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As always, thanks Tiff. ran into a problem. Medicare has now decided No to the surgery. I am done with ALL my hurdles. Passed the Psych no problem. See the surgeon next week and we will try to make aplan to convince medicare, I had back surgery and almost dies from a staff and take antibiotics every day for life and take ibuprophen every day. He said there are ways to get it thru so i am trying to be hopeful.

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I had a horrid sinus infection not too long ago. Along with it came a headache from hell. At 3 am I couldn't get back to sleep because I hurt so much. We were traveling and the only thing I had in the hotel room (besides the tylenol my husband had bought me earlier) was one lone advil in the diaper bag. I took it because I was desperate. it took the edge off my headache and thankfully didn't screw up my stomach. Ibuprofin is the best pain killer for me, but sadly we cannot take it. I think a very random one every few months would be ok, but not for daily use by any means.

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As always, thanks Tiff. ran into a problem. Medicare has now decided No to the surgery. I am done with ALL my hurdles. Passed the Psych no problem. See the surgeon next week and we will try to make aplan to convince medicare, I had back surgery and almost dies from a staff and take antibiotics every day for life and take ibuprophen every day. He said there are ways to get it thru so i am trying to be hopeful.

Getting Your Health Insurance to Pay for Your Vertical Sleeve Gastrectomy, Page 2 of 3 - Associated Content - associatedcontent.com

Because we have a normal functioning stomach, instead of a pouch like band and RNY patients NSAIDS are approved.

I take Aleve a few times a week, and have been doing so for months. I also take Advil cold/sinus on occasion. I was just scoped on February 4th, and absolutely no signs of damage.

I do not and will not trust full strength Tylenol. During the rapid weight loss stage, our livers are already being tasked double time. I'm not willing to add acetaminophen.

What is the Vertical Sleeve Gastrectomy (VSG)? The Vertical Sleeve Gastrectomy (VSG) is essentially the same procedure as the Duodenal Switch (DS) without the bypassing of the small intestines. This procedure is restrictive only. Potential complications are the same as the lap band with the addition of leakage at the internal incision site.

pic-vertical-gastrectomy-san-mateo-.jpg

How much time will I be off of work? How much time off of work depends on what you do for a living. The typical time off for a laparoscopic procedure is anywhere from 3-6 weeks. Of course if you have a desk job you may be ready to go back in 3 weeks but if you have a very physical job you may be out for 6 weeks. This will be determined by your surgeon.

How much weight will I loose? The average estimated weight loss for RNY is 75-85% of the excess weight, lap band is 55-65% of the excess weight, the DS is 85-90% of excess weight & the VSG is 75-85% of excess weight. Weight loss comes off fastest with the RNY, then DS, then VSG, then lap band. Weight loss of course varies person to person, some may loose more or less than the average for each surgery.

What insurance requirements will I need for approval for surgery? Typically an insurance company requires a Body Mass Index (BMI) of over 40 or between 35-40 with 2 or more co-morbid (medical conditions related to obesity) conditions such as diabetes, hypertension, sleep apnea, high cholesterol, high triglycerides and more. Many insurance companies also require a psychological evaluation, nutritionist evaluation, support group meetings, 6 month physician supervised diet, 5+ years of documented obesity, cardiology & pulmonary evaluation, and sleep study. Some insurance companies may require less or more than what?s been listed. To know for sure what your insurance company needs to approve weight loss surgery (WLS) call your insurance company directly and ask them what they need for approval.

What kind of Vitamin supplement/exercise regimen is expected after surgery? This may vary upon which surgery you have but the standard is a Multi-Vitamin, Iron, Calcium, B1 & B12. Exercise is as tolerated. In the beginning you can expect walking until you?re cleared by your surgeon for all activity. At that time you can begin more intense workouts (cardio & weights).

Will I need Protein shakes/bars forever? No. Supplementing your Protein intake is typically only done in the very beginning when you are able to eat very little. Over time most surgeons expect you to get your protein from food sources (remember if it has a mom you can eat it!).

