The VSG appears to offer the fastest recovery, weight loss similar to the RNY and the least amount of side effects. One recent publication, “The Best Bariatric Operation for Older Patients “ by Drs Lee, Cirangle, Taller, Feng and Jossart, 2005, concludes that “These data suggest that the best bariatric operation for older patients may be the laparoscopic VG because it achieves the greatest weight loss with the shortest operative time and the fewest complications”. I have investigated this procedure very thoroughly including attending support groups and talking with others who have had it. I have completed most of the preoperative testing and strongly believe this is the best procedure for my circumstances II. THE VSG SHOULD NO LONGER BE CONSIDERED INVESTIGATIONAL The only stated reason for denying approval for the VSG is that it is investigational and …” current available medical studies do not show that this service improves health outcomes, is as good as or better than standard alternatives, or shows improvement outside the research setting”. It is respectfully submitted that this conclusion is incorrect. The conclusion ignores the 36 studies now available on the effectiveness of VSG which indicate that excess weight loss is similar to the RNY and that complications from surgery are actually lower than RNY. It also ignores the fact that the VSG is now widely performed and is routine for many bariatric surgeons and has long been performed outside the research setting. Anthem’s policy on Surgery for Clinically Severe Obesity is set forth in a document with an effective date of April 22, 2009. This document reviews the various forms of bariatric surgery and explains when weight loss surgery is considered medically necessary. VSG is excluded from ever being medically necessary because it is designated as investigational and that “…there is insufficient convincing evidence in the peer reviewed medical literature, in terms of safety, to support the use of …sleeve gastrectomy…other than biliopancreatic bypass with duodenal switch, in individuals with clinically severe obesity.”. Nevertheless, the lap band and Realize band procedures are approved as medically necessary in this same document based upon what appears to be two three year studies involving 219 and 352 patients respectively. There is now a considerable body of data and studies supporting the safety and effectiveness of the VSG as a primary procedure for weight loss. The June 2009 Supplement to Bariatric Times reporting on the Second International Consensus Summit on Sleeve Gastrectomy (available at www.bariatrictimes.com) includes 10 papers pertaining to the safety and effectiveness of the VSG presented by leading bariatric surgeons. In Reducing Risk in Bariatric Surgery: Rational for Sleeve Gastrectomy, Dr. Eric J. DeMaria concludes that “A growing body of evidence suggests sleeve gastrectomy may be an appropriate primary bariatric surgical procedure primarily due to low risk and ease of surgical revision when required.” In the paper presented by Drs Jossart and Cirangle, four years of data showed a 68% excess weight loss by VSG patients, a figure not largely different than RNY patients of the same time range. Most significantly, in Debates and Consensus: a Summary by Dr. Michael Gagner, important questions concerning the VSG were debated and conclusions reached by the 400 conference participants. Question 6 was as follows: “Question 6: In your opinion, is there currently enough published data to support the sleeve gastrectomy as a primary procedure to treat morbid obesity on par with adjustable gastric banding and Roux-en-Y gastric bypass? Several groups presented cohorts of patients with follow-up periods of 4 to 8 years the day before. Jossart and colleagues in San Francisco presented eight years’ experience including 1,200 cases, whereas at more than four years, weight loss resulted in a similar curve to gastric bypass. At higher BMI (greater than 55kg/m2) a plateau of nearly 40kg/m2 demanded a second stage, but below a BMI of 55, the operation was terrific. Schauer and colleagues assessed the literature from 35 reports, studied more than 3,000 published sleeve gastrectomy cases, and found an extremely low mortality rate (near 0.12%). Results