VSG quotes n jus sayins


PLEASE ADD YOUR FAVS TOO!
 

 "Those that say it can’t be done should get out of the way of those doing it" Chinese Proverb
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TWO WOLVES: a cherokee tale (relate this story to your weight loss journey)

A Grandfather from the Cherokee Nation was talking with his grandson.

"A fight is going on inside me," he said to the boy.

"It is a terrible fight and it is between two wolves."

"One wolf is evil and ugly: He is anger, envy, war, greed, self-pity, sorrow, regret, guilt, resentment, inferiority, lies, false pride,superiority, selfishness and arrogance."

"The other wolf is beautiful and good: He is friendly, joyful, peace, love, hope, serenity, humility, kindness, benevolence, justice, fairness, empathy, generosity, true, compassion, gratitude, and deep vision."

"This same fight is going on inside you, and inside every other human as well."

The grandson paused in deep reflection because of what his grandfather had just said. Then he
finally cried out; "Oyee! Grandfather, which wolf will win?"

The elder Cherokee replied,
"The wolf that you feed"
             ------------

 

THERE'S A HOLE IN MY SIDEWALK
Autobiography in Five Short Chapters
By Portia Nelson

Chapter One
I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost .... I am helpless.
It isn't my fault.
It takes forever to find a way out.

Chapter Two
I walk down the street.
There is a deep hole in the sidewalk.
I pretend that I don't see it.
I fall in again.
I can't believe I am in this same place.
It isn't my fault.
It still takes a long time to get out.
Chapter Three
I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in ... it's a habit ... but, my eyes are open.
I know where I am.
It is my fault.
I get out immediately.
Chapter Four
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.

Chapter Five
I walk down another street.

____________

This too shall pass

Its a Marathon, not a sprint

"Insanity: doing the same thing over and over again and expecting different results"..einstein

Excuses are just reasons for doing the same thing...joyce meyers

What you think of me is none of my business...T. Cole Whittaker

My ambition is handicapped by laziness.....Charles Bukowski

Eating crappy food is not a reward  its a punishment....comedian Drew Carey

You are never too old to set another goal or to dream a new dream. - C. S. Lewis

You are a success when you feel good about what you are doing.

"The surest way not to fail is to determine to succeed. Richard Sheridan 


“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something,  you accept no excuses; only results.”  ?


We must be willing to get rid of the life we've planned,
so as to have the life that is waiting for us. 
The old skin has to be shed before the new one can come.
- Joseph Campbell


Success is a state of mind.
If you want success, start thinking of yourself as a success.
Dr. Joyce Brothers

Like driving a car...Drive into your future looking at the open road ahead rather than into the rear-view mirror of your past.

I am unlimited.
I take responsibility for my life.
My every action is a conscious choice.
I can accomplish anything good that I truly set my mind on.
I keep focus, and persevere.  ....Jonathan Lockwood Huie

Whatever course you decide upon,
there is always someone to tell you that you are wrong.
There are always difficulties arising
which tempt you to believe that your critics are right.
To map out a course of action and follow it to an end requires courage. ... Ralph Waldo Emerson

From the Movie Benjamin Button: Benjamin Button: [Voice over; letter to his daughter]

"For what it's worth: it's never too late or, in my case, too early to be whoever you want to be. There's no time limit, stop whenever you want.

You can change or stay the same, there are no rules to this thing. We can make the best or the worst of it.
I hope you make the best of it.

And I hope you see things that startle you. I hope you feel things you never felt before. I hope you meet people with a different point of view. 

I hope you live a life you're proud of. If you find that you're not, I hope you have the strength to start all over again"

 
 
  

   
                                                                                                                                                        


 .
.
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1 comment

VSG BOUGIE SIZES


A BOUGIE (boo-ghee)...

IS NOT THE SIZE OF YOUR NEW STOMACH!!


Bougie / boughie means "candle" in French.  "F or FR/Fr" following a bougie size=French

Its just a guide that the surgeon uses to butt the stapler up against, when forming your VSG. The closer s/he gets to the guide the 'tighter' /truer to guide the sleeve is. During surgery the bougie is inserted into your mouth down your throat, towards the end of yer stomach where it meets the pylorus via an esophageal dilator. After the new stomach is formed, the bougie/guide is removed out of your mouth, possibly why some VSGrs complain of a sore throat post op.


Some surgeons will use an endoscope or other "guide" to size ones new stomach. I read an OH post of a VSGr who's surgeon explained an endoscope is the same size as a 32F bougie...Im not sure.

Bougie size determination is between YOU and YOUR surgeon. Discuss size, rationale for size chosen, type bougie and technique used when sizing your new stomach........ PRE-OP!!  

Some surgeons may "oversew" the staple line giving one a 'tighter' than bougie sized sleeve.
 In order for an "oversewn" staple line to affect stomach size it MUST be running or continuous oversewn suture line across majority of staple line not intermittent oversewn nor merely at intersected "junctures" where the surgeon has reloaded the staple gun as majority of "oversewn"  techniques (to prevent leaks) are done today. Make sure your surgeon explains  what his/her "oversewn" technique is. Do not assume because a surgeon "oversews"  you have a tighter than bougie sized sleeve.

A bougie is 1/3 mm PER french.  i.e to calculate ~ inches 40F bougie  1/3 x 40 = 13.33mm convert to inches = ~.52 inches or ~1/2 inch in diameter. 

Below are diameters of bougie/ "guides" in inches (edited out larger bougies since Jan 2010 VSG as stand alone only 32-48F are used in US)

32F = .40"

34F = .425"

36F = .45"

38F = .476"

40F = .5"

46F = .57"

48F = .60"

This VSG surgery video shows  a 'red' 34F bougie, one technique in sizing stomach, exised stomach, testing for leaks etc
.http://www.orlive.com/shawneemission/videos/weight-loss-surg ery-gastric-sleeve

Red bougies are older mercury filled ones. FDA is tryin to ban em because of disposal issues (mercury).

  


More surgeons will use SINGLE USE disposable sized bougies 

In this surgical video Dr. Alvarez shows a disposable 32F bougie and use/technique

http://www.youtube.com/watch?v=g3G4dSmJUro


                                           32F bougie inserted in an esophageal dilator     
    

 

2012 NURSGIRL OH VSG forum member BOUGIE pix from hospital she works at: 1st: 36F  2nd pic: 38F on left and 32F on right 
36 bougie  Bougies

                                                         

           General/ crude "pen" comparison created by MACK OH VSG forum member  2009

 



Standard sized bougies in the US and Mexico are 32F.  32F is the smallest guide a bariatric surgeon in the US may safely use in forming your sleeve. Your surgeon may prefer using any size bougie from 32-48F,may be based on YOU, your height, weight, or perhaps the need for a malabsorptive procedure in the future (staged 1st step of 2 part DS) so bougies may be larger yet. Discuss what to expect, rationale for size chosen with your surgeon of choice, if this is a concern. 

LapSF/Dr. Criangle on their routine use of 32F bougies in VSG  "Optimal weight loss may require the smallest possible pouch, which may yield the highest leak rate" .

Some surgeons will welcome discussion, your input on bougie sizes. For instance, my surgeon recommended a 32F bougie for me. After reading a published journal on the higher incidence of VSG surgically induced GERD (acid reflux/heartburn) in use of 28-32F bougies, I instead, requested a 34F bougie. My surgeon obliged me. Post op I never needed or took a prescribed or OTC PPI. Coincidence? more than likely! 

 In ~2000  use of 50-60F bougies were standard for VSG when it became a stand alone (primary) WLS, as they were the standard sizes of DS bougies, which VSG was modeled after. As the years went by, bariatric surgeons thought..smaller bougie, better restriction, less regain without malabsorption . So in ~2005 use of 32F-48F bougies became the accepted range.  Many VSGrs do EXTREMELY well with 40F-48F bougies as the guide to sizing their new stomach, losing all the weight they need to. 

An ~2012/13 study (a very large poll) on Bougie Sizes in VSG seems to indicate at 3 years post VSG. a LESS than 40F bougie and  GREATER than 40F bougie show no difference whatsoever in EWL*   2012/13 Bougie Size Comparisons
 

An ~2009 study (a large poll) on Bougie Sizes in VSG  seems to indicate at 5 years post VSG ... 32F and 44F bougies show exactly the same EWL    2009 Bougie Size Comparison 

An ~ 2008 study (small poll 135 pts) on Bougie Sizes in VSG seems to indicate at 6 mos and 12 mos post  VSG .... 40F and 60F bougies with no significant difference in EWL  2008 Bougie Size Comparison

*EWL = eventual, excess, estimated weight loss 


VOLUME/GASTRIC CAPACITY in VSG:

PRE VSG: Average stomach holds 32-48 oz or 4 to 6 cups per meal

POST VSG (~6-8 months out FOR LIFE) ..new stomach holds 8-12 ozs or 1 to 1.5 cups per meal 
    (depending on weight/density of foods you eat! can be much less or much more)

The length of an adult stomach is 10-12 inches..note the range in inches. DNA affects the length of our stomachs, as well as variations in shape. Tall people, for instance are known to have longer stomachs..so makes sense they have a bit more capacity, short people have shorter stomachs therefore less capacity.... so volume/capacity can be influenced by the length and physical anatomical variations in shape of an individual's stomach. 

Dr. Alvarez explains in this You Tube video about length of an individual's VSG stomach and how it relates
to volume. http://www.youtube.com/watch?v=-5E7G0Avz4w&feature=share

This limited 2009 study is interesting in looking at gastric capacity in VSG,
just 3 days post op (120 ml=~1/2 cup=4 oz) compared to 2 years post VSG (250 ml=~1 cup=8oz)
http://www.ncbi.nlm.nih.gov/pubmed/19533260

At the end (8:28 mark) of this LapSF VSG surgical video shows 1 DAY old (pod) sleeve Xray and a sleeve Xray at 4 years out. It is not clear to me if same pt. or solely to impress the new "normal" sleeve size. Note the "new normal" 32F tightly formed sleeve has dilated/stretched naturally to perhaps triple in size...The video also shows one technique of sizing the sleeve, as well as reinforcement of the staple line (to prevent leaks) http://www.youtube.com/watch?v=rRBKdTjY2Rg

This VSG video shows the speed with which LIQUIDS/FLUIDS empty from the sleeve. In normal stomachs fluid empty rate is 5 minutes or less due to space creating a reservoir for large volumes of fluids. In VSG stomachs: fluid empty rate looks MUCH faster than that... you decide! http://www.youtube.com/watch?v=K0GWL1Wtx30

The COTTAGE CHEESE TEST /CCT (link following) may be helpful to VSGrs that are curious about their new stomachs capacity. Developed for RNY but an effective tool in VSG as well!  I'd suggest waiting until you are on a regular diet before checking. 6 mos out, 1 year out and annually or bi-annually for personal reference. It is YOUR BREAKFAST...no fluids no food prior to testing please. When doing CCT:

            PLEASE eat to the sensation of satiety - no longer hungry, and absolutely not full. 

A simpler method, following the basic guidelines and time frame in the link provided... is to place 1 level cup (8oz) of small curd cottage cheese in a bowl and eat from that. Using a measured tablespoon to eat any remaining cottage cheese from the original container. Add or subtract any cottage cheese eaten or not finished using the measured tablespoon. 2 TBS=1oz.  Total...the amount consumed = your sleeve's capacity.


       COTTAGE CHEESE TEST:     http://www.bsciresourcecenter.com/proddetail.php?prod=A4


STRETCHING in VSG:

YOU CANNOT STRETCH/DILATE out your sleeve to anything remotely close to its original size. 

From LapSF/Dr. Criangle: The removed section of the stomach is actually the portion that stretches the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food. 

The fundus (inc. majority of stomachs '
body' up to pyloric canal) of the stomach is ALL but removed with VSG

Thefundus is the upper most part of the stomach's greater curvature. The fundus is:

1) the stomach's stretchy/expandable tissue, capable of expanding 2-3xs its resting 'unfilled' size
2) the pre-op 'mass quantities' of food, waiting to be digested, storage section 
3) where 70% of the body's circulating grehlin  a "hunger hormone" is produced.



Stretching, due to overeating is most common in RNYbecause more of the stretchy tissue of fundus is retained to make the 'pouch'/stomach.

Anecdotally, Ive read from select OH VSG members, or according to a/their particular surgeon..overeating (bites more past satiety) will cause your sleeve to stretch.  Ive read/found no scientific data, published or otherwise, to date that says this is a TRUE statement.


Since food stays in our stomachs less than ~ 3 hours after a meal..common sense tells me food doesn't stay in our stomachs long enough to create 'stretching'. Food once ingested, immediately begins to be churned into a liquidy sludge called chyme through peristalsis in the stomach. This liquidy sludge must be small enough to pass through our very small pyloric valve and into the small intestine for further digestion /breakdown and absorption of 'micronutrients'  ...so there cannot be enough pressure for long sustained periods of time in our stomachs to cause it to stretch.  


Post op VSG ... depending upon the amount of swelling/inflammation you have..even a little 'thick/er' dense liquids or pureed foods/mushies may or may not feel restrictive, as you pass through the progression of texture dietary phases ( to promote healing) and onto your regular diet ~2mos post op. ... swelling/inflammation has naturally reduced. Density of meals becomes a key player in restriction.  By 1 year out you'll find you can eat more than you could at 2 days post op, at 2 weeks post op, 2 months post op, and 6 months post op. Your sleeve has naturally and fully matured. 
Depending on the food..you can eat more or less than the 8-12 oz capacity of a fully matured sleeve.......at any particular meal.


                                Toleration of a food, does NOT make it a good choice!
                                           "just because I CAN...doesn't mean I DO"

                                 ---------------------------------------------------------------------------
The bougie size controversy/wars are ridiculous imo.. 'get a smaller one, you can stretch it out, you're not going to have any restriction, that bigger one is all wrong, you'll re-gain easily years out, my surgeon made mine smaller and I got to goal in 6 months'
...all nonsense  DO NOT PAY EM NO MIND!!  This is YOUR story! YOUR journey!  


