I am 39 years old and I have been overweight my whole life. I was always the "big" kid in school... and now am the "fat chick" at work. Like everyone else I have tried every diet under the sun. I even lost 70 pounds on the Dr. Berstein diet, but promptly gained it all back plus a lot more. Recently my PCP tried to send me to a healthly eating clinic. I went to the consult with the doctor from the clinic and then kept putting off the initial consultation with the nutritionist. At first I didnt understand my reluctance. Then one day it hit me. This would be just another diet I would try and fail at. Yes it wasnt a diet per say. It was Healthy eating, but I knew I wouldnt be able to control my portions eventually and I would just end up back at square one. Around that time a girlfriend of mine went and had RNY surgery. I was frothing at the mouth to talk to her about it and find out how she got covered to do it. I had NO idea OHIP covered this kind of surgery! I knew I could not afford it on my own. After I talked to her it was like lightning had struck me. I knew that this was what was going to work for me, and save me. So I have set the ball in motion and am going through testing to be able to qualify my decision on the OHIP application. Please keep your fingers and toes crossed for me. I know I need the DS surgery and OHIP right now has changed their qualifications for this type of surgery. Let's hope OHIP agrees DS is for me!

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OHIP application link:

Prior Approval Application for Full Payment of Insured Out-of-Country Health Services: 1442-84_.pdf  <-- CLICK HERE

Need to help your doctor with the OHIP forms? Read these bulletins from OHIP:
(Please Note: OHIP states that a doctor must fill out the form)

Bulletin 4459
http://www.health.gov.on.ca/english/providers/program/ohip/bulletins/4000/bul4459.pdf

Bulletin 4469
http://www.health.gov.on.ca/english/providers/program/ohip/bulletins/4000/bul4469.pdf

OHIP Phone Numbers:
Holly 613-536-3134
Bev Lyman (A/Manager) at 613-536-3123

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Real DS Surgery Videos:

Duodenal Switch Surgery Part 1

http://youtube.com/watch?v=uk3Tn5wCBEE

Duodenal Switch Surgery Part 2

http://youtube.com/watch?v=7tsirC06Pq0

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Co-morbidities List

1 Abdominal gas and frequent nausea
2 Acid Reflux (GERD)
3 Acne
4 Activity Intolerance - shortness of breath and severe fatigue even with minimal activity
5 Amenorrhea related to obesity
6 Ankle/knees swelling
7 Anxiety
8 Asthma
9 Bells Palsy
10 binge-eating disorder
11 Birth Defects Cancers
12 Breast Cancer in Women
13 Breast Cancer in Men
14 Cancers of the Esophagus and Gastric Cardia
15 Endometrial Cancer
16 Cancers associated with obesity, including colorectal and prostate cancer in men and endometrial, breast, and gallbladder cancer in women
17 Cardiac Arrhythmias
18 Cardiomyopathy
19 Cardiovascular disease
20 Carpal Tunnel Syndrome
21 Chronic leg pain
22 Chronic Skin Infections
23 Chronic Venous Insufficiency
24 Colon polyps
25 Cor Pulmonale (right heart failure)
26 Coronary artery disease
27 Colorectal Cancer
28 Congestive Heart failure
29 CPAP
30 Daytime Sleepiness
31 Decreased endurance limiting daily activities, including, but not limited to - walking, housework, working, dressing, standing, getting up, bathing, sitting, travel
32 Decreased Exercise Tolerance
33 Deep Vein Thrombosis
34 Depression due to weight, difficulty coping with frequent failures at diet attempts, inability to exercise, and health-related issues.
35 Degenerative Joint disease
36 Diabetes
37 Discrimination
38 D.J.D.
39 Dysfunctional uterine bleeding
40 Dyslipidemia
41 Dyspnea
42 Eating Disorder
43 Elevated Cholesterol
44 Elevated Triglycerides
45 End stage renal disease with difficulty dialyzing
46 Excess Facial & Body Hair (Hirsutism)
47 Excess Sweating
48 Excess Testosterone
49 Extremity edema with ulceration
50 Family history of heart disease
51 Family history of stroke
52 Family history of Diabetes
53 Family history of heart attacks
54 Family history of (Fill in the blank)
55 Fatigue
56 Fatty Liver
57 Fibrocystic breast disease
58 Fibromyalgia (chronic fatigue syndrome)
59 Fluid retention
60 Frequent constipation alternating with frequent diarrhea
61 Frequent yeast infections
62 Gall Bladder
63 Gout
64 Heart Attack & Congestive Heart Failure
65 Heat Disorders
66 Heavy Snoring
67 Heel spur surgeries
68 Hemorrhoids
69 Hernias
70 Hiatial Hernia
71 High Cholesterol (Hypercholesterolemia)
72 Hip pain
73 Hormonal Abnormalities
74 Hyperlipidemia
75 Hypertension
76 00000000000000000000000000000000000000000000000000000
77 Hypothyroidism
78 Impaired Immune Response
79 Impaired psychosocial and physical functioning, causing a negative impact on their quality of life.
80 Impaired Respiratory Function
81 Inappropriate Coping Strategies
82 Incontinence related to obesity
83 Increased risk of certain cancers
84 Infections Following Wounds
85 Infertility
86 Insulin resistance
87 Intracranial hypertension (pseudotumor cerebra)
88 Irregular or Absent periods
89 Kidney stones
90 Knee surgeries
91 Lack of Self Esteem
92 Liver Disease
93 Loss of Job Potential
94 Lower Back Pain and muscle spasms (can't stand/work in house for more than five minutes without pain in lower back)
95 Lung restriction
96 Migraines/Headaches directly related to obesity/cranial
97 Hypertension
98 Neuropathy in feet, ankles, hands and lower arms
99 Obstetric and Gynecological Complications
100 Obstructive Sleep Apnea
101 Ocular Hypertension
102 Osteoarthritis
103 Polycystic Ovaries
104 Prior Surgical Complications
105 Pulmonary Artery Hypertension
106 Rashes
107 Recommended joint replacement from specialist
108 Renal Cell Cancer
109 Renal Disease - End Stage
110 Renal (Kidney) failure
111 Repeated pneumonia
112 Repeated pleurisy
113 Repeated bronchitis
114 Rheumatoid arthritis
115 Sever Acute Biliary and Alcoholic Pancreatitis
116 Shortness of breath upon exertion
117 Skin Tags
118 Sleep Apnea
119 Social Rejection
120 social stigmatization
121 Stress incontinence
122 Stroke
123 Symptomatic ventral hernia
124 Thickened heart walls due to weight/hypertension
125 Traumatic Injuries to Teeth
126 Venous stasis disease

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Duodenal Switch Surgeon Questions

Questions Surgeons History

1 Are you a general surgeon or is your practice limited only to bariatric surgery? 
2 Do you have records of your patients weight loss statistics? 
3 What year did you begin performing WLS? 
4 When did you begin performing the DS?
5 How many DS surgeries have you performed?
6 What is your overall mortality rate? To what do you attribute those deaths? When did these deaths occur?
7 How many WLS patients have you lost? DS patients?
8 What is your complication rate?
9 What sort of complications have your patients had?
10 How many of your patients have lost their spleen?
11 How many of your patients have had leaks?
12 How often do you see leaks?
13 How many of your patients have had serious post-op infections?
14 Have you ever started a DS and could not complete it? 
15 Do you perform the surgery alone or will you have another surgeon assisting you? Who will that be? Can I review his/her credentials?
16 Will I have a choice of Anesthesiologists? Will I meet the Anesthesiologist before the day of surgery?

Questions Diet

17 What is the pre-op diet? 
18 How much protein should I be consuming per day? 
19 What kinds of protein should I be eating? Can I use a protein drink/bar as a supplement? 
20 How many calories and fat grams should I be eating post-op?
21 Are there any specific foods I should not consume post-op?
22 Can I/should I drink milk after surgery? 
23 Can I have sugar after surgery? 
24 Can I have fats after surgery? 
25 Can I have Sugar free soda? 
26 What will my diet be at discharge from the hospital? 
27 What will be my diet one week after surgery? 
28 What will be my diet six weeks after surgery? 
29 What vitamin supplements will I take Post-op? How many?
30 Will my vitamin intake change over time?
31 What supplements/vitamins do you recommend to help prevent/lessen hair loss?
32 Do you have a nutitionist on staff that I can contact if I have any questions?