have shown excellent weight loss and co morbidity reduction that is comparable to or exceeds other bariatric operations and that the sleeve gastrectomy is safe and efficacious. Himpens of Belgium analyzed his patients from 2001 through 2002(sic) to attain six-year follow-up. Sixty-five percent of 46 patients were considered a “success” (%EWL greater than 50 ) at two years. At six years the success rate was maintained at 59 percent. Weiner from Frankfurt and MacMahon of Leeds, who started in 2000, also had similar results. *** Certainly, the audience thought there was enough evidence published to support the sleeve gastrectomy as a primary procedure to treat morbid obesity on par with adjustable gastric banding and Roux-en-Y gastric bypass with a yes vote of 77 percent. This is perhaps the strongest contribution to this second consensus conference.” A review article entitled “Systematic Review of Sleeve Gastrectomy as Staging and Primary Bariatric Procedure” was recently posted on the web site of the American Society of Bariatric and Metabolic Surgeons dated May 26, 2009. The authors are Drs Brethaur and Schaur and Jeffrey Hammel M.S. of the Bariatric and Metabolic Institute of the Cleveland Clinic, Cleveland, Ohio. Thirty-six studies involving 2570 patients who had the VSG procedure were analyzed. Their conclusion was: “From the current evidence, including 36 studies and 2570 patients, LSG is an effective weight loss procedure that can be performed safely as a first stage or primary procedure. From this large volume of case series data, a matched cohort analysis and 2 randomized trials, LSG results in excellent weight loss and co-morbidity reductions that exceeds , or is comparable to, that of other accepted bariatric procedures. The postoperative major complication rates and mortality rates have been acceptably low. Long-term data are limited but the 3- and 5- year follow up data have demonstrated the durability of the SG procedure. “ To date ten thousand patients have had the VSG surgery with good success. Many are going to Mexico or other foreign countries because their insurers refuse to pay for the VSG even though it is less expensive than the RNY procedure, the so called “gold standard” of weight loss surgery which takes several hours and requires a hospital stay of 3 or 4 days. The VSG can be completed in one hour by a skilled surgeon and most patients stay only one night in the hospital. While there is certainly follow up care, the repeated fill and unfill procedures required by gastric banding are unneeded for the VSG. Nutritional supplements are much less of a problem than with the RNY. Many insurance companies are recognizing the value and cost effectiveness of the VSG and have approved the VSG for at least some patients, including BSBC Federal, Tri-west Tri-care Prime, United Healthcare, the Veterans Administration, Aetna, Blue Care Network HMO, Healthnet, Anthem BC of Connecticut, Definity Health/United Healthcare, PPO, Empire Blue Cross Anthem, and UHC. The VSG sleeve gastrectomy is now routinely offered by Kaiser Permanente to all patients that qualify for Weight Loss Surgery and would not do so if this surgery was not proven to work. I don’t think it is fair that if you have five people, one with Kaiser, one with United, one with Aetna, one with Cigna and me with Anthem Blue Cross of California, the other four will be offered the sleeve and I will not. The California Department of Insurance has recognized that VSG is widely accepted by the American Society for Metabolic and Bariatric Surgery as a standard procedure at medical centers for excellence. In Decision #EI09-9645 the physician reviewers reversed the health plan’s denial of the patient’s VSG request and concluded that VSG was the most appropriate option for the patient. The same conclusion was also reached in EI06-5882 though the patient had significantly more co-morbidities. That decision noted the important fact that the VSG is nothing more than the first part of the duodenal switch operation which includes the second step of intestinal modification and as such, the VSG portion has been performed for many years as part of the DS procedure. Some patients have the VSG first as part of a two stage procedure and find that they do