                                         ALWAYS REMEMBER THIS TRUTH:  
 
  YOUR WEIGHT HAS NOTHING TO DO WITH THE SIZE OF YOUR STOMACH, altered or not!

              Most important is the quantity and quality of the food choices you ingest post-op  

                                           ____________________________


     from this...........to this         

             APPRECIATE THIS GIFT AS A SECOND CHANCE, ENJOY YOUR NEW LIFE 
                                                and ROCK THAT SLEEVE :-)


VSG and HAIR LOSS

***please don't flame me because I have a VSG hair loss blog. Im sure there are others out there. Im only providing VSGrs with some information. I do not claim to be an authority on VSG induced hair loss, Im seriously only trying to help others that follow..understand this common complaint...more than they are being told.  Consider this a starting point to HELP YOU..find your way thru the hair loss maze! 
                                            

Summer 2011:  It bothers me that VSGrs have given up on finding solutions to this huge complaint.  They're told "it will happen or it won't happen", " there's nothing you can do about it", "I didn't have any hair loss (even tho 95% of us DO!!)", "up your protein" use "biotin, nioxin, rogaine, zinc,  hair-nails-skin, use expensive hair shampoo systems," etc...products that do NOT work or may be toxic for WLS induced hair loss, have been used/tried throughout the YEARS by VSGrs in a desperate attempt to prevent, slow or stop this phenomena, have been found to be totally ineffective... yet others keep recommending them anyway, perpetuating the SAME OLD powerful MYTHS...
                                       that do NOT WORK ....NOT FOR THIS!! 
                                              ________________________


Why ?  DIHYDROTESTOSTERONE (DHT), a hormone our bodies produce naturally, and is triggered into overdrive metabolically/hormonally (estrogens/testosterone-aromatase to DHT) within HOURS of VSG  yet does not manifest till ~3months post op  (see timeline below)

DIHYDROTESTOSTERONE is the same hormone that INCREASES as we age...it causes Male Pattern Baldness in elderly men affecting TOP and SIDES of head..
 ......and also observed in Post meno-elderly women- hair thinning TOP and SIDES ! 

in VSG hair loss....what we experience.... TOP n SIDES!!

THE AIM?  to DISRUPT the conversion of hormones to dihydrotestoserone, DHT. 

HOW?  
 DHT BLOCKERS!   DHT Blockers work by inhibiting the 5-alpha-reductase enzyme.  Basically, "a DHT blocker and 5-alpha-reducatase enzyme fit together like a puzzle.  When that happens, the enzyme can’t joint with testosterone to make DHT.  Thus, DHT levels go down, and our hair loss stops".

ESSENTIAL FATTY ACIDS and VITAMIN D3 are DHT blockers-androgen (hormone) inhibitors


Omega 3's: EPA/DHA minimum RDA is 410mg EPA and 274mg DHA please investigate:  1000mg EPA/1500mg DHA  combined with    Vitamin D3 (cholecalciferol) 2-5000 IUs


Americans are usually deficient in both Omega 3s and Vitamin D3 !  VSGrs are no exception!  It is VERY important that IF your raise your Omega 3s you MUST lower your Omega 6s and 9s! as they interfere/cancel each other out. 

Essential Fatty Acids  Krill Oil/Fish Oil Omega3 (EPA/DHA)  interferes with and disrupts the conversion of hormones (estrogens/testosterone to DHT) in acute telogen effluvium... where a  hormonal - metabolic TRIGGER such as VSG causes HAIR LOSS like nothing we've ever experienced in our lives. Would also help with the depletion of hormonal stores (estrogens produced and stored in adipose fat) post op during the rapid fat loss phase, when our hair loss is at its greatest, and we experience increased mood lability/emotional distress

How soon should ya start? the sooner the better !!   vs. AFTER the fact..waiting 3-5months.to see IF you will be one of the very few "lucky" VSGrs that elude hair loss, or chasing your hair loss making up for critical lost time in a panic!
Research hair loss pre-op ...
If considering the above start on your daily regime 2 weeks to 1 month pre surgery up until your told to stop all medications by your surgeon. Post op pick it up asap  Krill Oil (EPA/DHA) is small, Vitamin D3 (must specify cholecalciferol only) is small.  Both come in liquid form... EPA/DHA also comes in liquid form (salmon oil highly recc! is liquid).
 Use in conjunction with required post op vitamins, minerals, and protein intake requirements. Continue into the "critical stage" 0-3 months post op.  

Although there are DHT Blocker systems OTC one can purchase...usually ingredients consist of combinations of selenium, biotin, zinc, silica..we all know these vits/minerals are only worthy at HAIR REgrowth stage (6-7 months out), we get sufficient amounts from diet and daily multi-vit supplementation.


***Do not buy OTC  DHT blockers IF oral HeShouWu is an ingredient 

OTHER DHT BLOCKERS: 


saw palmetto 1500mg per day an essential fatty acid
 http://www.livestrong.com/article/289358-saw-palmetto-hair-loss-in-women/
http://en.wikipedia.org/wiki/Saw_palmetto_extract

GREEN TEA extract  an enzyme 5 alpha reductase to DHT  inhibitor 

Amino Acid  L- Lysine supplementation the most important amino acid in our post op "high protein" diets imo ...and has an effect on VSG hair loss as its another enzyme 5 alpha reductase to DHT  inhibitor 

Topical melatonin hair loss formula/scalp treatments for hair loss  http://www.ncbi.nlm.nih.gov/pubmed/14996107 ,
http://www.livestrong.com/article/292076-melatonin-hair-growth/

Topical only hair loss formulated  He Shou Wu/Polygonum multiflorum http://www.ncbi.nlm.nih.gov/pubmed/21419834 ,
http://www.mendeley.com/research/topical-application-polygonum-multiflorum-extract-induces-hair-growth-resting-hair-follicles-through-upregulating-shh-catenin-expression-c57bl-6-mice/#page-1

I would suggest VSGrs investigate/try these alternative methods..rather than continuing to take or use products that have failed consistently in the past.

Anything you put in your mouth, on yer head to stop hair loss....PLEASE RESEARCH IT YOURSELF!! do not rely on recommendations of others inc. me.... We need to try NEW approaches to this common post op problem!                                                                                           --------------------

 

Although plant sources of Omega3s, are not as bioavailable/absorbable as fish/krill... GLA, ALA are also essential fatty acids that can help with hormonally influenced hair loss. DHA is the most important of Omega3s in hair thinning... so know that  ~10 % of GLA, ALA derived from plant sources convert to omega3 EPA... even less to DHA.

Here's an exerpt from one article on EPO (evening primrose oil) and Hair Loss..thyroid hair loss is also METABOLIC-HORMONAL!! 

 

. . . evening primrose oil (also known as EPO) is a nutritional supplement that is frequently mentioned. In his book, "Solved: The Riddle of Illness," Stephen Langer, M.D. points to the fact that symptoms of essential fatty acid insufficiency are very similar to hypothyroidism, and recommends evening primrose oil -- an excellent source of essential fatty acids -- as helpful for people with hypothyroidism. The usefulness of evening primrose oil, particularly in dealing with the issues of excess hair loss with hypothyroidism, was also reinforced by endocrinologist Kenneth Blanchard. According to Dr. Blanchard:
"For hair loss, I routinely recommend multiple vitamins, and especially evening primrose oil. If there's any sex pattern to it -- if a woman is losing hair in partly a male pattern - -then, the problem is there is excessive conversion of testosterone to dihydrotestosterone at the level of the hair follicle. Evening primrose oil is an inhibitor of that conversion. So almost anybody with hair loss probably will benefit from evening primrose oil."

Evening primrose oil, 1,000 mg thrice daily. Can be replaced with 1,000 mg
borage oil one time daily. 
                                                                       __________


                               The search for that elusive WLS hair loss cure....continues!  
                                                            my original 2009 blog



                                                      
VSG HAIR LOSS
                           ________________________________________________________


PLEASE..read this article on Acute Diffuse Hair Loss/Acute Telogen Effluvium and the importance of PROTEIN and ESSENTIAL FATTY ACIDS  as well as the cycle of events describing VSG hair loss!
    
                                              
http://www.ccjm.org/content/76/6/361.full



  
Use the OH search engine ...sooooo much has been posted on Hair Loss (shedding/thinning) enough to choke a donkey! Its a HUGE post bariatric issue and majority of surgeons NEVER talk to their patients about. Or tell them use zinc, biotin, or increase protein only!  This is a metabolic/hormonal event that begins, is created within hours  of VSG itself .

An interesting article on Acute Telogen Effluvium  http://www.ehow.com/about_5390925_losing-hair-after-surgery.html    following bariatric surgery


Ya never realize how important your hair is to ya.... till yer LOSIN IT!  I don't care who is trying to make light of these times, it IS UPSETTING! Of course it is obvious mostly to the person losing it, and we often exaggerate the loss "coming out in clumps" "bald patches" "Im going bald".
To the men at Male Pattern Baldness forums...its upsetting!! Though their hair loss is genetic-'permanent', are indeed taking perscribed DHT blockers-medications (proscar/finesteride) but  are also supplementing with.....EPA/DHA ( fish oil ) in 3-5000mg range daily to disrupt the androgen conversion in effort ...to stop further hair loss.


For VSG triggered hair loss:

                                KNOW THAT:  THIS TOO SHALL PASS!!!  
                                            
you will NOT go bald!


On a personal note:  I had what only I considered "extreme"  hair loss after having VSG. This is totally ABNORMAL for me despite having gone through stress, trauma, surgeries, pregnancies, crash diets/rapid weight loss, medications,anesthesia at different times throughout my life, then menopause and I have NEVER experienced the amount  or  prolonged hair loss as when I had a VSG.  Hair shed everywhere, brushfuls of hair (my hair is long so looked worse than it was), shower drains n walls, pillow, car head rest, in prepared meals!  


I  tried almost every hair vitamin /supplements, hair products (inc. nioxin) suggestedby members of OH, WLS seminars, my surgeon & nut recs.. since I started losing it at 3 months out,
I tried each product/ supplement, even combined them for at least 30 days. I upped my protein intake to over 90gms protein daily, at the suggestion of my nut and surgeon....TO NO AVAIL!!  NOTHING WORKED to STOP it!  let alone SLOW
 IT DOWN!!

I was desperate! I wanted to believe that what I was taking for it, or shampooing & conditioning with was working, but the truth is...it really was NOT. I only wasted time and money. ...before I summized..the DHT conversion was set into motion the DAY I HAD VSG!!

From what Ive researched,  NUTRITIONAL deficiencies can increase and prolong hair loss ..only  Won't cause it, won't slow it,  won't stop it..... in  Acute Telogen Effluvium. Its the hormonal imbalance triggered by VSG..estrogen/s produced in fat and DHT conversion of hair follicle .... affecting mainly women, but also men  (aromatase) who may not notice / or report  hair loss due to it being normally short, shave their heads anyway,  are not interested in prevention as this temporary phase of hair loss is not as important to them. 

This blog is mostly geared for women! 
 Please consult with your doctor, dietician, endocrinologist re:  contributing factors- supplementation to your diet, secondary illnesses, deficiencies ..i.e.protein intake based on  age, gender and activity (muscle building/strength training), iron intake for menses aged women, medications w/ adverse effect of increased hair loss i.e anti-depressants,  Actigall/Ursodiol, and hormonal disorders such as PCOS, insulin (diabetes), thyroid, menopause which can also exacerbate hair loss. 

 


Things Ive learned along the way:


Hair Loss BEGINS             3-4 months post op
Hair Loss SLOWS              6-7 months post op    (new growth apparent)
Hair Loss STOPS               12- 18 months post op (or when your weight loss stabilizes)


 Just as hair loss slows at ~ 6-7 months, NEW GROWTH makes its appearance. 
Your pubes, armpit, leg hair may be affected as well and may grow back sparsely.


Biotin (Vitamin B7 aka Vitamin H) is great to use at the REGROWTH stage only...as it helps not only with growth but to replenish natural oils helps prevent dried, frizzed, listless hair commonly seen in post bariatric pts. 


1. PROTEIN PROTEIN PROTEIN : One interesting article
                       
http://www.nahrs.org/home/Default.aspx?tabid=66 
**Note 4th paragrah "especially insufficient intake of protein" in ACUTE TELOGEN EFFLUVIUM phase we experience post op.

Hair loss can be related to chronically LOW/er PROTEIN INTAKE during the critical stage (0-3 months post op) Keep protein levels at least 60-70gs DAILY for women. Do not exceed 80gs daily , playing catch up, after this period, thinking you will stop hair loss. Won't happen! Talk to your nut, see your guidelines based on your specific individual protein requirements. Please find a good TRACKING site online to track your protein intake (supertracker, myfitnesspal, sparkpeople, dailyplate, fitday etc). VSGrs that had tracked and got in the necessary protein intake from the get go ...STILL report hair loss, or having some to no effect.

I think it is noteworthy L-lysine an amino acid in protein IS a DHT blocker! Could our reduced protein intake the first few weeks post VSG be an influence? Would supplementing with L-lysine be a 'better' option for us post op to prevent hair loss?  More info on L-lysine from Bariatric Times below



2. SAVE YOUR MONEY on vitamins, hair care products recommended by hairstylists, nuts, surgeons, forum members that claim a product will "save/help your hair" from loss. Either they are toxic, unnecessary / ineffective, must be used for 6 months or more for result$, or claims are unproven! 

Please research any recommendations wellbefore taking them.. to learn the TRUTH about them. You get enough selenium, biotin, zinc, silica from your diet, and daily multi-vit. There has RARELY been an incident of these nutritional deficiencies post VSG. They merely promote hair REGROWTH!. Will NOT do 1 thing to prevent, slow or stop hair loss! ..NOT IN VSG triggered hair loss!! 


