There is a wealth of information on this site. It is probably the Smithsonian of DS information.

http://dsfacts.com/

Here is a link to a post that should cover all the bases. Just remember to pack light. You REALLY won't need much. Trust me on this.

http://www.obesityhelp.com/forums/ds/3862854/List-of-things-to-take-to-the-hospital-things-Ill-need-at/

 This was posted on the RNY board just 2 shorts weeks prior to my already scheduled RNY. It caused quite a stir. It was this, my first surgery war,  that introduced the DS to me. Prior to that I had never even heard of it. Thank goodness for ignorance eh?

 

http://www.obesityhelp.com/forums/rantsandraves/3830240/My-Thoughts-on-The-DS/

 

Message
	ValueMe Buffalo, NY RNY Member Since: 09/05/08 [Latest Posts]	Post Date: 1/8/09 2:10 pm Last Edit: 1/8/09 4:48 pm I have been seeing DSers pronouncing the "joy" of DS over RNY. I want to see some stats on whether DSers have a lower rate of revisionism/wt. regain than RNYers. Personally, I don't think so. The reasons that DSers seem to be so joyeous about their choice is because they can EAT way more than RNYers and consume more Fat. Well, I frankly find that OFFENSIVE. One of the main reasons I chose RNY was because I want to CHANGE, I want to DEVELOP NEW, Better eating habits and a NEW Lifestyle. I want to use my WLS as a TOOL, NOT as a CRUTCH or Wheelchair. So is the DS some type of panacea for wt loss patients, if so why haven't more people gotten it. I just can't see bragging because you had WLS and can still pig out and lose weight...I thought having life threatening and life changing surgery was about a desire to change. The DS just seems like a way for some people to have their cake and EAT it too>>>for a while anyway until it catches up to them. In the end, I guess it is like any other WLS, It IS a TOOL - and if you don't maximize it's use in that short window of time (Meaning Developing new good eating and exercise habits) the Fat will just come back on and then folks will be to the REVISIONIST! Truly, excluding some special condition, is there any way to gain weight other than eating more calories than one burns (basically overeating)...I think not, so my thinking is why turn WLS into a Crutch/Wheelchair and every 3-5 years be back under the knife. I'm sick of people wanting a quick fix...WLS IS NOT one, it will take hard work for the rest of our lives. OHHH Junk, over 1000 hits and 77 posts so far     And, I'm NOT reading past 1 1/2 pages, after that it's just redundancy, ROLMAO!!! to ME! Be Well, Live Well I Am Most Excellent - Affirmed Only Of GOD. I wish for You, what I pray for Myself: Wellness, Happiness and Success In ALL Things Good! First Weigh-In:       Day of Surgery:       Current:        Goal:

 

(This explanation is courtesy of Diana Cox.)  Put it in a safe place or you're going to freak out.

A "stall" is inevitable, and here is why.

Our bodies use glycogen for short term energy storage. Glycogen is not very soluble, but it is stored in our muscles for quick energy -- one pound of glycogen requires 4 lbs of water to keep it soluble, and the average glycogen storage capacity is about 2 lbs. So, when you are not getting in enough food, your body turns first to stored glycogen, which is easy to break down for energy. And when you use up 2 lbs of glycogen, you also lose 8 lbs of water that was used to store it -- voila -- the "easy" 10 lbs that most people lose in the first week of a diet.

As you stay in caloric deficit, however, your body starts to realize that this is not a short term problem. You start mobilizing fat from your adipose tissue and burning fat for energy. But your body also realizes that fat can't be used for short bursts of energy -- like, to outrun a sabertooth tiger. So, it starts converting some of the fat into glycogen, and rebuilding the glycogen stores. And as it puts back the 2 lbs of glycogen into the muscle, 8 lbs of water has to be stored with it to keep it soluble. So, even though you might still be LOSING energy content to your body, your weight will not go down or you might even GAIN for a while as you retain water to dissolve the glycogen that is being reformed and stored.


The surgery works.  Just focus on healing and stay away from the scale or you'll drive yourself crazy.