not need the second stage. Thus, the VSG is not as new and investigational as Anthem’s conclusions seem to imply. Anthem does cover the DS procedure which includes the VSG as one part. According to an article published in the Detroit Free Press on August 17, 2009, Blue Cross Blue Shield of Michigan, in conjunction with the University of Michigan, has been compiling a large detailed data base on bariatric surgery in order to improve surgical outcomes and provide cost savings. In three years of data collection, it appears that the VSG now accounts for as much as 12% of all bariatric procedures. This percentage indicates that the procedure is far beyond investigational status. This data base indicates that 10,000 VSG procedures are known to have been performed. My Anthem group policy excludes investigational procedures and defines that term as procedures: “ 1) that have progressed to limited use on humans, but which are not generally accepted as proven and effective procedures within the organized medical community; or 2) that do not have final approval from the appropriate governmental regulatory body; or 3) that are not supported by scientific evidence which permits conclusions concerning the effect of the service, drug or device on health outcomes; or 4) that do not improve the health outcome of the patient treated; or 5) that are not as beneficial as any established alternative; or 6) whose results outside the investigational setting cannot be demonstrated or duplicated; or 7) that are not generally approved or used by Physicians in the medical community. It appears that the VSG, based upon the articles cited above, has been performed on thousands of patients, has been accepted by a consensus of participating members of an international conference devoted to this subject, is widely accepted by the ASMBS, does not require FDA or similar government approval, is in fact supported by at least 36 studies analyzed by highly respected physicians, is as effective as the RNY and more effective than gastric banding in terms of percentage of excess weight loss, has fewer complications than the RNY, has as good or better reduction of co morbidities as other procedures, and has results that are similar in studies by both United States and foreign physicians. The VSG therefore no longer falls within the definition of investigational procedures excluded from coverage. The conclusions stated in the previously cited Anthem Policy on Surgery for Clinically Severe Obesity are simply no longer correct and that policy should be updated to include VSG coverage or disregarded. With the VSG patients lose about 68% of excess weight and lower BMI patients like me often do much better. Weight loss will most certainly help my back and hip pain and improve ability to exercise. High triglycerides, high blood pressure, and borderline diabetes are corrected in about 76 percent of WLS cases and I am hoping for this result. It is therefore highly likely that my health will be improved by this procedure and I respectfully ask for your reversal of this denial. I am a mother and soon to be a Grandmother and I want to improve the quality of my life so that I will be healthier and able to help raise my grandchildren and be able to take an active role in their life.Thank you for your review of this matter. I greatly appreciate the fact that the state of California has a procedure to help insured patients who find themselves in disagreement with their insurance companies. I strongly believe this decision will greatly affect the quality of the rest of my life. Thank you for your time. I eagerly await your decision regarding this. I can be reached as indicated below if further information is needed. Enclosed is a copy of my denial letter from Anthem Blue Cross My HMO is Healthcare Partners Primary Care Provider is xxxxxxxxxxxxx Gastric Surgeon xxxxxxxxxxxxx Sports Medicine xxxxxxxxxxxx who ordered MRI and diagnosed arthritis Cardiologist xxxxxxxxxxxxx did my last EKG and stress test All these doctors agree Weight Loss Surgery is a good option for me. Respectfully yours, Jeani Anderson xxxxxxxxxxxxxxx xxxxxxxxxxxxxxx (xxx) xxx-xxxx Work info: xxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxx xxxxxxxxxxx CA 91101 (xxx)xxx-xxxx ext. 244