****MENSES aged women...PLEASE KEEP YOUR IRON INTAKE AT ACCEPTABLE LEVELS...iron deficiency will exacerbate your hair loss 
****PERI-MENO/MENO women...PLEASE
 KEEP YOUR CALCIUM and VITAMIN D3 at ACCEPTABLE LEVELS. Hair loss in meno aged women is very common...another HORMONAL trigger of acute telogen effluvium. 
**** Hypervitamintosis A has been found to increase hair loss


3. PREVENT BREAKAGE Altho much of your initial hair loss, occurs from the ROOT, at ~7 months out..you will notice numerous remaining hair strands on yer head have a "weak point" of up to ~1/64th of an inch long..where the diameter of each individual hair strand/shaft is THINNER (weak point) between the old hair and new hair growth on that particular strand. PROTECT THESE STRANDS because it is a major HAIR BREAKAGE point. Use a mild protein shampoo and protein conditioner once a week max.

DO NOT use protein shampoos more than 4x a month because they are VERY drying and damaging to your hair. Nioxin or its generic counterparts IS TOXIC! (links towards the end of this blog).

Have you ever noticed post op bariatric patients pics or in real life with DRY,BRITTLE, FRIZZY, LISTLESS hair?
Contributing factors may include: poor protein intake, overuse or too high concentration protein-chemical shampoos/conditioners, main.stylelist.com/2011/01/10/deep-conditioner-how-to-choose/  cotton pillowcases that rob moisture from hair, not to mention hormonal age-related factors when our hair naturally changes (increased DHT), and chemical processing has taken its toll. 


4. CREATIVITY 
Hats, wigs, hair pieces, accessories.
Get creative with styles and parts. 

Camouflage! eye shadow, eye pencils, fillers- tint colored powders, thickeners- hair sprays that match your hair for parts, hair line until regrowth appears.
Great time to go for that shorter hair style! It'll make you feel so much better.

Just as YOU think your hair is paper thin, can see Grand Canyons in yer part, and yer definately going bald..your hair stylist will tell you ~9 months post op...You don't even need a volumnizing cut!...all those little new hair growths will give ya lots of volumn naturally!

5. COOKING HAZARDS:Keep yer hair under wraps or up in a loose bun ..if you insist on maintaining long hair like I do WHILE COOKING and preparing meals!! Talk about losing one's appetite... I can't tell you how many dinner guests have pulled a strand of my hair out of their meal ...my first year post op.

6. AVOID COTTON PILLOWCASEs use a satin/silk pillowcase! handwash/ rinse separately.  Cotton pillowcases.. absorb moisture..natural oils from your hair ... the friction will cause increased hair loss and damages/frizzes hair.  
Your face and your hair pressed against harsh detergent/fabric softeners/chemicals like chlorine bleach for up to 8 hours ...think about this fact not only during the hair loss phase but ... as you age 

 
7. SHAMPOOING/ SCALP MASSAGES:  Do NOT shampoo your hair everyday unless it is very oily. Thin out existing shampoos so less harsh. Look for Keratin or Amino Acid shampoos. AVOID SULFATES in shampoos that rob moisture not to mention color! Use the pads of your fingers to massage yer scalp gently, and stimulate circulation. Protein Shampoos/Conditioners (see above #3) may be needed to prevent breakage when the time comes.

Per Dr. Mercola and Dr. Oz coconut oil ($5 at cooking oils section of Walmart) applied at the root as it does not clog hair follicles, is a NON-TOXIC (unlike Nioxin) DHT inhibitor!...Apply 30 minutes prior to shampooing ..best applied and left overnight (shower cap), shampoo in am. 

Cosmetology schools and hair salons offer Tesla scalp massages for a nominal fee. A neon tube electric 'rake' stimulates circulation & massages the scalp. Per The DRs (television show) rec Tesla scalp treatments to anyone with hairloss.

8. AFRICAN AMERICAN/BLACK HAIR:  Black women please ease up on chemical straightening, weaves, braids/extensions, locs, loc extensions, hot irons anything stressing yer already thinnin scalp the first year unless yer going for the Naomi Campbell look!!
                        
    

See gettin CREATIVE section #4. There are VERY NICE lace-front wigs out now under 100 dollars.  Use combs vs. pins that may pull at root when removing. 

DO NOT USE: Hair growth "potions", Nioxin, Minoxidil, Rogaine products ..research and online reviews claim they will cause your hair to come out in clumps! Check these products out THOROUGHLY before using!
                                       _____________________________


                                                   CONCLUSION!!

SO ..you've gotten in all your protein, all your vitamin and mineral requirements... you may have tried all sorts of OH suggested remedies, hairstylists, surgeon, nut recs.....same old past  FAILS to NO AVAIL we all tried!...you probably have deduced by now.......

NOTHING will SLOW or STOP  this phenomena (VSG-triggered HAIR LOSS)  but ...TIME. (note the timeline above)   As your weight loss stabilizes you may notice your hair loss has completely stopped.  

My weight loss came to a grinding halt at 13 months post op. Coincidentally, so did my hair loss!
All that stressing, money and time popping worthless biotin, hair skin nails supplements, buying & using shampoo systems........FOR
 NOTHING! 

Chronic telogen effluvium occurs after 18 months of hair loss. Other hormonal influences / nutritional deficiencies may contribute to, prolong it. Please see your PCP/surgeon for labwork, endocrinologist, dermatologist if this is the case.

Acute Telogen Effluvium RETRIGGERED? check
Nutritional deficiencies
 
Post VSG  surgeries (
^anesthesia influence):  plastics, revisions, gallbladder surgery..although no where as prolonged or pronounced as in initial VSG. 
Hormonal - endocrine disorders i.e. thyroid, adrenal, menopause 


                                          __________________________________________

NIOXIN:I have many more websites showing very mixed results and also showing people using this system for 5+ years!! and swear by it.. even tho Nioxin website CLAIMS results within 10 days of use. Yes some people do believe it snows in Phoenix, AZ in the middle of summer! I sure did when I used the 3 part system for my hair loss. The tingly sensation from metholation convinced me it must be doing something... until I found out how toxic it is! 

Nioxin website:

http://www.nioxin.com/en-US/the-5-effects-page.aspx
effects#1 
NIOXIN is designed to make hair strong, healthy and thicker-looking

health benefits #2 note  "DENSER-LOOKING" and "APPEARS" as operative words used.
http://www.ewg.org/skindeep/product/272909/Nioxin_Cleanser_System_1/
and


________________________________________________                                                   

   Bariatric Times Articles:


2011  WLS and HAIR LOSS
http://bariatrictimes.com/2010/11/11/hair-loss-among-bariatric-surgery-patients/

2008 Nutrition and WLS INDUCED HAIR LOSS:
http://bariatrictimes.com/2008/09/19/the-latest-on-nutrition-and-hair-loss-in-the-bariatric-patient/

Protein:

Low protein intake is associated with hair loss. Protein malnutrition has been reported with duodenal switch, and in gastric bypass to a much lesser degree. Little is known about incidence, as only around eight percent of surgeons track labs such as total protein, albumen, or prealbumen.3 Limited studies suggest that patients with the most rapid or greatest amounts of weight loss are at greatest risk.4 With surgical reduction of the stomach, hydrochloric acid,5 pepsinogen, and normal churning are all significantly reduced or eliminated. Furthermore, pancreatic enzymes that would also aid in protein digestion are redirected to a lower part of the small intestine. It is thus likely that maldigestion rather than malabsorption is responsible for many cases. Some studies have also implicated low protein intake.6

***Biotin 
Many individuals believe that supplementing with, or topically applying, the nutrient biotin will either help to prevent hair loss or will improve hair regrowth. To date, there is no science that would support either of these presumptions. While biotin deficiency can cause dermatitis, hair loss is only known to occur in experimentally induced states in animal models or in extreme cases of prolonged diets composed exclusively of egg whites.

Other
Other nutrients associated with hair health include vitamin A, inositol, folate, B6, and essential fatty acids. Hair loss can also be caused by systemic diseases, including thyroid disease and polycystic ovarian syndrome (PCOS), and is influenced by genetics.
 

Conclusions:
Hair loss can be distressing to bariatric surgery patients, and many will try nutrition themselves to see if they can prevent it. Unfortunately, there is little evidence that early hair loss is preventable because it is most likely caused by surgery and rapid weight loss. Later hair loss, however, can be indicative of a nutritional problem, especially iron deficiency, and may be a clinically useful sign. Educating patients about the potential for hair loss and possible underlying causes can help them to make informed choices and avoid wasting money on gimmicks that may have little real value.

Research also indicates that low levels of the amino acid l-lysine can contribute to hair loss and that repletion of lysine stores may both improve iron status and hair regrowth. In a study of anemic patients with hair loss who were supplemented with 1.5 to 2g of l-lysine in addition to their iron therapy, ferritin levels increased more substantially over iron therapy alone.
--------- 
An Article on Diet and Hair Loss:
Prevent Hair Loss with Foods: Six Diet Changes to Make

Do you dread trips to the beauty/barbershop? Cringe every time you pass a mirror? If so, you're probably concerned about hair loss. But whether you're starting to see strands of hair in your tub or are just worried that your thick head of hair won't last forever, there are certain foods you can eat that may help. Of course, if you're genetically predisposed to hair loss, there's not much you can do but keep your fingers crossed. But if not, adding these foods to your diet can help keep your scalp healthy, happy and hopefully hairy.

FISH, EGGS,BEANS
Hair is primarily made of protein; therefore, it makes sense to eat a protein-rich diet if you're trying to maintain your healthy hair. However, eating a steak every day isn't going to help you. High-fat diets result in increased testosterone levels, which have actually been linked to hair loss. Stick to leaner proteins such as fish (which has myriad health benefits beyond just maintaining your hair), chicken, calf's liver, brewer's yeast, low-fat cheese, eggs, almonds, beans and yogurt. Soy milk and tofu are also smart to add to your diet because they are high in protein and low in bad fats.

RAISINS
Iron plays a key role in manufacturing hemoglobin, the part of the blood that carries oxygen to your body's organs and tissues. When your hemoglobin is at a healthy level, oxygen is properly dispersed. This means your scalp is getting a good flow of blood, which will stimulate and promote hair growth. Adding more iron to your diet doesn't mean you have to feast on liver day in and day out, but when you're craving something sweet, remember that dried fruits (like raisins) and cherry juice are packed with iron. Eggs; dates; raisins; dark green, leafy vegetables such as kale; and whole-grain cereals are all high in iron. Vitamin C improves the absorption of iron, so fruits such as oranges, strawberries and lemons should also make your grocery list.

BEAN SPROUTS
Silica may not be a word you commonly hear associated with diet (or foods that prevent hair loss, for that matter). But if you're looking to promote hair growth and prevent hair loss, silica needs to be on your menu. The body uses silica to absorb vitamins and minerals; if you're not consuming silica, eating your vitamins might not be helping much. Silica can be found in bean sprouts and the skin of cucumbers, red and green peppers, and potatoes. Remember, when you eat these foods raw, as opposed to cooked, you're getting more nutritional value out of them.

SEAFOOD
Many people who suffer from hair loss are found to have zinc deficiencies. Zinc plays a key role in many of the body's functions, from cell reproduction to hormonal balance, and all of these functions affect hair growth. Perhaps most importantly, zinc manages the glands that attach to your hair follicles. When you're low on zinc, these follicles become weak, causing strands to break off or fall out. To combat this problem, eat zinc-heavy foods such as red meats, poultry, mussels, shrimp, nuts and oysters. Excessive amounts of zinc can eventually lead to hair loss, so it's best to stick to a zinc-heavy diet rather than eat these foods AND take a zinc supplement.

POTATOES
It may be tempting to eat fast food, but greasy foods are among the worst culprits for hair loss. If you have a craving for a burger and fries, your best bet is to cook the burger yourself and dice, season, and bake some potato wedges (leaving the skins on) to go along with it. Try to limit your intake of excessively cold, spicy and sugary foods as well. These can tax your body, and when your body's fighting something unhealthy, it's not functioning at its peak level.

 A BALANCED DIET
Just as your overall health will benefit from eating a balanced diet, so, too, should the health of your hair. Once it's gone, it's gone, so don't put foods in your body that speed up hair loss. You may be experiencing a thinning on top already, but you can counteract this (or at least slow it down) by eating from every food group daily -- concentrating on foods that are rich in protein, iron, silica and zinc.
-------------------------

VITAMINS and SUPPLEMENTS for HEALTHY
 HAIR 

--------------------------

                                     
HANG IN THERE, HOPE THIS HELPS!! 
                                  IT DOES GROW BACK!


VSG and Dumping Syndrome


Although uncommon, some post VSGrs report episodes of dumping syndrome,called Alimentary Hypoglycemia. Same rapid gastic emptying as seen in partial gastrectomy pertainig more to the liquid/fluid concentration of the intestinal tract. Same rapid gastric emptying seen in people who never had gastro or bariatric surgery also. Current medical data/ literature on VSG procedures do NOT eliminate the occurance of dumping but continue to suggest the occurance as 'minimal' post VSG. You will more than likely never see a stat or data on dumping in VSG it is so uncommon Recent information in dumping in partial gastrectomy shows occurance at 1% of surgeries.  True dumping is NOT the queasy, ick fatigue 'needing to lay down' one gets from eating processed high sugar type foods..on an empty stomach . It is NOT solely diarrhea, or solely nausea/ vomiting associated with eating too fast or overeating. It is a combination of 3 or more symptoms (list below). It is frightening so much so that some VSGrs may be compelled to go to the ER. 
Dumping syndrome in VSG...can occur with simple sugars carbs BUT it can occur with proteins: liquidy creamy, semi-soft proteins..(fluid concentrations of the intestinal tract),  and fats: esp  fried foods as well. 
The belief that dumping syndrome only occurs with high sugar (glucose from simple carbs rapidly emptying into the large intestine ) content foods is erroneous.  That is a reactive hypoglycemia, most common in 33% of RNYrs a reaction to simple sugar/carbs/glucose, and a behavior modification type surgery of choice for "sweet tooth" bariatric candidates. 