What is dumping syndrome? Dumping syndrome only occurs with the RNY and can occur when too much sugar or fat is consumed (sugar is the most common culprit). When the blood senses the quick rise in sugar/fat it triggers the pancreas to ?dump? insulin into the blood stream to combat the rise. It?s similar to a hypoglycemic episode. Sugar/fat tolerance varies upon the individual. Some patients ?dump? easily while others have never done it. Dumping may include some or all of the following to varying degrees (depending on how sensitive you are to sugar/fat and how much you consume) of vomiting, diarrhea, dizziness, abdominal cramping, heart palpitations, nausea, hot flash, sweating, and fatigue. Dumping can be avoided by not eating high sugar items. Many RNYers can tolerate natural sugars as found in fruit more than they can tolerate processed sugars as found in candies and such.

What kinds of foods will I be able to eat after surgery? Protein is key in any WLS. There are essential amino acids you get from meats that your body cannot get from anywhere else. Remember that if it has a mom you can eat it. Overtime other foods can be eaten and another key thing to remember is ?all things in moderation?. A person who is 2+ years post op should be able to eat just about anything a non WLS person can eat. Foods/drinks that are to be avoided vary per surgery. For instance RNYers and Lap banders are advised to stay away from carbonation. For the RNY it causes pain & discomfort as the stomach is so small there is no real room for the gas to expand, also it has the potential to stretch the opening at the bottom of the stomach leading to the intestines over time which can lead to overeating and that loss of feeling full. For the lap band carbonation can also lead to pain & discomfort as when the carbonation initially hits the pouch created by the lap band there is little room for the gas to expand. The typical post op diet begins with Clear liquids and then moves on to full liquids, soft/pureed foods and then more solid/dense foods are added later on. Your surgeon will have an in-depth timeline of which foods to eat when for you. Post op diets not only vary depending on the surgery you have but also on your surgeon.

Can I drink alcohol after weight loss surgery? After some time yes. However it?s a very different experience having a drink of alcohol as a WLS post op than it is before surgery, especially for those who have the DS, VSG & RNY procedures. Alcohol enters the blood stream much more quickly which makes the person feel drunk very fast. You have to be extra careful when drinking alcohol as a post op. Also some alcoholic beverages may not be able to be consumed after surgery due to carbonation or sugar content. You definitely don?t want to have a drink of alcohol very early post op as the stomach is still healing and could be irritated by the alcohol. There should be no real difference aside from how much can be drank at one time with the lap band procedure.

How does weight loss surgery affect my PCOS? WLS affects PCOS in many different ways and many doctors still aren?t exactly sure as to how. But what we do know is that the weight loss helps hypertension (high blood pressure), diabetes, insulin resistance, fertility, hormone levels and more. Many women who loose a large amount of weight following WLS find their diabetes/IR resolved and that menses return to normal cycle lengths which then results in increased fertility. Many women are able to get pregnant fairly easily once a large amount of weight is lost.

I want kids, what about getting pregnant after surgery? You can get pregnant after surgery (all kinds) and have a healthy pregnancy & baby. Of course nutritional needs are a little different than having a baby prior to WLS. You will need additional Vitamins and calories than the typical pregnancy. These guidelines should be established by both your WLS surgeon & OB/GYN. As for when you should get pregnant the longer you are able to wait the better. You should be at minimum 12 months post op (most surgeons prefer 18-24 months post op) so that you can not only maximize your weight loss for ideal health but also so that you are able to eat a descent amount of food and establish good eating habits. Of course getting pregnant early post op can happen (and does). Depending on how soon after surgery you get pregnant determines how ?high risk? you are to your surgeon & OB/GYN.

Will I have excess skin? It?s possible. Excess skin mostly depends on genetics & secondly to how fast the weight comes off. Think of your skin like a balloon. If you have a balloon that?s been blown up for a long time it?s stretched. As you let the air out the balloon shrinks. Once all the air is out does the balloon look like it?s never been blown up? No. Of course if the air comes out fast the balloon is larger or more wrinkled. It does continue to shrink for a bit of time after all the air is out though. If the air comes out slowly?it?s still not the same size as before being blown up it?s just more likely to not be quite as wrinkled. Now some will have more excess skin than others. Water & exercise do help but if you have excess skin pretty much the only thing that is going to get rid of it for good is plastic reconstructive surgery.