I too was a military wife. My husband just retired after 28 years. We had a conversation---he has always been against any type of surgery. For him, losing weight is just put your mind to it and do it. He loves me no matter what my size. I told him yesterday that it is not a vanity thing.....I want to be healthy. He loves to run, cross country ski, hike, kayak. I want to be able to share all of that. Of course I try but with the weight some of it is just impossible. That being said, I am so afraid. Don't know if this happens to you all, but the first things family members say is that is drastic. When you read that they remove 70 to 80 % of your stomach you realize that IS drastic. When I consider my sore knees, stiffness, hypertension , and pre diabetes I realize maybe I am in a drastic situation. Just plain scared!!!! I love hearing that you can get back to a normal life. Those who have had surgery---do you have many complications. Not to be too graphic but do you have to run to the bathroom immediately after eating? Do you have severe reflux? Is your quality of life a lot better? Think my biggest hurdle is to get over being afraid of the surgery and recovery.

In light of the recent post made by a gal who said she had some complications with the plication, I'm wondering if anyone who has had issues could post on here so those of us who have not had the surgery yet can be educated and also be enlightened as to how often complications occur. Also, who did your surgery if you had complications. This would really help so much!

I had it done Jan 10th, I have lost 12 pounds since surgery and 25 since pre op diet, I am down a pant size and almost 2 sizes, maybe a couple more pounds. My restriction is good and I do feel hungry, not ravenous hunger and not hungry all the time. I exercise a lot and follow a strict diet of healthy choices and small portions. NEVER felt bad or had a complication. My BMI was 45 and I have over 100 lbs to lose. I didn't choose plication because I wanted a surgery to do all of the work for me, like the VSG seems to do. I want to feel like I am on a more level playing field with myself and my ability to cope with my food addiction. I want the "work", I want to look back and say "I did this", with a little help, emphasis on a little help. Not everyone wants the same things for the same reasons. Some have battled and struggled a lot in life over being fat and they are done fighting and get the VSG, maybe someday if I fail, I will too, but right now I still have fight in me and I want to face my enemy. Sounds corny I know. but hey... Oh! my doctor DID talk to me about ALL of the risks, including the blood flow to the stomach and leakage. We talked about a lot of things one on one prior to the surgery, over the phone. Whenever I had a question I could e-mail him directly and if I needed to speak to him he would call me. That was before I went to Mexico, when I was still trying to choose a Dr. I didn't get that kind of time with any other Dr. I looked into. Find a Dr. who will give you their time, as much as you need. Not the patient coordinator, but the Dr. and not just one conversation but as many as you need. If you find that kind of Dr. one who takes that kind of interest in you as a person, go with them, for whichever surgery is right for you.

The man was from infection at the incision site And the lady was complications from the surgery

OK, first of all...breathe! This is not the end of your life as you know it, just a change. Yes it is a major change, yes it will be very different, but the foods you love are not leaving the planet. They really aren't. So...let that sink in firstly then we can talk about the emotional aspects of eating. I honestly didn't think I was an emotional eater. I didn't think food was that important to me but after surgery during week 2 of liquids I had a couple of melt downs just because I couldn't eat the food i wanted to eat right that minute...I stayed true to my diet but had actual tears over the foods I couldn't eat right then...which I later gave myself a mental smackdown for but I have to own those feelings. After particularly stressful events I would eat more than I should for dinner, not always unhealthy stuff, just way more of it than I should. I am an emotional eater. I am watching for triggers now and distracting myself but like you before, food was the center of my life. I still have to plan my meals in order to stick to my healthy plan, not planning for me is planning to fail so I have to do it and stick to it and then I am fine...gives me that control. One thing I do want to address however that I wish someone would have told me before the band is that the band will not make you eat less. You have to choose to eat less. You have to measure it out and know you are not getting seconds. You have to do that. The band will make it so that your appetit is surpressed for a longer period of time than it would hav been before when you eat 4 oz of meat and 6 oz of veggies. That's all. It's not about restricting what you can and can't eat, it won't stop you from eating until you are in pain, and if you can't get that under control before surgery you are looking at slips and erosion complications that can be very serious. I would honestly try really hard to measure out your portions and be done...not as small as you will post band...but practice limiting yourself right now. Distract yourself when you feel the emotional hunger come on, try to recognize what those triggers might be for you, at the very least journal everything you are eating now so you can be truly honest with yourself about what your current habits are, and what things will need to change. I beleive the band was the best thing I have ever done for myself and I am seeing a lot of success and it is a lot easier to just eat my one yogurt for Breakfast and be done but it does nothing for me when I have an emotional attack that makes me want to eat. I have to wrangle that stray thought in myself and battle with that. The band can't help me with that. chocolate will go down just fine, as will other snack foods that I just have to choose not to eat. There are still daily and hourly choices invlolved with being successful. I wish you every bit of luck and happiness on your journey. It is worth the effort I can promise you that, but it's really all up to you. The band is just a tool that dims the appetite, that is all. Just know that going in and put your expectations in the right place and you will do great!