 I, personally have experienced dumping syndrome 3x's in 6 months post op. 
The FIRST episode at 2 months post op, then 4 and 5.5 months out. Symptoms  in all episodes inc. heart racing, diaphoresis (sweats), abdominal cramps, dizziness feeling like I was going to pass out en route to bathroom,  severe diarrhea.. food eaten in the toilet..undigested, unabsorbed. Then followed by EXTREME fatigue...needing to "sleep it off'  

2:3 episodes foods I dumped PROTEIN!!  1 cup "canned" 99% FF cream of chicken soup (5g carbs) at 4 months out, and 1/2 cup "canned" ground beef chili no beans (9gs carbs) at 5.5 months out.
These dumping episodes were totally RANDOM!   Ive had those same foods  since 1wk post op (soup) and  then again 2 weeks after dumping on them and NEVER had a problem with them before or after dumping episode. The fluid/concentration of my intestinal tract must have been prime. 


Majority of dumping in VSG forum posts reflect  no episodes of dumping syndrome post 6 months, as the case with me!,..perhaps due to stomach being fully healed, homeostasis  at that time. Important to note that dumping syndrome occurs in people who never had WL or GASTRO surgery. If dumping happens to you, realize: 

                                             THIS IS NOT IN YOUR HEAD.  VSGr's can and do DUMP!

The symptoms will pass depending on severity from 1-12 hours from personal experience which includes the extreme fatigue that follows an episode.  If persists consider seeking medical advice.

Prevention tip: do not eat simple sugars on an empty stomach unless you are at least 6 months out.  
Eat Protein (dense, firm, solids) BEFORE/FIRST!  Combne protein w/ simple carbs i.e. fruit with cheese, nut butters.  


The BEST remedies to overcome Dumping Syndrome: 
1, SOLID proteins  avoid creamy, liquidy protein foods  (decrease fluid concentration of intestinal tract)
2.  SOLUBE FIBER...to soak up excess fluids in the intestinal tract
3. REPLACE ELECTROLYTES lost  ..i.e pedilyte, G2s, Zero sports drinks.

The reason these episodes are called a syndrome is because usually one has 3 or more symptoms each occurance. Here is a list of symptoms:

                               Symptoms

Symptoms of dumping syndrome occur during a meal or within 15 to 30 minutes following a meal, they may include:

Nausea

Vomiting

Abdominal pain, cramps

Diarrhea

Dizziness, lightheadedness

Bloating, belching

Fatigue

Heart palpitations, rapid heart rate

Signs and symptoms may develop after 30 minutes, they may include:

Sweating

Weakness, fatigue

Dizziness, lightheadedness

Shakiness

Feelings of anxiety, nervousness

Heart palpitations, rapid heart rate

Fainting

Mental confusion

Diarrhea

Some people experience both early and late signs and symptoms. Conditions such as dizziness and heart palpitations can occur either early or late — or both.

Some people experience low blood sugar (hypoglycemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Hypoglycemia is more often related to late signs and symptoms.

Gastrectomy and Dumping Syndrome:
http://emedicine.medscape.com/article/173594-overview

                    Alimentary hypoglycemia

Alimentary hypoglycemia is caused by food being dumped too quickly from the stomach into the small intestine. This causes the carbohydrate to be released too quickly, and this is followed by an over-reaction of the pancreas, and over production of insulin. Alimentary hypoglycemia occurs with an abnormality of the stomach, usually because of stomach surgery. Unlike the normal stomach, which can hold food over a long period, the reduced size of the stomach after surgery makes the holding time shorter. Alimentary hypoglycemia can also occur in some cases of gastrointestinal abnormalities not caused by surgery, depending on where in the system the problem is.

The sudden drop in blood sugar can be very dangerous and, in rare cases, can cause seizures and coma. Usually symptoms will appear a half hour to two and a half hours after eating.

                 Alimentary Hypoglycemia

Hypoglycemia is an affliction common among children and diabetic people, resulting from the body’s natural defense mechanisms reacting wrongly to blood sugar levels that are too high or too low. There are different and varying types of hypoglycemia based on their causes but the most severe type is what they call Alimentary Hypoglycemia.

Alimentary is a word that pertains to or concerns food, and while hypoglycemia itself concerns food and their glucose contents, none is more directly related to actual food than this type of hypoglycemia.

Unlike other forms of hypoglycemia, which result in consumption or lack of blood glucose, Alimentary Hypoglycemia happens when food that you have chewed and swallowed is dumped too quickly from the stomach to the small intestine. This abnormal occurrence causes all the carbohydrates in your food to be released faster than intended, and will immediately prompt the pancreas to overreact, which in turn releases far too much insulin, driving the body’s glucose levels far too fast and too low than your body was designed to handle. This sudden drop in blood glucose levels is among the most severe in all hypoglycemia types, and can cause seizures and even put the patient in a comatose state.

Alimentary hypoglycemia has two subgroups, with the first one occurring to those who do not have any experience with gastric surgery in the past, and the second one being for those who have had prior gastric surgery, either with gastric resection or vagotomy. With the second subgroup, the severest form of alimentary hypoglycemia may occur after subtotal gastric resection, and the constant defecation resulting from diarrhea may further complicate management and treatment. Patients suffering from this irregular digestive system will greatly benefit from a diet rich in soluble fiber while a person with normally functioning digestion should focus more on foods rich in fiber.

Alimentary hypoglycemia tends to happen after mealtime, and is usually caused by excessive moving such as jumping, running or brisk walking. In order to avoid this reactive form of hypoglycemia, it is best to take a few minutes of rest after every meal to ensure that the food you ate has settled down and can be digested thoroughly and properly. Children in particular are very prone to this kind of hypoglycemia, as kids have a habit of immediately running, jumping or playing around after a heavy meal. As such, it is important for the parents to regulate their children’s activities and implementing strict rules regarding behavior after eating.

Alimentary types of hypoglycemia can also be caused by improper administering of medicines that affect the body’s adrenal glands, particularly energy-regulating ones that promote and could result in excessive production of adrenalin, effectively putting the body in a state that digests food faster than normal, and laying havoc to the digestive system.

Always remember that hypoglycemia happens even to people who are not suffering from diabetes, and it is very important to be responsible with your eating habits and daily activities in order to prevent developing or triggering a hypoglycemia attack.


Pre-Surgical Psychiatric Evaluation Criteria


My surgeon gave me the following ASBS psych eval (for interview), I typed it here ver batim in hopes to give pre-surgery candidates a heads up on what to expect, and lessen the fear associated with the interview/testing process. 

Below are links to the ASMBS Psych Eval (for interview) and links to sample questions as well as a synopsis of the MMPI-2 (computer/pamphlet) of how MMPI-2  is rated.

Suggestions for the Pre-Surgical Assessment of Bariatric Surgery Candidates from the American Society for Bariatric Surgery : 


Behavioral
1. Previous attempts at weight management
2. Eating and dietary styles a. binge eating, b. overeating c. grazing d. night eating syndrome
3. Physical Activity and Inactivity
4. Substance Abuse
5. Health Related Risk Taking Behavior a. impulsive behavior b. compulsive behavior c. compliance with medical treatment d. adherence to self management regimens
Cognitive and Emotional
1. Cognitive Functioning
2. Knowledge of Morbid Obesity and Surgical Interventions
3. Coping Skills, Emotional Modulation, Boundries
Psychopathology Specifically the assessment needs to address
1, Whether there is a history of or current self-destructive or suicidal behavior (ideation, plan or attempt), the outcome of this behavior and the resultant interventions, if any.
2. Any history of psychiatric hospitalizations, the circumstances precipitating this, the type of treatment provided and its efficacy.
3. Any psychiatric history including major affective and psychotic disorders. Relevant information should include a thorough history with regard to onset, course, and treatment history. Risk of possible relapse during the immediate and long-term post operative phases. How the patient plans to meaningfully address these issues should they occur, including both professional and interpersonal supports.
4. The possible impact of the surgery both from the standpoint of symptom resolution as well as potential exacerbation. In general, a documented period of at least 6 consecutive months of good stabilization as it pertains to both symptom and medication management is required before the patient is ready for surgery.
5. Outpatient psychotherapy history including recent and current treatments. Information should be obtained from the patient's treating provider(s) regarding the patient's emotional stability, coping skills, psychological resources and ability to manage life stressors, impulse control issues and compulsions, as well as the client's capacity to follow directions and adhere to self-management guidelines. Treating mental health professionals may also provide valuable information concerning what they believe will be the most difficult change or adjustment for the patient during the post operative phase and what reservations, if any, they have about the candidate's decision to pursue bariatric surgery.
6. The history and course of psychotropic medications. If the candidate is stable on psychotropic medication regime information needs to be gathered about the length of stability, frequency of follow-up visits, or the need for possible titration or revaluation of the current medication regimen prior to surgical procedure.
7. The potential medication issues post surgery. Many medications affect appetite and weight gain. Some medications interact with potential posoperative conditions, e.g., dehydration and some no longer appropriate in the same form as pre-surgery, etc.
Developmental History Areas of note to be gathering during the interview should likely include:
1. Patient recollection about the stability of their childhood, any significant adverse events and long-term impact.
2. Parent availability and stability as well as the quality of the bond with the identified parent
3. Degree and quality attachments in social relationships outside the home
4. Any childhood history of weight-related ridicule and its related impact
5. An understanding of the childhood role that food played, along with any attempt to use it as a source of love, comfort, companionship, control or dissociation.
Current Life Situation
1. Stressors The assessment needs to tap information about: a. What significant life stressors have occured in the past year or are ongoing. Stressors might include significant discord with childern or with one's partner, divorce, death of a loved one, loss of a job, buying a home, moving, or starting college. b. What stressors does the candidate expect in the upcoming year. c. How well the candidate is or is not likely to cope in light of the fact that the rapid, widespread post surgery changes.
2. Utilization of Social Support
Motivations and Expectations
Psychological Testing Instruments and Assessments
Summary

In sum, the pre-surgical assessment addresses whether the candidate is adequately prepared--from a psychosocial perspective -- to go forward with bariatric surgery and whether there is evidence of any barriers that may interfere with patient safety and with adjustment to the surgical procedure. 
                   ________________________________________________________

MMPI-2  first 75 questions: antipolygraph.org/cgi-bin/forums/YaBB.pl

synopsis:     www.psychologistanywhereanytime.com/tests_psychological/psychological_tests_mmpi.htm



THE ASMBS  (American Society for Bariatric Surgery) Pre-Surgical Psych Assessment

                                   http://www.asmbs.org/html/pdf/PsychPreSurgicalAssessment.pdf


VSG Leaks and Strictures

Leaks and Strictures are 2 most common complications affecting VSG post ops. They account for LESS THAN 2% of total VSGs done in the U.S. This stat was based on 1-2009 data when this blog was written

New update on leak stats...Dec 2011 incidence of leaks is  2.4% in US, as many more VSGs are being done, stands to reason, leak rate increases.   http://www.ncbi.nlm.nih.gov/pubmed/22179470 
Stricture rate is currently below 1% (link will be provided soon!)

From 3-2011 (international) consensus (of ALL bariatric surgeons)
The total number of LSG cases performed by those panelists who shared data was 12,799. The mean patient age was 42 years, with 26% male and 73% female. The mean body mass index of the patients was 44 ± 4.47 kg/m2. The mean bougie size was 37F ± 5.92F. The average length of hospital stay was 2.5 ± .93 days. The conversion rate was 1.05% ± 1.85%. On average, patients experienced a 1.06% leak rate and .35% stricture rate. The postoperative gastroesophageal reflux rate was 12.11% ± 8.97%.

Even the most experienced bariatric surgeon can cause a leak or stricture, sometimes due to the complexities of the case or history, medical condition of the patient, inc stomach erosion from previous WLS procedures/lapband, 32F bougie/boughie and technique also influence occurance.  They do NOT randomly happen. A VSGr does NOTHING to cause a leak, or stricture. They ARE
 a RISK of surgery. No one is exempt.

This is presented as informational only as told to me by my surgeon, and gathered from posts and articles Ive read. No way is it a replacement for professional medical advice. 

*** PRE-OP: Talk to your surgeon ask how s/he checks for the presence of a leak. Ask how s/he reinforces the staple line to safeguard from leaks.

 

 

LEAKS (gastroesoghageal anamostosis)

When Leak Test Done: Prior to discharge post VSG from the hospital, majority of surgeons have done or will have you do a "leak test". Some surgeons do a leak test after VSG has been completed,  using air pressure/methylene blue, inside the stomach and saline outside the staple line, while in surgery/operating room (OR).  Much like checking for leaks on a bicycle inner tube (bubbles=leak).
~Day after surgery, some surgeons may have you do a leak test with Swallow & Xray. The swallow solution may inc. barium, a contrast gastrogafin white or a stain methylene blue.
Some surgeons will do BOTH leaks tests: one in OR and one after surgery.
Some surgeons 'claim' OR leak tests are 'unreliable', and don't do them. Know that a sole post-op swallow/Xray can also be 'unreliable' as a small leak may go undetected, until swelling/inflammation is reduced. 

Symptoms: unexplained consistent fever 100.5^ , pain: left upper torso shoulder/back, left ribcage, tachycardia (fast heart rate) also increased abdominal pain, shortness of breath, sweating, chills, general malaise.

Occurance: 3 days to 4.5 weeks post op most common. Rarely after 6 weeks post-op, have read of several cases on VSG Forum of leaks discovered at 6 - 7 months post op, VSGrs complaining of symptoms since early on, going to ER and misdiagnosed as kidney infections, or some other malady before discovering/confirming the leak.

At the stomach/esophageal juncture.  A surgeon not getting a tight clean staple line along the top stomach (excised fundus area) because of a "misfire" / angle of the staple gun during the final cut, not using smaller staples due to difference in tissue density from antrum to fundus being the most common, can staple the stomach to the esophagus, knick the esophagus with the stapling gun, overstaple

Diagnosis: Can be found immediately post op doing the leak test barium swallow w/ upper GI Xray, later using CT scan (most effective), GI Xray or ultrasound. May need to be repeated to confirm, as a very small leak due to swelling and inflammation blocking the leak , location of one can go undetected.