How long post-op should I wait before I can consume alcohol?
 

 Questions Surgery

33 What are the preparations for the surgery? (i.e. diet, bowel prep, special soaps, etc) 
34 How will you prevent blood clots? Will I get injections of Heparin to prevent blood clots? Will I give myself Heparin injections after I leave the hospital?
35 Will I need a Greenfield filter or other device to prevent blood clots? If so, who will do this procedure and when?
36 Will I have an epidural? 
37 Will my surgery be open or laparoscopic? 
38 How long is the incision with an "open" procedure? How is this different with a laparoscopic procedure? 
39 How will the incision be closed? Stitches, Steri-strips, glue or staples? When will the stitches/staples be removed?
40 How big will my stomach be? 
41 How will you stitch the stomach together? Resect with stapler and then the Serosal to Serosal stitch?
42 How long will my common channel be? Do you use the Hess method? 
43 How long will my Alimentary Limb be?
44 How long will my Biliary Limb be?
45 How long should the surgery take, barring any complications? 
46 Will you do a liver biopsy? 
47 After surgery, how do you detect for leaks? When do you do the leak tests? 
48 Will I have a Foley (Urinary catheter)? If so, how long will it stay in? 
49 If I am nauseated or vomiting after surgery, what will you do for me? 
50 What are the odds of developing adhesions as a result of DS surgery? 
51 What are my odds of getting a UTI (Urinary Tract Infection), bladder infection or yeast infection? 
52 Will I have a drainage tube? For how long? Will I go home with it? Who will remove it?

 Questions General

53 How soon can I be scheduled for surgery? 
54 What percentage of my excess weight can I reasonable expect to lose? 
55 What do you think my goal weight should be? What is the goal based on? 
56 Will I be tested for H. Pylori Bacteria (causes Peptic Ulcers)? And, is there anything I can do to prevent it? 
57 In your practice, is there a surgeon on call 24/7, 365 days a year in case of emergency? 
58 Will this on call surgeon be available for telephone consultations with out of town physicians? 
59 Will I bring my Cpap machine with me to the hospital? 
60 Are there gowns in the hospital for my size? 
61 Will I get a binder (Surgical support) in the hospital or do I need to provide my own? Will I need one after I leave the hospital? 
62 Can someone stay with me IN the hospital? 
63 How long will I be in the hospital?
64 What is required for me to be dischargable?
65 When are the staples/stitches removed? 
66 How long do you require out of town patients to stay in the area after discharge from the hospital? 
67 Can lab work be ordered by my PCP and faxed to your office for analysis? 
68 Will you order my medications pre-op? Post-op? How long will you consider me your patient? 
69 What do I do about my medications pre-op? Post-op? 
70 Do you have a list of medications that I can/cannot take? 
71 What causes a hernia? How can I prevent getting one? What are my odds of developing a hernia? 
72 What is an internal hernia? Does having DS increase my chances of getting one? 
73 Does having DS put me at a greater risk than the general population for developing intestinal/bowel problems? 
74 How might this surgery affect health problems I may develop later? (Cancer treatment, need for stronger meds for arthritis, ostoeporosis, etc?)
75 Should I get a medical alert bracelet? What should I put on it?
76 What supplements/vitamins do you recommend to help prevent/lessen hair loss? 
77 What about future pregnancies? Will they be considered high risk? Will I need a special OB/GYN?