Please note that I am posting in the "RANT" section and avoid this if you don't want to read my tantrum. OK so this surgery sucked royally for me. The pre-op diet was challenging to say the least. (Fat chick trying to muster up enough self control to eat only Protein powders for 2 weeks---give me a break) Then I go for surgery day and my heart stopped beating when they inflated my abdomen. Chest compressions, followed by panic resulted in my surgery being canceled....I was fine with that. A week later we try again....(please note that this required an additional week of the pre-op diet---grrrr.....) and once again--heart refused to cooperate. Took some extra hands and enough drugs to kill a horse, but I was sleeved. Because the surgery ran really long and my heart rate was low, I wasn't given anything for pain after surgery. They brought me to the room in so much pain that I was unable to see. (Seems if you are in enough pain your brain will start to shut down--vision goes first.) After the longest 4 hours of my life we finally got the pain under control.....sleep 2 hours.....then they want me up in a chair. OK. I can tough it out now. However every time they moved me I blacked out. It took forever for them to get me into the chair and I was terrified of blacking out--falling--and injuring myself. Forward a few days--I am out of the hospital and in a lot of pain. Severe sharp shooting pains in my upper chest and left shoulder---plus I can't get fluids down. Back to the hospital I go for tests and fluids. A few days later (9 days post-op) my drain is removed---I pass out and wake up with most of the pain gone. Seems the drain was on a nerve and that was causing the pain. Now I know that this could all be worse. But for the amount of pain--strike that---agony I experienced during those first two weeks after surgery I should have done my fair share of suffering. It still hurts to eat and drink--but I am managing. I can only get in 500 or so calories a day--at the most. Most days it is more like 300. By this past Friday I had lost 18 pounds. Then, I stopped. Now, 5 days later, I have GAINED 4 pounds back. How is that even freaking possible? I know 3 week stall....water weight....liver replacing glycogen..... menstrual Fluid retention...blaugh blaugh blaugh..... I AM PISSED....and rather disheartened. I told people that I was having the surgery done--now I am the go-to person for all those in my world thinking about WLS......but you know what---I AIN'T YA POSTER CHILD. This whole experience has thus far sucked in a big big way. Maybe I will lose and in a few months be glad that I had it done, but right now I refuse to encourage anyone to do it. What I tell them now is that they need to understand that this is a MAJOR surgery and they need to be prepared for complications. I also tell them they need to go to the support group because I haven't been sleeved long enough to be a good resource. That is the most positive I can muster up. I would really like to tell them that, at this point, I am not real thrilled about my choice and am hanging on and hoping for a change in my point of view.

I'm very happy for everyone here who are successfully losing the weight! It gives me hope that I too will be a successful lap band patient! I've only lost 5lbs since i've been banded (9/11) and I'm hoping with my first fill I will actually lose more.. "more" to the point that I will actually reach my short term goal of being under 200lbs by mid december. Sometimes I wonder "Did the surgeon forget to put the band in?" My appetite is so severe that I've been eating.. and eating well! With out any complications... Idk what to do, I do have my good days and that usually happens when someone compliments me on my weight loss.. but then I have my bad days (like today) when I eat solid foods when I shouldn't. Maybe, I should go back to replacing two meals with Protein shakes?? I feel like that's the only thing that works when it comes to losing weight. But s**t, does that mean I have to be the special cases that stays on Protein Shakes? Has anyone else had a severe appetite before their first fill? And find that the fill really did help? I have a meeting with my dietician this week and boy am I nervous! This is harder than I thought.. like really hard! Love, Keep hope alive

One year ago today was the beginning of the rest of my life. The past year has been an absolute blessing. I have truly enjoyed everyday of my journey and I am still in total bliss with my sleeve. This has been one of the best decisions I have ever made. I feel absolutely wonderful. I have not felt this good in more than a decade. Of course the weight loss has done wonders for my self esteem and self image. It feels wonderful to have people constantly telling you how good you look and being able to receive it because it is true. I love my life. I love how I feel. I really like how I look. Everything is going really great. I have not had one complication. I could not have asked for a better experience.