Treatment:  hospitalization, leak repair can inc. one or more options:  stent, Jackson-Pratt "jp" drain, fibrin sealant, suture Post op VSGrs w/ leaks report hospitalization 2-60 days depending on severity, where and how soon diagnosed, treatment and its efficacy.  At home recovery may be 2-6 months. Rarely over 1 year.

                          _____________________________________________________

 

 

 

 

Disadvantages of the LSG are: 1) this procedure involves gastric division, and therefore leaks and other complications related to stapling may occur  Obesity Surgery, 15, 2005, pg. 1127

LapSF on 32F bougies in VSG
"Optimal weight loss may require the smallest possible pouch, which may yield the highest leak rate" .




STRICTURES (VSG gastroduodenal anastomosis)

Symptoms: persistent nausea /vomiting, inabilty or gradual inability to keep anything down including liquids. Post-VSGrs w/ strictures also report: liquids backing up in their esophagus, foamies, heaving, fatigue.

Causes: When a surgeon inadvertantly narrows the entrance from stomach to pyloric canal because of misalignment of bougie, "misfiring" of stapler, 
staples your stomach to small intestine (duodenum) 

Scar tissue begins to adhere to staples within 72 hours post op. Scar tissue/adhesions tighten the opening to the pyloric canal/sphincter further. Akin to a clogged drain..over time forcing food/drink to 'back up'.

Occurance: usually from 3-6 weeks post-op, but have read of cases 2-6 months out due to scar tissue build up gradually narrowing the already narrowed opening to the pyloric canal (**see below).

Diagnosis: upper GI, abdominal CT scan , and/or Xray.

Treatment: hospitalization, cleared with endoscopic balloon dilation providing mild stretching at site,  dilation treatments may need to be repeated before resolution.

**We often delay in getting medical help because we think, or are convinced by others that these symptoms are NORMAL. ALWAYS...error on the side of caution!

                         *****************************************
Links that may be helpful:

 Managing Sleeve Gastectomy Complications

Complications of Gastric Sleeve

Europe:VSG leaks
http://bariatrictimes.com/2009/09/23/treatment-of-leaks-after-sleeve-gastrectomy/ .


Stalls and Plateaus


                               
To help tackle EMOTIONAL EATING online...SHRINK YOURSELF  visit  
http://www.shrinkyourself.com/?bhcp=1

Coach Calorie Ultimate Fat Loss CHEAT SHEET http://www.coachcalorie.com/weight-loss-cheat-sheet/

For IRL OVEREATERS ANONYMOUS group in your area.. visit  FIND A MEETING



For online, IRL meetings n help FOOD ADDICTS ANONYMOUS ...visit 
http://www.foodaddictsanonymous.org/

For VSG emotional eating testimonial & strategies Kellawanda's YOUTUBE videos I highly reccommend them ALL


Are you familiar with the PHYSICAL SIGNS OF HUNGER? stomach rumbling, being lightheaded, shaky, poor concentration and headaches. 
                                        
Are you familiar with the NON-PHYSICAL/APPETITE signs of hunger? - emotional, boredom, taste, "scheduled time to eat" and social situations.

On distinguishing between HEAD HUNGER and REAL hunger please take a look at this post
http://www.obesityhelp.com/forums/vsg/4368324/HEAD-HUNGER-8-signs-emotional-eating/#36096100

Identify YOUR  head hunger/emotional eating patterns by doing this simple Shrink Yourself exercise
www.shrinkyourself.com/get_instant_help.asp


DOCUMENT YOUR JOURNEY!! 
Concrete evidence your SLEEVE is WORKING even though the scale doesn't say so!


**** MEASURE YOURSELF ****
Take your Baseline measurements 1 week before or after VSG
Everything inc. foot width and head width. Record them
Re-measure yourself every 1-3 months. 


****WEIGH YOURSELF**** 
Weigh daily (if you must) but please record your weight ONCE a WEEK only.  Allow for periodic hormonal flux (menses), IV fluids, travel, i.e. contributors to water retention/re-gain up to 5 pounds



****TAKE PICTURES****
front, back, side profile, arms out 
Thereafter once a month
--------------------------------------------------

You may read or hear about VSGrs sayin they don't get hungry, and that they have to remind themselves to eat.  Wondering why not ME!! It will be YOU!  Someday....but few VSGrs report this LASTING long term.  I lost all physical and non-physical signs of hunger at 10 months out. You may experience this event at some other point, before or after.  EVERY*BODY* is different.  
You must keep your calories at proper levels based on such things as activity, gender, BMI even though you do not feel true hunger. Setting your clock to every 3 hours to get some calories (energy) in during this mode. Your body will go into "famine mode" :  your resting metabolic rate decreases.  One of the biggest culprits of Re-gain, poor weight loss, and over-eating at meals...is SKIPPING MEALS!


DO NOT get in the BAD HABIT of comparing your weight loss journey to anothers. It is self-defeating behavior. 
                              _____________________________________________________________

A Stall is no weight loss in LESS THAN 4 weeks
A Plateau is no weight loss in 4 weeks and OVER

Classic (common) VSG stalls during the 1st year post op. occur around 3 weeks, 3 months, 6 months, 9 months and may last anywhere from 1-6 weeks. The 3 week stall is the TOUGHEST to break imo, due to post op dietary guidelines/restrictions. Frustrating! and definately can cause unfounded worry that your VSG is not working!  So important to keep measurement logs as during VSG stalls often notice we've lost inches NOT pounds, concrete evidence our sleeve is indeed working even tho the scale says otherwise! These INCHES LOST are gone forever!  Technically it isn't a STALL/PLATEAU during our 1st year ..as our bodies are STILL WORKIN on changing ... those adipose fat globules shrink, take up less space, redistribute, and get ready for the NEXT BURN PHASE...once we're out of that stall, the scale moves on down and so it goes.  Majority of VSGrs report their weight loss.. as a STAIR STEP DESCENT...note the word DESCENT...we lose , we flatten out (stall) ....we lose, we flatten out (stall)...down each step during the rapid fat loss phase of VSG. 
PATIENCE and sometimes downright EXTREME PATIENCE is needed to get down that next step.

Majority of time there are reasons why our stalls/plateaus last as long as they do, and many times WE KNOW WHY we're at a standstill in our weight loss. We ARE or ARE NOT doing something that prolongs them. .  

     
                                                      MY PERSONAL WEIGHT LOSS GOAL



Optimize this fat-burning PHASE! because AFTER the initial 6-8 months of VSG.... weight loss slows considerably. 
1 year post op.. stalls/plateaus are usually elective or your body may have reached  " the set point:"..is tellin you.....Im done, Im ok, this is me, love me or keep workin on it! .....Documented studies show individual VSGrs actively losing weight into 2 years post op. 


OPTIMIZE this rapid fat loss phase  ( first 6-8 months post VSG) to get to YOUR personal goal by staying and caring to be accountable to YOUR individual

NUTRITIONAL NEEDSfood: quality, choices, and portion size inc. water intake, vitamin and mineral supplementation
ROUTINE EXERCISE
and SLEEP !



             *****KNOW THAT THIS STALL WILL PASS!  THEY ALWAYS DO***** 
                                IF you want them to by changin it up! that is ,-)



IT IS GOOD TO HAVE AN END TO JOURNEY TOWARD...
BUT IT IS THE JOURNEY THAT MATTERS IN THE END

                                                                        Ursula Leguin

  YES to  POSITIVE... NO to NEGATIVE  your attitude on this journey makes ALL the difference in the world!

                                                
                                               ___________________________________________

Our bodies are very complex and adaptable machines, food ruts, and exercise becomes mundane  
                                 WAKE IT UP, SHAKE IT UP, BOOST YER METABOLISM

Best stall breaking tips....  


1. UP YOUR CALORIES, 4-5 measured portions/ mini meals a day. Mini MEALS...every 3-4 hours. This goes against everything we know or are told by our surgeons. Calorie shifting to break these stalls WORK!  (see link about calorie shifting below).  Eventually limiting calories intake does work but sometimes 'stall breaking!" , ya got to TRICK yer brain out of starvation/famine mode (adaptive thermogenesis for all you scientists out there!)

2. SHAKE UP your exercise routine... body adapts quickly to the mundune ...break a sweat, change routine for a few  days, and you break yer stall. Aerobic exercise FIRST very important! BRISK walking, jogging, sprinting then slow walking repeat. SWIMMING (aquacize! yes it IS possible to SWEAT IN WATER!) Stength/weight training is very important in ^weight loss. Ladies..up the weight..we get too used to using small weights, which wind up having little to no effect on burn. SAUNAS! 30 minutes great to help eliminate TOXINS (like adipose fat!) that accumulate in our bodies.

3. INCREASE  water intake (a simple reminder/trick-divide your current weight in half. That number is the amount of ounces of water to AIM for)...If your pee (AFTER the first morning void) ...is not a pale yellow or pale neon ,-) greenish-yellow (vitamin B2-riboflavin supplementation) ..you ARE dehydrated!!  Use tall wide cups, and a straw ...can get more in throughout the day

 

...please consult with yer NUT when you are permitted to use a straw so you aren't swallowing any more air that can cause increased pain for a newly post op.
  
PLAIN COLD FILTERED TAP (local) WATER is best. HIBISCUS, GREEN, ROOIBOS, WHITE or BLACK TEA great too! 

SUGAR
 SUBSTITUTES: Use STEVIA, LUO HAN GAU Extract, XYLITOL i.e  vs. other artificial sweeteners that can CAUSE sugar/carb cravings later on!!



4.  Get NUTS** about PROTEIN and VEGGIES!!    
        
       LEAN PROTEINS  FISH!  CHICKEN, TURKEY, GAME MEATS (AVOID SKIN!!) 
       Meal needs to be ~75% protein based. At each meal eat PROTEIN FIRST.
       
Still have room?....veggies next. Protein is the log on our metabolic furnace. Keeps us full for longer. Thermogenic takes more energy to burn than the kindling (carbohydrates) on our metabolic furnace.  Little affect on insulin. Saves and builds muscle  (major calorie burner!!)

       Use Protein MR (meal replacement) or Protein Whey CONCENTRATE supplement SHAKES (avoid whey isolate-isomers rancid protein-acid processed not alkaline like reg whey!!)
   
       FIBROUS VEGGIES best!  
       Veggies and Nuts as close to RAW as possible, lightly steamed.boiled  
       Almonds, Walnuts are great source of fiber too!

      Avoid  ALL fruits** except avocados*, olives, berries, coconut  & small citrus*
       LIMIT  starches inc bananas  (unless green), potatoes, corn, rice  and grains
      LIMIT refined and processed carbs - flour grain containing products
       Cooking??  Use coconut oil!!  vs. hydrogenated & partially hydrogenated oils    (note smoke point of cooking oils) 
             Organic Coconut Oil at WalMart is about $5.oo  A little goes a LONG way!  
                http://www.organicfacts.net/organic-oils/organic-coconut-oil/health-benefits-of-coconut-oil.html

    
                           
         * If watching calorie counts and strict lo carbing it  limit or omit these items from your diet

 **IF the liver toxin sugar: fructose in fruits/vegetables/sugars is a concern please research "fructose charts" online to view content.

 interesting articles on effects of fructose and levels in fruit chart & fructose in carbs effect on fat storage and leptin resistance
articles.mercola.com/sites/articles/archive/2012/05/07/the-sweetener-that-is-more-dangerous-than-alcohol.aspx


http://articles.mercola.com/sites/articles/archive/2012/08/18/fructose-and-the-fat-switch.aspx?e_cid=20120823_NewWNL_art_3      

                     ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

       Lo Carb recipe/menu/food planning ideas inc: 

ATKINS  http://www.atkins.com/Recipes.aspx?searchmode=all  +  Atkins LoCarb Recipe Forum 

Linda'sLoCarb  http://www.genaw.com/lowcarb/recipes.html                  

Coach Calorie Healthy Foods http://www.coachcalorie.com/healthy-recipes/             

Eggface   http://theworldaccordingtoeggface.blogspot.com/ 

LighterSide http://yourlighterside.com/your-lighter-side-cookbook/       

Paleo Diet    http://www.paleoplan.com/recipes/                                

Bariatric Foodie    http://bariatricfoodie.blogspot.com/  

SkinnyTaste   www.skinnytaste.com/    

Maria Blogspot Weight Loss    marianutrition.com/                                                        

 DETOXONISTA (vegan vegetarian) http://detoxinista.com/recipes/most-popular/                                                  

and  20 Protein Powder Recipes
                     
                                                                          

5.  
AVOID most types of refined processed  CARBOHYDRATES in LATE AFTERNOON/EVENING...keep meals heavier on protein meat/meatless/complex carbs-higher in protein content side. higher protein as your evening meal will help you sleep too (amino acids tryptophan, arginine, lysine, glutamine i.e) ....WAKE UP to liquid PROTEIN breakfast within 1 hour of waking, pre workout or if intermittent fasting (12-16 hours no solid food) ....solid protein/ carbs ok thereafter


6. GRAZING /Snacking??     Catch yourself...YOU ARE THIRSTY NOT HUNGRY.  DRINK INSTEAD
ANY time you think of grazing/snacking grab that water!! carry a water bottle around like its your baby! 


  
Give your body at least 3 days trying these techniques to break the stall..does or doesn't work? ... go back to calorie restriction 
Our post op dietary manuals say NOTHING about stalls & plateaus. Only about calorie restriction, i.e. 600 to 800 calories until goal reached,  then 1000-1200 calories thereafter with emphasis that its individualized requiring follow-up with your nutritionalist.

CALORIE SHIFTING
 http://www.articlesbase.com/nutrition-articles/diet-plateau-avoided-by-calorie-shifting-1034944.html           

Calorie Shifting Breaking a Stall   http://www.coachcalorie.com/how-to-break-a-weight-loss-plateau/     
                                              
                                             __________________________________________
                     
                                                    ****  5 DAY POUCH TEST ****
                                                           (link below)


FOR VSGr's at least 6 months post op or further.......THE 5 DAY POUCH TEST (5DPT) may be helpful. Developed for RNY but useful tool for us VSGrs as well. 
It is a back to basics program and I have found it useful in breaking stalls and jump starting my weight loss. You will get that restriction tightness feeling in your pouch/stomach back..CONFIRM your restriction is STILL THERE and NEVER LEFT!!