 Questions Post-op

78 How will you manage my post-op pain while in the hospital? 
79 What level of pain/nausea should I expect?
80 What type of pain medication will I be given for home use after surgery? 
81 Generally how long do your patients stay in the recovery room? 
82 Do all of your patients routinely go to the ICU after leaving the recovery room for the first day? 
83 Will I be in ICU post-op, due to my sleep apnea? 
84 Will I have leg compression devices that help prevent blood clots? 
85 How long after surgery will I be at an increased risk of developing blood clots or leaks? 
86 How soon will I be able to shower after surgery? Wash my hair? Have a bath?
87 How long will it be before I an 100% healed from surgery barring any complications?
88 How long should I expect to be off of work?
89 What type of follow-up do you prefer for DS post-ops? Can a local doctor provide this? What kind of doctor? How can she/he communicate with you about my particular long-term needs? 
90 How often will labs (Blood tests) be checked in year one? Thereafter? 
91 After surgery, when can I resume my normal activities? 
92 How soon will I be able to drive? 
93 Do I have a limit on how much I can carry or lift? For how long? 
94 How soon can I begin an exercise regimen other than walking? 
95 What types of exercise do you recommend and at what stage post-op?
96 How often are post-op follow-up visits scheduled? 
97 Will I see you or someone else at these visits?

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Thank you to MajorMom for providing this helpful list!
 

2/7/08

Vitamin & Mineral Schedule and Shopping List for

Distal RNY, BDP, BPD/DS 
 

The following is NOT to be construed as medical advice.  This Schedule has been known to work for most Distal RNY Patients and not intended to replace your doctor's instructions. 
 

Our prices on our products, roughly figured for Distal RNY, not considering sales, specials or applicable taxes or shipping and handling fees. 
 

SCHEDULE: 
 

AM:  2- Vitamin C; 2- Iron (Polysaccharide) or 12 Tender Iron (Carbonyl)

Lunch: 1- Vitamin A; 1- Vitamin B-12; 1- B Complex; 1- Vitamin E; 2- Calcium Citrate; 1- Multi;

      1- Zinc

Evening: 2- Vitamin A; 1- B-1; 1- Vitamin E;  2- Calcium Citrate;  1- Multi;  1- Zinc; 1 Vitamin D-3

Bed Time: 1- Vitamin A;  1- Vitamin C;  2- Calcium Citrate 
 

 

Initial Shopping List:
 

Qty    Item     Price    Will Last   Avg Cost/Day
     1 Dry A (25,000IU)    100 Cap  $7.49  25 days = .30

      1 Vitamin B-1 (Tender Thiamin)    200 Cap  $9.99  200 days =   .05

      1 Vitamin B-12 Sublingual (5000mcg)    60 Loz  $28.99  60 days  = .48

      1 Vitamin B Complex    200 Cap  $19.99  200 days = .10

      1  Vitamin C (1000mg)*    500 Tab  $17.99  166 days = .11

      1  Vitamin D (50,000IU)    100 Cap  $24.99  100 days = .25

      1  Dry Vitamin E (400IU)    250 Cap  $26.99  $125 days = .11

      1  Calcium Citrate w/ D & Mag    240 Cap  16.99  40 days = .42

         (500mg, 200IU, 250mg)

      1  Iron (150mg Polysaccharide Iron)*    100 Tab  $24.99  50 days = .50

      1  Multi-Vitamin/Mineral*    500 Tab  $18.99  250 days  = .08

      1 Zinc (50mg)      250 Tab        6.99       125 days  = .06

           Average cost per 30 Day Month  = $73.80      Per Day    = 2.46 
 

*If chewables are desired we can substitute:

      1 Iron (Tender Iron) (25mg Carbonyl)    400 Tab  $15.99  33 days = .48

      1 Chewable Vitamin C (500mg)    500 Tab  $15.99  166 days = .10

    1 Chewable Multi-Vitamin/Mineral    300 Tab  $14.79  150 days =  .10

    Average cost per 30 Day Month  = $73.50  Per Day    =  2.45

     

This is to help you to calculate & budget your monthly cost for basic vitamin and mineral needs.

Pricing based on current prices on date printed above and subject to change without notice.