Flagyl W/O Rx- Per LeaAnn's Blog

I'm getting a lot of requests for the link on how to get Flagyl without a prescription, so I'll just post it here so no one misses it:

http://www.lambriarvetsupply.com/i_001TLZOL-100_Fish-Zole

These are the 250 mg. so you'll need to take TWO of these 3 x a week, OR there are also some 500 mg. available on that same site. The tablets taste gawdawful, so put them WAY back on your tongue to swallow them and swallow them with something strong tasting (lemonade) or milk....

Here is a portion of published medical text on the need for antibiotics because of bacterial overgrowth [in our bypassed loop of intestine] (supplied by our excellent resident Nurse Practitioner, Carolyn):

From: http://www.oley.org/lifeline/bacter.html

EXCELLENT ANIMATION OF DS SURGERY If you have trouble with the link, copy and paste this link into the address bar of your browser. http://cmcwls.com/default/understanding-obesity/biliopancreatic-diversion About halfway down the page click on the "click here to view animation link" below the DS section. Vitalady's DS vitamin plan http://www.obesityhelp.com/forums/DS/3815623/Trying-to-Paste-VitaLadys-DS-Schedule/ AM: 2 Vitamin C (1000mg ea) 3 Iron LUNCH: 1 Vitamin A (25,000 IU) 1 Vitamin B-12 (5000mcg) 1 B-Complex 1 Vitamin D-3 (50,000 IU) 1 Vitamin E (400 IU) 3 Calcium Citrate 1 Multi 1 Zinc (50mg) DINNER: 1 Vitamin A 1 Vitamin B-12 1 B-Complex 1 Vitamin E 3 Calcium Citrate 1 Multi 1 Zinc BEDTIME: 3 Calcium Citrate 2 Magnesium Citrate

 

Not to be construed as medical advice, this list includes labs we have had performed as gastric bypass patients.  The first group, every 3 to 6 months for life, as we are able.  The second group, annually, as long as the results were comfortably within normal limits for more than 2 years in a row.

 

1^st Group

 

*80053          Comprehensive Metabolic profile: (sodium, potassium, chloride, glucose,BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase)  (10231)

* 84134          Pre-albumin:

* 7600            Lipid profile: (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)

* 10256          Hep panel: includes ALT (SPGT) & GGT)

* 84100          Phosphorous – Inorganic:  (718)

* 83735          Magnesium:

* 84550          Uric Acid:  (905)

* 7444            Thyroid panel: (T3U, T4, FTI, TSH)  (84437; 84443; 84479; 84480)

* 85025          Hemogram with platelets:  (1759)

* 7573            Iron: TIBC, % sat

* 83550          Ferritin:  (457)

* 84630          Zinc:  (945)

* 84446          Vitamin A:  (921)

* 82306          Vitamin D: (25-hydroxy)   (680)

* 84052          Vitamin B-1: (Thiamin)  (4052)

* 84207          Vitamin B-6: (Pyridoxine)

* 7065            Vitamin B-12 & Folate:  (82607; 82746)

* 83970          Serum intact: PTH

* 83937          Osteocalcin:

* 84597          Vitamin K:

* 85610          PT:

* 85730          PTT:

* 86141                     C Reactive Protein

 

2^ND GROUP

 

* 593              LDH:

* 31789          Homocysteine, Cardio:

* 83921          MMA:

* 367              Cortisol:

* 84255          Selenium:

* 84590          Vitamin E:

* 82525          Copper:

 

 

For diabetics: *496 - HEMOGLOBIN A1C   

 

 

 

POSSIBLE DIAGNOSIS CODES

 

 

269.2              Hypovitaminosis

269.8              Vitamin D deficiency

275.40            Calcium deficiency

266.2              Cyanocobalamin deficiency  (B12)

281.1             other B12 deficiency anemia

281.0              Pernicious anemia

280.9              Iron-deficiency anemia

281.2              Folate deficiency anemia

285.9              Anemia, unspecified 

269.3              Zinc deficiency

244.9              Hypothryoidism

250.0              Diabetes 

401.9              Hypertension

276.9              Electrolyte and fluid disorders

272.0              Hypercholesterolemia

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

 

*579.3             Surgical malabsorption* 

*579.8             Intestinal malabsorption  *

 

*  Bands or sleeves should not use these codes as they are not accurate.