There is no need to purchase the manual. All the information you need to jump start your weight loss is there! Be sure to prepare for each subsequent day in advance, to ensure your success.  The recipes tab...is quite helpful! 

You must adhere to it as IT IS WRITTEN! Do NOT deviate. ITS ONLY 5 DAYS!!. It is basically a carb-detox schedule of 5 days. ALL CARBS are SUGAR/STARCH...yes even good healthy complex carbs!

Carb withdrawal symptom most common is a severe headache, or irritability ~day 2, as you go into ketosis. This resolves by day 3...as your brain adjusts to using ketones (fatty acids) vs. glucose as the primary fuel.  By Day 3 you'll also find you aren't as hungry anymore! 

Our bodies take ~48 hours to CARB DETOX and go into ketosis (strictly adipose fat burning mode).  Greatest weight loss  (typically 5 in 5 .... 5 pounds in 5 days) normally occurring on 4th and 5th day  Please pay xtra attention to what you are eating on day 4&5  that makes this so! 


I highly rec. that on Day 4...for possible constipation 
...add 2 TBS SF Metamucil /psyllium generic to your sf pudding  ...will give vanilla flavor an orange creamscicle taste. Thin with milk/  almond milk. ...Do not add water/make a drink of sf metamucil.  The water you drink between meals will be sufficient.

or ...Senekot laxative ( vegetarian friendly-senna/sennosides) ~17mg before bed      
or... Epsom salts..1 TBS. in 8oz of  warm water ..stir till dissolved...use a straw cuz it tastes nasty!! suck on a lemon or tomato slice right after.  lots of water between meals
or...Miralax..follow directions ~ 17gms, lots of water thereafter
                                  
Day 6 and beyond  ..don't lose your momentum!! ...continue these principles......and  slowly start to incorporate HI FIBER veggies into your diet...I highly recommend ATKINS induction phase 6 days and beyond as a starting point/guideline since you're still in ketosis "fat burning" mode following the 5DPT. 
    
                                             
                 http://www.5daypouchtest.com/plan/theplan.html   5DPT the plan
                       

                 http://www.youtube.com/watch?v=-12I8ziXSPE   5DPT video by author

IF the 5DPT is just too much to handle. I highly recommend doing the FIRST TWO DAYS ONLY.  A liquid protein based FASTING (NO SOLID FOOD!!) for 2 DAYS. Slowly incorporate HIGH FIBER complex carbs higher in protein into your diet.
                  ______________________________________________________

                                             OH MAGAZINE ARTICLE link ON PLATEAUS

                                    http://picadmin.obesityhelp.com/magfiles/pdf/Plateaus.pdf

                                          _______________________________________


 
DOCUMENT YOUR JOURNEY!!
Concrete evidence your SLEEVE is WORKING even though the scale doesn't say so!


**** MEASURE YOURSELF ****
Take your Baseline measurements 1 week before or after VSG
Everything inc. foot width and head width. Record them
Re-measure yourself every 1-3 months.


****WEIGH YOURSELF**** 
Weigh and record your weight ONCE a WEEK.


****TAKE PICTURES****
front, back, side profile, arms out
Thereafter once a month
_____________________________________________

SOME AREAS TO LOOK AT:

Are you tracking your food intake in a food journal? or online (links below)

Are you tracking every single calorie that passes your lips? (flavored water, vitamins,
fiber, supplements, gum, single pieces of candy) Even if you aren't keeping track
of calories, your body is

Are you eating too MANY calories?

Are you eating too FEW calories?

Are you taking in enough protein? 60-80g/day

Are the fats you're eating healthy (polyunsaturated and monounsaturated)

Are you eating too many simple carbs (bread, pasta, potatoes, sugar, pasta, rice)

Are you eating enough veggies and fruits? (fruits are Hi fructose a sugar, which can inhibit weight loss also avoid starchy veggies like potatoes, corn, rice.

Are you drinking 64oz of water daily? (water flushes fat toxins/ketones from our body)

Are you grazing? (Break grazing by drinking more water! you're thirsty NOT hungry)

Are you eating the right quantity? Measuring and weighing foods?

Are you eating on a schedule?  (EVERY 3-4 hours)

Are you exercising hard enough? Long enough? Fast enough? Break a sweat periodically

When's the last time you changed your exercise routine? (The body becomes
efficient and doesn't burn as many calories after we've done the same thing
for 4-6 weeks)

Have you added weight/resistance training to your workouts? (muscle burns more
calories at rest)

Are you taking DAILY vitamins and supplements..so important for a VSGrs first year especially?
Multivitamins, B12/SuperBcomplex, 1200 mg of elemental calcium citrate w/D3

Are you taking medications that might promote weight gain, insulin resistance, ^blood sugar

Menses age: expect monthly water weight gain of up to 5 pounds, limit salt and processed carbs

Are you getting a good nights SLEEP?  influences metabolism, check if Melatonin (also ++ influence on digestion!!) supplementation 1 hour before bed may help vs. other hypnotics/drugs
__________________________________________


 Helpful Suggestions
 

1. Make sure you really are stalled. Take your body measurements with a tape. Check how your clothes fit. Try on a piece of clothing that was tight before you started low carbing.

2. Don't go hungry. Eat smaller more frequent meals, and make sure you have some protein with every meal and snack. Avoid going more than 5 hours without eating (except overnight, then make sure you have a protein-containing breakfast).

3. Don't restrict your calorie intake, it will just force your metabolism to slow down to "starvation mode". Increase the amount of protein and fat with your meals. Eat some cheese, fried pork rinds or a handful of nuts as a snack. Use good olive or flax oil on your salads. Use heavy cream and egg yolks to make sauces for fish, eggs and vegetables.

4. Bump up your exercise level. Increase the duration and/or the intensity. Change your routine. Add weight lifts if you are just doing aerobics. And if you're not exercising yet, get moving!

5. Avoid eating carbs before bedtime. This will trigger insulin, which will inhibit fat-burning while you sleep and in fact, will initiate fat STORAGE. ^ Protein prior to bedtime will also help you sleep!

6. Drink more water and other zero-carb fluids to enhance fat hydrolysis, and to flush ketones.

7. Keep a diet diary. Record the time and amount of what you consume. No one else will ever see it, so be brutally honest. Get a good food counts resource, or at least a pocket-size carb gram counter.


To Break A Plateau:

BEFORE DOING ANYTHING-
Realize many, in fact Most Post-Ops
Share this common experience-
Done everything right and lost weight steadily,
Suddenly- the scale won't budge.
Like many others, you've reached a plateau.
When weight loss slows and comes to a stop.

Before you get discouraged and abandon
Your long-term weight loss Strategy of life-style change,
Understand that plateaus occur in any slimming-down process.
Stick with the program and your weight loss will kick in again.

Before you rush to "prosecute,"
And take drastic action,
Do some investigation.

Figure out if you really are on a plateau.
The scale may be a less than least reliable reflection of fat loss.
Look at other indicators. Are you feeling better?
Do your clothes feel looser?
If you're losing inches but not pounds,
Your fat cells are still shrinking.

Figure in the duration of the stall.
You're only on a "plateau" if there's NO change at all
For more than four weeks.

And even at 4 weeks, don’t "assume" anything.
There may be a very Tangible Reason
For the slowdown and Plateau.
If you Truly want to BREAK a Plateau,
Identify and understand the true "Culprit"
Before you just "Open Fire!"

Get this one out of the way first
By being scrupulously honest with yourself.
Are you "Cheating?"

Cheating? It’s not a Diet!
Correct,
But weight loss is directly the result of –
Calories in versus Calories Used.
Are you putting in any "unplanned" nutrition?
Empty Calories?
A little thing will be the "tipping point."

Emotional and compulsive behavior
May allow you to "sabotage" yourself.
It certainly does so many Pre-Op.
Yes?
Look at what you are doing with extreme scrutiny.

Then-
Check for hidden sources of –
Calories / Carbs / Sugars / Un-wanted Fats-
Read Your Labels Carefully!
Sugar goes under many different names
And in some cases does NOT appear as "sugar" on the label.
Many vitamin tablets have sugar fillers. CHECK!

Conversely, Are you taking in too Little Nutrition?
Many times you carry over habits from other diets & eat too little.
EAT UP... Food is Necessary Fuel, not the Enemy!
Don't skip meals. Just eat Protein First,
Higher nutrition, Lower Calorie Foods.

Don't cut your caloric intake to less than 1200 calories per day.
Increase the amount of protein in your meals.
Don't starve yourself.
Cutting calories to an extreme will Not help you.

Try cutting excess fat and calories to a reasonable level
(usually 1000 to 1500 calories a day, but determined by YOUR Size, activity level.)
And divide these up into frequent small meals
(of about 200 to 300 calories each) every few hours.
Eat a decent amount of protein with each meal
To help you feel satisfied longer.
If you keep your carbohydrate intake to no more than 20 grams a day
Your body will go into a state of Ketosis and it will be Hard Not to lose.

A frequent eating schedule will provide a constant source of energy,
Keep your metabolism higher without the insulin rebound.
Six small feedings a day are better at maintaining level metabolism
Than 3 large meals.
(notice I did not say that 6 meals are better than 3, just better AT...)

Perhaps aim for foods with a lower glycemic index.
Check into it at- "http://www.glycemicindex.com/

You may have a mineral imbalance.
How’s your blood-work?
Such as zinc/copper. Or a trace mineral shortage.
Such an imbalance can definitely slow the metabolism
Reducing your "resting consumption" of calories.
Certain nutrients are often recommended to aid in weight loss,
Including chromium, pantethine, selenium, vanadium
And biotin to help stabilize blood sugar and metabolize fat.

Getting enough Potassium?
Potassium shortages are common
For early out Post-Ops. How’s your blood-work?

Exercise? Exercise can improve circulation,
Stabilize blood sugar & other important metabolic benefits.
If you’re walking, great.
But at some point in your loss,
Walking becomes just Activity
And no longer "Exercise."
Are you Breaking a Sweat?
If you have been only walking or cycling,
Try doing some weight lifts and vice versa.
If you are not yet exercising
Try to add some sort of activity to your regular schedule.
At least 20 minutes a day is recommended for beginners.
Walk, Walk, Water, Water...
There’s a reason for that "Mantra."

Increase your water consumption to stimulate lipolysis
(The breakdown of fat stored in fat cells )
And clean your system of excess ketones.

Many Nutritionists recommend
Avoiding eating within 3 hours of bedtime.
Especially avoid any foods that are higher in carbs
As this can trigger insulin production which in turn
Will inhibit fat-burning while you are asleep.

Have you considered Food Allergies?
These may cause all sorts of problems, fatigue, headache, etc...
Check possibility of such causes by dropping out one food
From your diet and checking for changes in how you feel.
The most common culprits are-
Milk, Eggs, Nuts & Peanuts, Fish, Shellfish, Soy and Wheat.
Perhaps checkout- "http://www.foodallergy.org/allergens/index.html


Maybe you have issues with food additives.
Some food colorings cause metabolic responses
Such as sluggishness or hyperactivity in some sensitive children.
Example- YELLOW 5 ... Artificial coloring found in
Jell-O, baked goods, etc... Causes mild allergic reactions,
Primarily in aspirin-sensitive persons.
Check some of the food additives that show up on your labels.
Perhaps a look at- "http://www.cspinet.org/foodsafety/index.html


Caffeine? Yes, it’s a "fence sitter" when it comes to "Dieting"
But- Coffee, cola & tea stimulate release of insulin
With a temporary lift in energy followed by hunger,
Fatigue & slower weight loss.

Are you Drinking Alcohol?
Empty Calories and Alcohol stimulates insulin.

While we’re on "the bible-belt vices,"
Smoking? Smoking uses up vitamin C & stimulates the adrenal gland.
Although quitting smoking is classically
A cause for weight increase,
Long term non-smoking, actually aids
The metabolism to remain a constant fat-burning, healthy machine.

None of the above?  It may be medications you are taking.

Many drugs, even aspirin, can cause or increase incidence of hypoglycemia.
Watch out for hormones, amphetamines, diuretics, antihistamines,
Anti-inflammatory drugs, analgesics, anticoagulants, anti-diabetics,
Antibiotics, tranquilizers, clofibrate, acetaminophen, and propanolol.
Beta-blockers, can make your body extremely resistant to weight loss.
Sometimes it isn't what you ARE taking
But what you WERE taking that slows you down.
Different meds last month?

Hormones? They can slow down weight loss
And stimulate the production of insulin.
Estrogen (used in birth control pills) and
Testosterone have much the same effect.

Too much Salt? Typically early on this is not an issue,
But later, excessive salt can cause some water retention.

What about ‘plain old’ portion sizes?
Many people misinterpret the instructions regarding
Eating as "Just Eat till you are Full!
The pouch size will ‘tell you’ when it’s too much."
That assumes you have "re-learned" the feeling of Satiety
As opposed to "Full."

You may need to track your caloric intake and exercise more closely.
Many people find "tracking at fitday.com" a very useful tool.
Check it out at- "http://fitday.com/

So you’ve made it through this long list and EVERYTHING
Checks out. Perhaps you have a metabolic resistance to losing weight,
And if that is the case, you must consider EVERYTHING –
EXCEPT GIVING UP AND ADMITTING DEFEAT.

Your Plateau, if it continues, could possibly require
Medical attention.
Continued thyroid problems would definitely call for medical solutions.
Excessive yeast infestation may be part of your problem.
Overgrowth of yeast in the digestive tract has been shown
To provoke food intolerance, headaches and immune-system weakness,
And can keep you from losing weight
By causing unstable blood sugar.

If your plateau WON’T Break,
Enlist your physician to help find the problem.

Done all of this and still looking for the "short list?"