 

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RNY compared to the DS

RNY – expected weight loss

• 50-65% expected excess weight loss (percentage varies in opinion – this is the most commonly seen estimate)
  • Results may vary
• Regain
  • Possible regain: more prevalent after 5 years
  • 50-100% regain of weight has been recorded
  • Results may vary
  • Must follow “pouch rules” in an attempt to not regain

DS – expected weight loss

• 85% expected excess weight loss
  • Results may vary
• Regain
  • Studies show little to no regain (20 pounds recorded)
  • Results may vary
  • Highest success rate over 10 year study (78% avg. Excess Weight Loss – EWL)

 RNY – have a stoma (stomach made into a pouch – size of an egg)

• Size: 2 oz
  • Stretch to average size of 6 oz in 2 years  (possible to stretch up to 9-10 oz)
  • You can eat more as time goes by
  • Average after 1 year is 1-1.5 cups of food
• No Endoscopes on blind stomach/remnant stomach that is bypassed
  • Doctor evaluation: cannot use an endoscope (to find ulcers and tumors)
  • RYGBP construction makes the large bypassed distal stomach inaccessible to standard non-invasive diagnostic modalities. Neither x-ray contrast studies nor endoscopy can assess this potentially important but hidden area.
• Stoma: pouch
  • Should not take Nonsteroidal Anti-Inflammatory drugs (NSAID).
• NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascription, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish
  • NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains.
  • Taking NSAIDs could develop into a bleeding ulcer and interfere with kidney function.
• Possible Problems
  • Ulcers (Some doctors recommend taking prilosec for 6 months to 1/2 years in an attempt to prevent the ulcers)
  • Possibility of a staple line failure
  • Noncompliance: simply do not lose enough (even with following the rules)
  • Vitamin Deficiencies
  • Narrowing/blockage of the stoma
  • Vomiting if food is not properly chewed or if food is eaten to quickly
  • Dumping syndrome, NIPHS, Hypoglycemia
    • No Valve (pyloric valve that opens and closes to let food enter intestines is bypassed) which means food empties directly into the small intestines and causes dumping and/or can cause NIPHS or Hypoglycemia
• Dumping: food (most commonly sugar but not necessarily “just” sugar) enters/dumps directly into small intestines and causes physical pain (some people believe this pain enforces good eating habits)
  • Dumping varies in degree of occurrence and discomfort
  • Dumping symptoms:
    • Nausea
    • Vomiting
    • Bloated stomach
    • Diarrhea
    • Excessive sweating
    • Increased bowel sounds
    • Dizziness
    • “Emotional” reactions
• NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction.  The change occurs on a cellular level, hard to diagnose.  Treatment: Removal of half the pancreas.”
  • RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow.  Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food.  With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.  
  • NIPHS, Hypoglycemia is deadly if not corrected

 DS – whole stomach (size of banana)

• “Whole working stomach” - meaning the stomach’s outer curvature is removed as opposed to making a pouch/stoma.
  • Part of the stomach removed is where most of the hormone called Grehlin is produced.
  • Grehlin gives the sensation of hunger so by removing most of that section of the stomach a DSer is not as hungry as before.
• Whole working stomach: no blind stomach.  Endoscope can be used.
• Can take NSAIDs
• Do not need to take Prilosec to prevent ulcers.
• Valves are in tack: no Dumping Syndrome or NIPHS

 RNY – Eating

• Eat protein first
  • 60g of protein a day
• Recommended to chew food to liquid consistency (pureed, soft, thoroughly chewed)
  • This is more important for people early out (new pouch stomach will stretch out with time).
  • Food is thoroughly chewed to prevent blockage (the hole/path leaving the stomach and into the intestine is roughly the size of a dime).
  • To get food unstuck, patients drink meat tenderizer mixed with water.
• Low carbohydrates
  • Carbohydrates can slow weight loss and lead to possible regain
  • Avoid sugars in particular (to prevent dumping syndrome)
• Low fat
  • Foods high in fat may cause Dumping Syndrome
  • Fatty foods can lead to slow weight loss or possible regain
• 64 oz of water
  • Stop drinking within 15-30 minutes of a meal
  • Do not begin drinking after a meal for 1-1.5 hours
  • Some doctors do not encourage the use of a straw (pushes food too quickly through the stomach and can cause gas/discomfort)
• Water Loading
  • 15 minutes before the next meal, drink as much as possible as fast as possible. 
  • Water loading will not work if you haven’t been drinking over the last few hours.
  • You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
    • Disclaimer: this is a practice some people use to feel “full” and lose weight. Not a requirement.