How do I know which surgery is right for me? Choosing the right surgery is a personal decision. One that needs to be made by you and your surgeon to best suit YOUR needs. For one it may be the DS for another it may be the lap band and yet for another it may be the RNY. You need to evaluate your weight loss & health needs and compare it to each surgery and then of course consult with a licensed bariatric surgeon. Don't choose a surgery based on "stories" you've heard...same for not choosing a surgery.

Will I be able to stop taking my prescription medications? That is to be determined by your personal physician. However, most people who have WLS are able to reduce the amount of medication they take daily and some are able to eventually stop medications as directed by their physician.

Are there medications I cannot take after surgery? With the RNY & lap band you are not able to take any NSAID (non-steroidal anti-inflammatory drug) such as Advil, Aleve, Asprin, Naprosyn and other drugs along those lines due to the ulcerative properties of these drugs. All NSAID drugs reduce the production of mucous that coats & protects the stomach. If this mucous production is lessened it can make the pouch of the RNY & the ?pouch? created by the lap band more susceptible to ulcers or injury by a sharp piece of food like a tortilla chip. Some surgeons however will allow a short term NSAID use after 1 year post op only when used in conjunction with Protonix. With the DS patients should avoid time released medications. With the VSG there are no medication restrictions.

What is average time between surgeon consultation & surgery? Again, varies upon your insurance requirements and how quickly you can get appointments scheduled. This process can take anywhere from 4-6 weeks to 1 year or more.

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What a great article Tiff. Thanks. I knew I could count on you. I think that we will try the ibuprophen thing since we have such strong documentation for my bad back. Besides I am already anemic and take B12 nose spray and a strong incidence of severe osteoporosis in my family. My surgeon tells me not to worry yet. At least I am cleared for surgery as soon as we get this thru. I do not take tylenol except if I have to take a percocet for my back once in awhile. I am trying to remain calm for the moment as I know if I get the approval the roller coaster ride will get bumpier. I have lots of notes for the surgeon for next Wednesday.

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I was allowed to take Ibuprofen post op, only was in suppository, to avoid breakdown/metabolising in the stomach, I dont know about long term tho.

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I thought it still metabolized in your stomach no matter where it was "inserted." Tylenol in the liver. Interesting. I may have to google this. I love my ibuprofin and will gladly stick it up my bum if need be LOL

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What a great article Tiff. Thanks. I knew I could count on you. I think that we will try the ibuprophen thing since we have such strong documentation for my bad back. Besides I am already anemic and take B12 nose spray and a strong incidence of severe osteoporosis in my family. My surgeon tells me not to worry yet. At least I am cleared for surgery as soon as we get this thru. I do not take tylenol except if I have to take a percocet for my back once in awhile. I am trying to remain calm for the moment as I know if I get the approval the roller coaster ride will get bumpier. I have lots of notes for the surgeon for next Wednesday.

Hey Carol,

Is your inter-nasal B12 by prescription? I've read a little about it, and have considered talking to my PCP because I wonder just how effective and if the sublingual B12 are really highly absorbed by our bodies?

If you need some of the more recent research links that others have successfully used in their appeal letters, let me know I can send them to you. If you have to go that route, I hope you don't have to fight long.

Fingers crossed for approval ! ! !

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i know for myself and my mom... we both have Rheumatoid arthritis and take all kinds of medications for this, which includes NSAIDS. the sleeve was the only WLS option for us due to the drugs we take just to be able to function, my mom's sleeve was in feb of 2010 and i will hopefully have surgery in 8/2010. my mom has had no issues taking any of her medications. so i know that a motrin would be fine... just take it with a little bit of food so that it is easier on you stomach. which is suggested even if you have not had the sleeve. kelly

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