Then
"Eat Meat, Cottage Cheese and water for 10 days!
– NOTHING ELSE! NO EXCEPTIONS!
Just try Not to Think of it as a Diet."

You will most likely get a "Bang!"
That will jolt your metabolism into losing.

But if you want more than a bang,
If you want a real "Chernobyl Nuclear Disaster"
To make your system Un-inhabitable for excess fat,
For generations to come,
Then adjust your "Life-Style for Life."

                     _____________________________________________________

STALL CONSIDERATIONS:

1. Carbohydrate level is too high- the number of carbs you can consume per day to continue to lose fat and weight varies from person to person. Some lucky individuals may be successful at 50 or more grams per day. Others are metabolically resistant, and must keep the carbs at no more than 30-40gs per day.

2. Hidden carbs - Carbohydrates can sneak into your food without you really noticing! A gram here and there; pretty soon they add up to an extra 10 or more grams a day that you may not realise you're eating. Herbs, spices, garlic, lemon juice, bottled salad dressing - these foods are not carb-free. Processed lunch and deli meats, bacon, ham and sausages often have added starch, crumbs, sugar, dextrose etc. Make sure you are accurately measuring the "known" carbs. A whole stalk of broccoli is more than 1/2 cup. And keep an eye on the coffee. It is not carb-free - a 6 oz cup of java has 0.8 carb grams. That's a small cup too. Add some cream, and a packet of sweetener, hmmm.... 3 or 4 mugs a day can add up to significant carbs. Also, beware of foods made in the US - their labelling laws allow manufacturers to list the carb count as zero if it's less than 1 gram, even if it's 0.99 gram! Get a good carb counter, and look up the foods you're eating. Keep an accurate food diary, and maybe you will spot a trend.
Atkins website is pretty good. See it at: http://www.atkins.com/Program/FourPhases/CarbCounter.aspx 

3. Undereating- Most of us choose to follow a low carb WOE after unsuccessful attempts to reduce with the standard lowFAT, calorie-restricted mythologies. It's difficult to grasp the idea of a "diet" that instructs you to EAT when we are so used to restricting, cutting back and denying hunger. Avoid the tempatation to eat less, thinking that this will boost your efforts and speed up the process. In fact, undereating is one of the surest ways to stall your efforts and bring your weight loss to a grinding HALT. When you go for more than 4 or 5 hours without eating, your body interprets this as a fast, and will adapt very quickly by slowing down your metabolism and conserving your stored energy, ie. your fat. This is exactly what you DON'T want!

Also, make sure you are eating adequate amounts of protein. In general, an average sedentary woman requires a minimum of 60 grams per day. If you are large, do strenuous exercise or are male, your daily protein requirement is even higher. Ideally, the protein should be distributed throughout the day in several meals and/or snacks. Protein is required by the body to provide the building blocks of all our muscles, organs, hormones, enzymes, etc..... if we do not consume the protein in our diet, the body will use the only available source - your muscle tissue - to get what it needs. Less muscle tissue further contributes to a slowed metabolism, and reduced fat-burning. So, eat up!!

4. Overeating - In general, it's not necessary to restrict or even count calories.. You should eat when you are hungry, and eat until you feel satiated. But don't go overboard; it's not a license to stuff yourself to the point of being OVERfull. Studies have shown that eating smaller but more frequent meals lead to more weight loss success than eating the same amount in 2 or 3 larger meals per day. Eat slowly, and chew your food thoroughly. Listen to your body, and learn to recognize when it says "enough". Overeating can sometimes be a consequence of meal-skipping as well. You are just so hungry when you do get around to eating, or you may feel you need to "make up" for the fact that you haven't eaten all day. It can really work against your weight loss efforts if you fast all day, thus forcing your body into slowed-metabolism "starvation" mode, then eat and eat all evening. This night-time eating will trigger the release of insulin, which will cause your body to make and STORE fat while you sleep.

5. Lack of Exercise - If you have not been exercising regularly, this may be a reason for your stall. Exercise will boost your metabolism and burn fat. Exercise, especially weight-training, will build muscles, and muscles are more metabolically "active", thus will increase fat burning as well. If you have been exercising, and have hit a plateau, perhaps your body is signaling for you to change your routine. Increase the duration and/or the intensity. If you've been jogging or cycling only, try adding some weight-lifts to your workout - and vice-versa, if you've only been weight-training, you should add some aerobic activity as well.

6. Not Drinking Enough Water - Adipose tissue, ie. fat, is mobilized through a process called hydrolysis. As the word suggests, hydrolysis requires plenty of water. Insufficient amounts of water in your body will hinder effective breakdown of fat. If you're exercising, or if your environment is warm and/or dry, you need to drink more water. If you are in active ketosis, you need to drink more water to flush the ketoses out of your system. How much is enough? A bare minimum recommendation is 64 fluid oz (that's 8 - 8 oz glasses) of water a day. Some experts suggest you should divide your current weight in pounds by 2; this number is how many ounces you should drink each day, but no less than 64 oz.

There is no disagreement on the need to drink sufficient amounts of fluids every day, but there are some arguments that it's not necessary to drink only plain water. If you choose to not drink large volumes of water, you should ensure that you are consuming adequate fluid in the form of calorie and carb-free liquids. Note that coffee is neither calorie nor carb free. Three small 6 oz cups of coffee yield 12 calories and 2.4 carb grams. Add in the cream and packets of sweetener .........hmmm. Teas and herbal teas are generally close to zero carb, as well as diet sodas and mineral waters. Be careful that some diet sodas contain citric acid as a flavoring, as this has been known to stall some folks. It's best to strive to drink as much plain water as possible; at least half of your day's intake, more if possible.

7. Medications - There are a number of medications that can and will hinder your weight loss. Most notable are diuretics ("fluid pills"), both prescription and over-the-counter types. These will initially seem to make you lose MORE weight, as you lose excess body fluid. But when you are in active ketosis the LACK of fluid will inhibit fat-burning. Many antidepressants cause weight gain as well. Steroids and hormones, such as cortisone, birth control pills and estrogens will cause weight gain. So too will some seizure medications. Unfortunately, medications that are intended to lower your cholesterol will inhibit the liver from converting fat to glycogen, thus decreased fat-burning. And insulin and many oral diabetic medication will decrease fat burning and increase fat storage. DO NOT STOP OR DECREASE YOUR MEDICATIONS WITHOUT A DOCTOR'S SUPERVISION AND FOLLOW-UP.

8. Food Allergy & Intolerances- A significant percentage of low carbers report that over-consumption of cheese and dairy products will put them in a stall quicker than anything else, even when the carbs are not "hidden" but are accounted for in the daily total. There is some suggestion it may be an intolerance or allergy to the casein protein in cow's milk dairy products. If you have been eating a lot of dairy foods lately, try cutting way back, or even eliminating altogether for a week or two, and see if this breaks the plateau. Food allergies and intolerances are difficult to pin down, but are known to trigger weight gain, fluid retention, sinus congestion, skin rashes, and digestive upsets, diarrhea etc. The most common food allergens are - wheat and wheat gluten, cow's milk dairy products, corn, soy and chicken egg whites. Again, try eliminating any or all of these from your diet for a few weeks. Then, add each food back gradually, and see if symptoms return and your weight stalls again. You may have to avoid the offending food permanently, although many people find that after a few months they may cautiously eat a small amount of the food once in a while, without adverse effect. 
                
                               ________________________________________________________

 

 

A FEW WEBSITES THAT MAY BE HELPFUL include:

 

IIFYM.com (if it fits your macros) IIFYM macro calculator  xlnt macro calculators based on YOU and your diet of preference  

http://www.obesityhelp.com/morbidobesity/information/post+op+planner.php 
OH WL goal planner BMI based

http://www.healthyweightforum.org/eng/calculators/calories-required/

Caloric Intake for Weight Loss Goal Setting

http://www.halls.md/ideal-weight/body.htm   BMI Ideal BW calculator Halls

http://easycalculation.com/health/body-adiposity-index.php   BAI Calculator

http://www.calculator.net/bmi-calculator.html  Calculator.Net  BMI, BMR, Body Fat Mass

http://www.halls.md/body-mass-index/bmi.htm      BMI calculator Halls

http://www.nhlbisupport.com/bmi/  BMI calculator  NIH

http://www.caloriesperhour.com/index_burn.php                                    
BMR calculator (cals expended)

http://calorielab.com/burned/                                                               
Calories burned by exercise


http://www.atkins.com/Program/FourPhases/CarbCounter.aspx             
Atkins Carb Counting
http://diet.lovetoknow.com/wiki/Category:Diet_and_Fitness                     
Diet & Fitness
http://www.carbs-information.com/                                                       
Carb Counting & Nutrition
http://www.glycemicindex.com/                                                            
Glycemic Index
http://www.mendosa.com/gilists.htm                                                 
Glycemic Index & Glycemic Load

TRACK INTAKE!
 www.choosemyplate.gov/SuperTracker/Home 
SuperTracker!  find out YOUR nutrient needs/what your lacking. INDIVIDUALIZED

http://www.myfitnesspal.com/   
 Fitness Pal ....TRACK intake


http://www.livestrong.com/thedailyplate/                                                
Daily Plate  ... TRACK intake

http://www.fitday.com/                                                                          
Fitday .....TRACK  intake
__________________

NUTRIENTS IN FOODS   look up NUTRIENT CONTENT, ingredients of foods

http://nutritiondata.self.com/tools/nutrient-search    NutritionDatabase

http://www.nal.usda.gov/fnic/foodcomp/search/index.html   USDA Nutrient Database

http://nutrientfacts.com/       NutrientFACTS

__________________

BURN THE FAT, FEED THE MUSCLE

http://idreamz.nl/fileshuttle/d28136ea.pdf

_________________________________________

20 HEALTHY WEIGHT LOSS TIPS... QUIT "DIETING"  

http://www.coachcalorie.com/healthy-weight-loss-tips/



_________VSG ONLINE DIETS_____________

www.muhealth.org/documents/bariatric/Bariatric%20Booklet%20VSG.pdf
Missouri Bariatrics XLNT dietary AND VSG  answers to FAQs


http://xnet.kp.org/misg/bariatrics/after.html                
Kaiser Cali 

www.muhealth.org/documents/bariatric/Nutrition_Guidelines_Before_and_After_Vertical_Sleeve_Gastrectomy.p
UM Bariatric

www.surgicalassociatesvhc.com/Nutrition-and-Exercise-following-Sleeve-Gastrectomy-82011.pdf
Surgical Associates Virgina VSG diet


http://www.cornellweightlosssurgery.org/pdf/dietary_guidelines_sleeve_gastrectomy.pdf  
CORNELL VSG DIET

http://www.hopkinsbayview.org/bin/c/a/nutrition_sleeve.pdf         
JOHN HOPKINS VSG DIET

http://www.bethesda.med.navy.mil/patient/health_care/surgery_services/bariatric
_surgery/bariatric%20nutrition%20guide-sleeve%20gastrectomy.pdf
                           

NAVAL VSG DIET

http://www.northwestobesitysurgery.com/pdf/sleeve-gastrectomy-diet.pdf                      
NORTHWEST VSG DIET

www.sleeveguide.com/uploads/1/7/9/4/1794785/dietguidevged42006feb.pdf
search-pdf-files.com/pdf/1978173-facs-weight-2006-resered-manual
  LapSF VSG DIET

www.laplose.com/Media/Forms/SleeveDietGuide.pdf
Institute of Bariatric Surgery VSG DIET

 


VSG Insurance Woes

Update:  June 27, 2012  ITS OFFICIAL!!!

MEDICARE APPROVED , APPROVES VSG opening the State floodgates to Medi-cal, and Medi-caid covered VSG/ LSG link:
 MEDICARE APPROVES VSG

Katikati post link:  Medicare Update 7-2012

MEDICARE UPDATE

 


--------------------
 
Update: Nov. 3rd 2009 ITS OFFICIAL!!!  

VSG IS NO LONGER EXPERIMENTAL OR INVESTIGATIONAL 

   EFFECTIVE  January 1, 2010

OFFICIAL CPT CODING......... 43775      
VSG CPT
 
              ___________________________________________________________

KNOW the wording to your INSURANCE PLAN for bariatric surgery.
Look ONLINE if you do NOT have the plan IN FRONT OF YOU. Insurance Websites link may be helpful
  http://www.obesityhelp.com/forums/insurance/cmsID,8933/mode,content/
 
IF your policy states LapBand, RNY are covered but VSG is considered INVESTIGATIONAL, EXPERIMENTAL and states these types of procedures are NOT covered
....YOU CAN GET INSURANCE TO COVER VSG!! This is a typical insurance policy. It only means you have to appeal. That's it.
EXCLUSIONS are very difficult cases to WIN. IF the word: EXCLUSION to VSG is in your policy, prepare for major obstacles to win, which could involve hiring an attorney and even then outcome may not be a positive one.  Hopefully VSG will gather formal acceptance Jan 1, 2010 and will help remove ALL insurance barriers to VSG not only those based as investigational or experimental, but exclusions as well.

Currently VSG is considered "investigational" or "experimental" by most insurance companies. NUMEROUS denials are overturned by providing a simple statement to appeal based on these 2 conditions to your insurance company.
VSG will NOT be be removed from experimental/investigational until the AMA gives it an OFFICIAL CPT Code .
Every Jan 1st. AMA provides NIH (see below) with new official CPT codes for medical procedures.VSG is expected formal acceptance in 2010 (see below) 
Once NIH accepts VSG as officially accepted it clears the way for VSG to be approved & paid thru Medi-care and Medi-caid (federal and state medical insurers).
Once federal and state level insured programs accept VSG as formally accepted WLS procedure, ALL insurance companies are MANDATED to follow NIH guidelines and formally accept VSG as an alternative WLS.  Currently to be denied on the basis of "investigational" or "experimental" is distressing, but standard insurance protocol.
Currently many insurance companies are unofficially CPT coding VSG to 43659. If you do NOT know what your surgeon's office coded for VSG  FIND OUT!! Many times a denial can be due to a wrongly submitted CPT code!!