I haven’t had any complications... it’s the phases they follow when I attended the classes. I have to drink 2-4 8 oz protein shakes a day plus work toward 64 oz of water or sugar free beverages. I’m doing pretty good with it. They just added protein shakes last Thursday. I’m just struggling to eating anything. Like I just want something...

JoAnn I am so sorry to hear about your problems and wish you all the luck in the world with the decisions that you make. Please do some serious research as to what other form of WLS you will chose if that is the way you go. There are so many more complications with the DS then the RNY if you choose to go that way. There is more malabsorption, higher death and complication rate, among other issues. There are alot of Drs that will not even do that surgery anymore because of the complication rate. Don't get me wrong all surgeries specially WLS have their issues but the DS has more then the RNY. Including severe offensive smells from stools and when you pass gas. That is something that will never go away. I have friends that have had both done and do know that the one that had the DS done now wishes that she would have looked into the two choices better then she did. She just figured she had a larger amount of weight to loose and you tend to lose more with the DS then the RNY. So that was how she went. I am offering you all this information as a friend and someone who has seen the outcomes of both very close up. I also happen to work in a hospital where our Drs will not do the DS because of the higher mortality and complication rate. To me that says a whole lot about that particular surgery. Again, Best wishes in whatever your choice is. I will keep you in my prayers just give it to God with him all is possible.

Well in two days I will be banded. I am looking forward to it, but am wondering about all the complications I have read about. My husband says you wont' know until you try. I will be self paying $11,000. I have been busy the last two weks entertaining dlegates from our Sister City in Japan. They just left yesterday, so I haven't had much time to think about it, which is good. Aslo our daughter had a baby on Saturday, August 12th. she was just 5# 12 ounces and a real cutie. I have been taking care of our 4 year old granddaughter so her parents can make the adjustment to two. We drove today 30 minutes to Blackfoot to pay for the surgery and to find out when I am supposed to show up at the hospital. I learned today that I am suppose to be there at 6:30 am. My husband works in Idaho Falls just a half hours drive further north. He will drop me off and then come back to se me later in the afternoon. I will spend the night at the hospital and then do the barium swallow the following morning to see if the band is placed correctly. Then I will be back home to recover and begin to learn about my new band and how it will react to foods. I have been on high protein and low cabohydrates these past two weeks. After surgery I will be on 2 weeks of clear liquids and then 2 weeks of other liquids and then 2 weeks of mushies.

Each person has their own "negatives". I personally had an extensive, exhausting and mentally/physically draining recovery because I was a revision patient with major complications. The negatives for me were: 1) Trying to sip enough early out seemed impossible 2) Taste buds changing 3) Developing a whey protein intolerance and mild lactose intolerance post-op 4) Lack of energy early out, but it was temporary Of course, the positives far outweigh the negatives especially since everything I experienced was over within a few weeks to couple of months, and I have a very normal, active, fun social life. There are plenty of us out here that "get WLS" there's others that don't. Unfortunately, the sleeve only does so much. I still have to be mindful of what I put in my mouth. I can still suck down a 3000 calorie milkshake if I wanted to so the point is making a permanent, and lifelong commitment to better food choices, and to honestly change your relationship with food. The sleeve makes this process much easier. Every WLS has failures even the heavily touted Platinum standard Duodenal Switch. I've read several stories of regain, or DS'ers not getting to goal, and their surgery is far more drastic than even RNY. I take 4 vitamins a day. That's it, nothing major, 2 multis, 2 calcium citrate. Make it a habit, it's really not that big of a deal. To address some of your concerns: 1. Death - huge I know. Ask your surgeon their mortality stats. If it's more than 1% get a new surgeon, and find out the details. 2. A Leak - also very risky. Same as above 3. My head hunger issues will be brought out huge. Start working on it now, get a new coping mechanism in place before surgery, therapy is a great tool especially if you can find someone that works with bariatric patients, along with support group meetings and using online support groups, find a buddy that has surgery around the same time to share ups and downs, get a mentor that you trust, and can talk you off the ledge when you're wanting to take a dive in the pool of caramely goodness of Girl Scout Samoa cookies. 4. My "food to cope" tool will be gone! Same as above 5. possible acid reflux... what's worse being fat or popping a Prilosec or Nexium to prevent reflux? 6. Gaining the weight back Establishing better habits, measuring portions, staying within your caloric intake guidelines is the best options to avoid gain. It's easy to gain weight, I won't lie, but for me, it's still super easy to lose it by following the rules. 7. not really losing anything that's pretty rare, I've read plenty of slow losers, but you have control of how you lose weight. Some do it differently than I did and that's okay, some do not want to give up carbs, I did because I knew I'd lose fast and hard. That's the path I chose, and I couldn't be happier with how I did it. Some have metabolic issues that slow weight loss down, and that has to be taken into consideration as well as activity level, and each individuals needs. One thing you have to remember is that the VSG is not some miracle that is going to cure it all. They operate on our stomachs, not our brains. So, getting ahead of the curve by establishing some good habits NOW will go a long way post-op. Eating slower, chewing your food more, sit your utensil down in between bites, do not drink with your meal, eat protein first, stretch your meal out to at least 20 minutes. Don't sit in front of the TV to eat, focus on what you are putting in your mouth/body and see how your body responds. Best wishes! ! !