DS – Eating

• Eat protein first
  • 80-100g of protein
  • DS patients can on average eat more food than any other type of weight loss surgery.
• Low carbohydrates
  • Carbohydrates can slow the weight loss and lead to possible regain
  • No dumping syndrome from eating sugar (or fat)
• Eat high in fat
  • DS only absorb 20% of fat (do not need to eat low fat)
    • If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or RNY absorbs ALL 20g. (this is just an example, measuring absorption is not an exact science)
    • When experiencing a “stall” (slowed weight loss/plateau) a DS patient commonly increases fat consumption to resolve
• 64 oz of water
  • Can drink with meals
  • Can use a straw

RNY – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins B12, iron, and zinc
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Gas
  • Constipation
  • Dumping in the form of loose stools
• Reversible procedure (Reversals of any surgery is very complicated)
  • Revision often performed instead of reversal
  • Revising to a different type of surgery is possible.

 DS – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins A, D, and iron
  • “Water soluble”/ “water miscible” / “dry” vitamins absorb best (in other words get vitamins that are not fat/oil based)
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Gas
  • Loose stool (Most common in the first few weeks of surgery. Generally food related)
• Reversible procedure
  • The intestinal bypass is reversible for those having absorption complications
    • revision: lengthening common channel (to stop losing weight and/or to absorb vitamins)
  • Stomach is obviously not reversible (part of stomach was removed)

 

RNY - Diabetes

• 85% cure rate
  • RNY can put diabetes in remission.
  • Diabetes may come back in two or three years--even if the
    patient maintains most of their weight loss.
  • Even a small amount of weight gain, long-term, can cause a diabetes
    relapse.

 DS – Diabetes

• 98 % cure rate for type II diabetes.

 

DS – Myth or Fact

The DS is only recommended for the super morbid obese (BMI over 60) = Myth / Not True

• To be eligble for ANY type of weight loss surgery, a person has to be 100 lbs. over weight or have a body mass index (BMI) of 40 or more.
• BMI’s under 40 have also been approved (usually require a comorbidy/health problem - an example is sleep apnea).

The DS is “experimental and investigational” = Myth / Not True

• Medicare approves the DS
• Many insurance companies are starting to cover the DS.
• DS has been performed since the 1970s

DSer will have a problem when they become old = Not True

• We wont need to eat as much when we are older b/c our bodies will adapt
• The little hair-like villa located in the intestines grows longer to adjust to the new digestive system (grows longer to increase absorbtion).

DSer’s gas stink = true

• The gas does smell. (This is true for the DS and RNY)
• There are products called air fresheners that a person can use.
• May take Flagyl or fish zole

DSers may need to wear a diaper = Myth / Not True

• That is silly

Skin color turns yellow or pallor = Myth / Not True

• Patients who follow their regular vitamin regime (keep up with blood work) do not turn pallor
• If someone looks pallor, they could have a vitamin deficiency.  This applies to any type of weight loss surgery. For both RNY and the DS.
• Vitamins and blood work must be monitored for life. For both RNY and the DS.

DSers will have a heart attack from all the fatty food they eat = Myth / Not True

• Cholesterol levels lower after having the DS. 
• 80% of the fatty food is not absorbed – the fatty food is healthier to eat as a DSer than a person without surgery.
• If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or a person with the RNY will absorb ALL 20g.  Good meal for the DSer. (this is just an example, measuring absorption is not an exact science)

Dsers don’t need to exercise = Myth / Not true

• DSer’s are aware of the benefits of exercise (body and soul).
• Exercise helps in losing weight and maintaining goal weight 

 *Some practices may not be used by all patients. Some recommendations will differ depending on a person’s surgeon.  Possible issues are just that, “possible,” and may or may not occur.  

Not every surgery will be right for everyone. Not every surgery will be covered by insurance. Good luck to everyone and thank you for reading my comparison chart. Hayley F.

 

* Contact [email protected] for photo issues like resizing your avatar.

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