Per my surgeon more and more insurance companies are approving VSG as it comes out of its "investigational" category. VSG is still relatively new procedure for WL, altho used for other medical conditions in past. First partial-gastrectomy being done like in 1881! VSG as a weight loss surgery has almost 5 year studies breaking through now. Per protocol 12 US VSG surgeons report their findings on VSG to ASMBS ( American Society for Metabolic and Bariatric Surgery).
ASBS (American Society of Bariatric Surgeons)  also submit their data on VSG to ASMBS
ASMBS THEN petitions the AMA for an OFFICIAL CPT CODE. The deadline for CPT petition is in November. In January the AMA releases all new OFFICIALLY ACCEPTED
CPT Codes for medical proceedures.
                                                   
                                                     http://www.asbs.org/



From BariatricTimes 6/09

 

SLEEVE AND THE INSURANCE INDUSTRY

The American Medical Association (AMA) has not yet authorized the codes for sleeve gastrectomy. Most insurance companies deem the gastric sleeve to be experimental, and so this specific procedure is usually not a covered benefit. There are only two insurance companies that cover the procedure—Blue Cross® and Blue Shield® Federal Employee Plan (FEP) and Oxford Health Insurance® from United Healthcare Network®. Medicaid officially states that sleeve gastrectomy is investigational. There are exceptional cases that can be covered by Medicaid.

There are signs of progress with multiple insurance companies. It should be expected that in 2010 sleeve gastrectomy have its own code and a formal acceptance.
                                       ___________________________________

                                         MY STORY n Im stickin to it!

My co-morbidities included a BMI over 40
Diabetes Type II and hypertension diagnosed Jan 08.
Orthopedic problems- plantar fascities diagnosed May 07 was facing surgery to relieve.
High Triglycerides diagnosed ~15 years ago
I have a family history on both sides with diabetes, hypertension, & atheroclerosis.

ALL OF THESE ISSUES ARE RESOLVED POST VSG. At my 3 months post op appt. my PCP dropped the diagnosis of diabetes II, hypertension, hyperlipidemia, and plantar fascities.  

                ======MY INSURANCE WOES!!======


My surgeon's office submitted (pre)authorization for VSG  mid August 08.

I was denied late August on basis VSG considered "investigational"
   (this is STANDARD INSURANCE PROTOCOL no worries! )

I appealed by telephone August 29th. 2008

Oct 21, 08 denial overturned and I won VSG 100% coverage on appeal. An Appeals Board member contacted me by phone, as they "supposedly" could not reach me by mail/did not have my current mailing address.
I have BC/BS Anthem Cali
So approx 3 months TOTAL for me! From denial to approval on appeal, supposedly Appeals Board got letters returned; didn't have a current address on me, my surgeon's office never notified me that I was approved. I finally got a call from an Appeals Board Rep tellin me I won on appeal. Got my address and received a letter within a week (see below)...confirming it.

I have since learned:
Pre-authorization request can take up to 7 business days for review. 
Appeals take up to 30 business days for review.


                                            _________________________________
 

You have the right to CALL YOUR INSURANCE COMPANY EVERYDAY if YOU so choose to get an update on your case whether its, original pre-authorization, or appeal. Even if they say...its pending, in review whatever...call everyday if you want!

You can APPEAL a denial by phone, email, or in writing depending on what your insurance company provides.

TO APPEAL AN INITIAL DENIAL on basis of "investigational, experimental" :
CALL OR WRITE YOUR INSURANCE CO. AS SOON AS YOU KNOW YOU HAVE BEEN DENIED

 A SIMPLE STATEMENT is ALL that is NECESSARY....i.e. "I want to APPEAL this decision and Im requesting that a BOARD CERTIFIED BARIATRIC SURGEON be a consultant on the APPEALS & GRIEVANCE Board. Please PUT THIS REQUEST IN MY NOTES UPON SUBMISSION" Get the NAME OF THE PERSON YOU TALKED to if appealing by phone!! They will send you a letter confirming your request to APPEAL within 1-2 weeks. Do NOT send any additional information with your appeal at this level. The Appeals and Grievance board has ALL pertinent information about you when your surgeon submitted for authorization.

                                   ________________________________

           DECISION OVERTURNED..WIN ON APPEAL INSURANCE LETTER 

I have BC/BS Anthem PPO of California

Date of inital "investigational" denial - late August.
Date Appeal received by Ins. August 29th. 2008
Date of Reversal of Denial/Approved upon Appeal - Oct. 21, 2008

Here is my letter ver batim! ( the bold is my added comment/s)

Appeal Outcome: Appeal Authorization/ Decision Overturned

Place of Service: Inpatient Hospital

We have completed our review of the appeal for the above referenced services. After careful review of the additional information provided (I appealed by phone! I NEVER sent them anything nor did my surgeon!) , it was determined that the previous denial will be overturned as the services are, medically necessary based on the following review.

Your health plan has completed its review of your appeal for a sleeve gastrectomy (code: 43659) procedure to be performed by (my surgeon) for the treatment of obesity. After careful consideration, it was determined that this procedure will be approved. The reviewers included: an independant consultant who is a board-certified General Surgeon with expertise in Bariatric Surgery, (thee ONLY difference in getting this surgery approvedMy pre-authorization was reviewed and subsequently denied by an OBGYN! ) a health plan medical director, and an Appeals Nurse (RN). Please provide a copy of this letter to (my surgeon) with instruction to forward the claim directly to your plan at (address of insurance). This authorization is subject to your eligibility with your plan at the time of service. This authorization applies only to the service previously specified. All deductibles and co-payments will apply in accordance with your health plan benefit plan (100% covered NO copays or deductibles!)

Our physician/reviewer has reviewed your request. Through this program we evaluate the medical necessity of care and the setting in which care is provided.

If you have any questions regarding this decision please call us at (phone number) Thank you for your patience while this matter underwent review.

Sincerely

Dr. *****

Medical Director

Grievance and Appeals Department
                                     ____________________________________________
 

****IF YOU HAVE INSURANCE with bariatric surgery coverage DO NOT SELF PAY FOR VSG UNTIL YOU HAVE EXHAUSTED ALL YOUR APPEAL OPTIONS! Ive read about some people having to appeal 3 times before winning! -or- just get it done if you can afford self-pay and have no desire to fight your ins. company, YOUR call.

Personal note: On 9/10/08 I self-paid in full ..mandatory cashiers check at admission...to have the surgery of MY CHOICE! (VSG) anyway
2 weeks after I filed my appeal (the surgery date was set BEFORE I got that denial letter! Wiped out my savings to boot!) When my denial was overturned hospital submitted bill to my insurance. The insurance company paid the hospital within 2 weeks of hospital billing and Im STILL waiting for the hospital to reimburse my 14.5K !
Edited update: I finally was reimbursed all
$14.5K the hospital owed me in April 09. 


                   http://bariatrictimes.com/2009/06/18/laparoscopic-sleeve-gastrectomy/

                                         
                                                 2009 VSG AMSBS Featured Article 
                         http://www.asbs.org/html/pdf/soard_featured_article.pdf                                           
                           
 
                      
           
        http://www.ssat.com/video/2008/SSAT%2049th%20Annual%20Meeting(3)-Cirangle.htm 

                       __________________________________________________________

              INSURANCE "I need to save MY life" FIGHTS:
     
     
Inquire OH FORUMS- post or repost NEW TOPIC should always have
 
NAME + STATE of your insurance in the TITLE

Inside post: 

Name + State of your insurance 

Where you are in the process

A LINK to your insurance's WLS/Bariatric BENEFITS website is EXTREMELY helpful

REASON FOR DENIAL  EXACT wording is very helpful! 
 
BMI

CO-morbidities
       
People want to HELP YOU, not SNOOP!  
May have to periodically post if no response. No telling who may have your insurance and got approval that takes a break now and again from forums, or you may have missed someone's post. 

Scroll through past insurance related postings for vital information if not to learn about the insurance process, problems, ins. verbiage.

Do an OH search using their search engine  with keywords: NAME of your insurance, VSG and where you are in the process..whether denial  or  appeal

Post insurance questions at Insurance Forum
http://www.obesityhelp.com/forums/insurance/

Contact Shannon Mitchell/ OH Insurance Forum, works for insurance co. May Help w/ appeals
http://www.obesityhelp.com/member/shannonlmitchell/

VSG Forum
 http://www.obesityhelp.com/forums/vsg/   

Under Forums on OH ...check and post on YOUR STATE'S Forum with those that may have your insurance/surgeon and may have a plethora of info to share

     Visit Obesity Action Council Website at:
http://www.obesityaction.org/advocacytools/insurance/oacinsuranceindex.php

Request a Peer to Peer review : your surgeon & consulting bariatric surgeon on Appeals and Grievance Board. Please make sure your surgeon talks w/ another bariatric surgeon!

Contact your STATE's Managed Health Care system (look into your state's online IMR independant medical review claims for ammo on making a case for VSG)

Contact Obesity Law http://obesitylaw.com

          HOPE THIS HELPS SOMEONE OUT THERE IN LIMBO-LAND!

             
                    ________________________________________________________
                            
                                               
The National Institutes of Health (NIH) is the FEDERAL government overseer for national health care services. They are policymakers, allocating monies/grants for biomedical and behavioral research.  Added Update: August 7, 2009  Obama nominated F. Collins, was confirmed by Senate as NEW DIRECTOR of NIH. He is pro research and development, pro preventative medicine, and his religious beliefs will be kept personal and not interfer w/ science nor sway his decision making duties as told to Senate Confirmation Committee

         -----------NIH CRITERIA for Bariatric Surgery----------

 NIH convened a Consensus Conference in 1991 to determine who should be considered a candidate for obesity surgery.According to the National Institutes of Health (NIH)
a candidate for weight loss surgery must meet these criteria:

BMI of 35 or over with 1 major comorbidity

BMI of 40 or over  (NO major comorbidities)

Tried and failed reasonable non-operative approaches ( inc. Weight Watchers, Jenny Craig, Nutrisystem, South Beach, Zone, OA, Atkins, etc. Your insurance MAY have a medically supervised diet contingent in its bariatric benefits package. Many states are amending m.s. diets from 6 months to 3 months.  Know YOUR policy! CA. does not require m.s. diets because they are a waste of time and money!!)

Psychologically stable

Best possible medical condition

Surgery should be done in a multidisciplinary setting

Definitions

 BMI refers to body mass index. This index is an indication of weight taking height into account. Using BMI one can compare in a more meaningful way people of different heights and weights using a single number. You can calculate your BMI from the following formula: BMI = weight (lbs) X 700 / Height (in) X Height (in) or use a BMI calculator.
Comorbidity refers to other diseases such as diabetes, hypertension, and sleep apnea which are directly related to weight.
Failed non operative approaches means that before a patient undergoes surgery she should be knowledgeable about nutritional issues and that she should have tried and failed reasonable diet and exercise approaches to weight loss.
Psychologically stable means that a patient's psychological status be optimized. Any problems in this area should be diagnosed and under appropriate treatment before surgery.
Best Possible medical condition means that a patient's various problems be fully evaluated and under appropriate treatment going into surgery. For instance patients with hypertension should be on drug therapy, people with sleep apnea syndrome should be on CPAP or BiPAP where appropriate, and smokers must quit at least two months before surgery.

                       
                           http://win.niddk.nih.gov/publications/gastric.htm

              __________________________________

                                      CO-MORBIDITIES 
                       (provide medical history documentation as needed)


Diabetes Type II - metabolic disorder resulting from the body's inability to produce enough, or to properly use, insulin

Metabolic Syndrome- a syndrome marked by the presence of usually three or more of a group of factors, such as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and insulin resistance, that are linked to increased risk of cardiovascular disease and type 2 diabetes; also called insulin resistance syndrome

Sleep Apnea - when a person stops breathing during periods of sleep

Pseudotumor cerebri - increased pressure in the brain which causes chronic headaches and eye problems

Hypertension - higher than normal pressure inside the arteries

Dyslipidemias -abnormal concentrations of lipids in the blood (^cholesterol/triglycerides)

Non-alcoholic steatohepatitis - fatty inflammation of the liver that is not caused by alcohol damage

Venous stasis disease - faulty veins that allow blood to collect in the lower legs

Significant BMI over 35

Significant impairment in activities of daily living

Intertriginous soft tissue infections - infections in excess folds of skin that are caused by obesity

Stress urinary incontinence - involuntary leakage of urine caused by increased abdominal pressure from excessive body fat

PCOS- Polycystic Ovarian Sydrome  called a syndrome as it can take on 3 or more of the following:

No menstrual period
Infrequent menses and/or irregular bleeding 

Infrequent or absent ovulation
Increased levels of male hormones
Infertility
Cystic ovaries
Enlarged ovaries
Chronic pelvic pain
Obesity or weight gain
Insulin resistance, overproduction of insulin and diabetes
Abnormal lipid levels
High blood pressure
Excess body hair
Baldness or thinning hair
Acne/oily skin/seborrhea
 

GERD Gastroesophagael Reflux Disease - a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus

Weight-related arthropathies (joint diseases), orthopedic problems (knee, plantar fascietis, arthritis) which impair physical activity. Weight bearing joints

Obesity-related psychosocial stress - treatment of depression, self-esteem, job discrimination

Failed medically supervised weight programs Fen-Phen, Opti-Fast, Ionomin, Fastin, Phentermine
                                 _________________________________________
 
                                             IMPORTANT OUTSTANDING ISSUES
                                   (not a comorbidity but will definately strengthen your case)

Need to take daily NASIDS  a stomach is required to absorb aspirin/NASIDS
making RNY unsuitable WLS.
ANEMIA   
 
making RNY unsuitable WLS.

Obesity related family history- for ex. colon cancer, hypertension; stroke, Diabetes Type II, heart disease.




 


About Me
Four Corners, NM
Location
VSG
Surgery
09/10/2008
Surgery Date
Mar 09, 2008
Member Since

Friends 261

Latest Blog 8

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