I'm in medical school and I can tell you basically what that means but of course your doctor will know much more. Renin is made in your kidneys in response to low blood flow through your kidneys or to too little salt going through your kidneys. Renin in turn stimulates the production of aldosterone (through a semi complicated pathway)...and aldosterone has a big role in how much salt (and therefore water!) your body keeps vs excreted through the kidney and released as urine. If you have hyporenin then your kidneys, for whatever reason, are not making renin, which means you cannot make aldosterone, which means you lose salt and can become very dehydrated (hypovolemic) with low blood pressure and such. Aldosterone is also important in regulating potassium, an electrolyte, in your body. Wonky levels of potassium can lead to heart problems. You can see just how important renin and aldosterone are for your body. What kind of symptoms have you been having and how is your doctor proceeding with treatment? Symptoms that occur commonly with too little aldosterone (which in your case is caused by too little renin being released from your kidneys) are: fatigue, dizzy with standing, racing heart, urinating a lot, craving salt, always hot. I wish you so much luck. It's enough to go through this surgery without more health issues popping up!

Hi guys just wanted to post update in case someone else may have similar complications. I have been taken off the operation list for Monday 6 May my bloods were apparently not encouraging and surgeon wants me to resolve the elevated liver enzymes before the roux en y. Not quite sure what to make of this second postponement. I'm praying that my liver is ok and bloods improve. I suppose being cautious is prudent. I thought the gall bladder was the problem but there seems to be a concern that in case it's not i may not be healthy enough to proceed with the wls. I wish everyone the best if I'm cleared for surgery I think I'll post operation instead of raising my hopes up. But I'll continue learning from all of you and trying to loose on the protein diet. All the best to upcoming surgeries.

Because I experienced some serious complications 5 days out of surgery and had to return to the hospital, my recovery was slowed considerably. My hubby had to drive me to all appointments and I went with him whenever he had to run an errand for us (I wasn't cleared for driving for a few weeks following 2nd discharge), so I considered every trip to the store a physical activity; each trip was exhausting for me, but every step I took in a store (using a buggy for support) and, every PT appointment to build-up my strength counted. Give yourself time to heal completely before returning to your pre-surgery normal workout. Everybody's recovery is a little different. As another BP member suggested - check in with your Dr. for his recommendation, esp. about the hot yoga.

If you want to see depressing just search these forums as well. You act as if the lapband doesn't have its fair share of problems theres tons of dissapointed people on here. I was just offering my experience and leaks are VERY rare. People who are curious I was just offering them an option. I am 100% happy and have had 0 complications and so do most of the people who have had the sleeve. There's complications with everything but at least it is life long and not a contious worry if you're leaking or if it's slipped.

I am happy for those who have converted and are happy. That is the aim, to have the WLS that suits you. However I am wondering if you would have been so happy if you had been one of the people that had a leak. Reading the stories from those who have had leaks they sound awful. So the bottom line is how much risk is someone prepared to take. Some of you were lucky and had minor complications with the band - far better that than being unlucky and having complications with the sleeve surgery.

I am wanting to get my membership deleted. The reason for doing so is that i have encompassed my whole "lose weight" purpose on getting this surgery. I have been denied by my insurance company and there is no way on god's green earth that i can afford to pay for it myself. I do not like checking my email box and seeing nothing but replies back from postings. I had my heart set on getting this so I could have a child and have been turned down time and time again. Not like being overweight is stress enough on my "well-being" it seems that all my hope and dreams of being a mother have gone down the drain. It seems that everything that i want in life is just a bag full of money away. Why should have this been any different. Its like insurance companies don't like that they have to pay when you have complications of being overweight but yet they don't want to help give you a tool to acheive sucess. God forbid you try to save them some money in the long run. So i was wanting my memebership to be deleted so that way i can let go of this dream that won't come true. becca

Just another thought to throw in the mix... there are several people on this board who are "flying solo" without a band (either due to complications or by choice). There is some great support available here to help you meet your weight loss goals. I'm so sorry that the band isn't working out for you. Keep your chin up - there are people out there losing without a band! (((HUGS)))

I have to agree with Missdietcoke I haven't been banded either so I don't mind hearing these stories,, at this time I choose to be banded, I don't know to much about the sleeve. And as far as gastric bypass , well that one is thrown out already for me . So everyone is untitled to there own opinion . So really in all reality any surgery is dangerous with complications and sometimes us newbies like to hear these things that's why we come on this site so we learn what others have been thru , congrates to ur sleeve . And it was good to hear ur experience .

Studies show that patients who had a 'healing period' between band and sleeve were less likely to have complications such as leaks...I would not recommend pushing your surgeon for 1 surgery if they are recommending 2. Also I have 2 close friends who had the sleeve about a year ago, neither has had complications but neither has lost much weight either. Do your research! I'm thrilled the sleeve is working for you but recommend everyone look at all the options and not make a judgement based on 1 persons experience. There is a vertical sleeve talk and RNY talk website you can learn a lot from as well! Good luck to all of you!!!!

If I had it all to do over again, it would be a sleeve. Hands down, a sleeve. Sleeves have far fewer complications long term than bands or bypass. They have better and faster weight loss, no restriction issues, and I've heard of people losing their band but never their sleeve. They used to save a more elastic portion of the stomach and it did stretch. Today they save a more muscular portion of the stomach and stretching isn't the issue it was in the 70s.

Because they don't sound as smart when they do. If you have to stop and think about what they mean, they feel extra special. ;o) Five year studies are coming out. Doc's already have access to them, the study is the largest study available so far. It is supposed to show that sleeves do not stretch like a banded pouch does, weight loss is better, it is faster (no bandster hell, no waiting for restriction), etc. This info is being given to bariatric docs first at various seminars throughout the country. Banding: 1-2 pounds per week, 50-70% EWL Sleeves: 2-3 pounds per week, 70-80% EWL I don't put a lot of stock into the EWL, I think that is all very individual and I don't think it is tracked well over the patient's long term weight loss journey. But sleeves do afford better and faster weight loss with fewer complications. It's a matter of what works for each person.

I think the most important questions are - How many SLEEVE surgeries have YOU done and how long have YOU been doing them? What complications have YOUR patients experienced? What aftercare do you provide? (support groups, staff knowledge- if you call, can the staff answer medical questions?) When I had laparoscopic knee surgery, the recovery was simple- I did not need a relationship with the Dr. With the sleeve, you have to feel comfortable asking your surgeon many questions, so make sure you like his/her personality.Good Luck.