*Some insurance companies will not pay for any procedure that uses these codes.

This is NOT medical advice, just my own targets for the main blood levels I watch. 

 

Protein:            7's

Albumin:          4's

Pre-Albumin: 20-30's

 

Iron:                80-100

Ferritin:        200-300

HGB:              12+

HCT:               36+

 

Vit A:               60- 80

Vit D:              80-120 

 

Calcium:        9.0-9.4

PTH:               20-40

 

Vit B1:                        Mid to top of range

Vit B6:             Mid to top of range

Magnesium:  Mid range  (but also go by if we have leg/foot cramping)

Zinc:                Mid range

 

Vit B12:          1000 +

Folate:            Top of range

 

AST (sgot):    Below 40

ALT (sgpt):     Below 40

 

We usually want to "meet or beat" pre-op levels.  In some cases, higher is better, and in other cases (Cholesterol, PTH for example), lower is better.

 

The only things *I* don't mind being on the high end of out of range are Ferritin and B12.  But that applies to ME. 

 

My doctors don't show interest in any of these until I am out of range. *I* am interested when I begin heading that direction.

 

  lab rat chart

http://www.epursimuove.com/ds/ 



  ds procedure~~from Lori

A short and easy description of the DS procedure

Duodenal Switch

This procedure modestly restricts food intake while radically limiting the absorption of calories, especially the obesity causing calories from fat, complex carbohydrates, and starches. Approximately 3/4 of the stomach is removed, but the natural outlet of the stomach, the pylorus, is left in, allowing the stomach pouch to function more naturally. As the stomach pouch stretches out in the first year after surgery, patients are moderately limited in the amount of food they can eat, reduced to about 2/3 of what they could eat before surgery. However, patients are not limited in the types of food they are able to eat, tolerating meats and whole vegetables without difficulty.

The food is rerouted through a radically altered intestine, limiting the amount of food that is absorbed, which is what results in weight loss, despite the patient eating freely. The intestine is essentially reduced to less than half of its length and the digestive juices (the biliopancreatic secretions) mix with the food at only the last 10% of the intestine. This arrangement means that not only are the total amount of calories eaten not absorbed, but especially fats, complex carbohydrates, and starches - the things that contribute to obesity.

Patients undergoing duodenal switch eat normally and have bowel habit changes characterized by frequent (2-4 per day) soft stools and a propensity for gas. Both of which are generally malodorous unless a stool deodorant (such as Devrom) is taken.

A	The stomach is trimmed to a 4-6 ounce volume, preserving its natural inlet and outlet ( the pylorus). Trimming the stomach results in a temporary restrictive effect on eating for several months, which then reverts to normal, and decreases the incidence of ulcer formation as well.
B	The small intestine that the stomach normally empties into (the duodenum) is "switched" to the downstream portion of the small intestine (the digestive limb-D). The outflow from the duodenum, carrying the digestive juices and enzymes (but no food) becomes the bilio-pancreatic limb (C) utilizing approximately 60% of the small intestines length.
D	The digestive limb takes up approximately 40% of the small bowel length, and most of this length is upstream from where the biliopancreatic limb deposits its juices to allow for the absorption of fats, starches, and complex carbohydrates.
E	The common limb, being the portion of intestine where both food and biliopancreatic outflow meet, is made up of the most downstream 100 cm of small intestine and is the only portion where absorption of dietary starches, fats, and complex carbohydrates occurs. The capacity for absorption reaches a maximum within several months after surgery and cannot be over eaten, resulting in long term sustained weight loss..
F	The gallbladder and appendix are removed.

  rny vs. ds~~from hayley_hayley

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

 

Antibiotics

If the dietary therapy is insufficient to control symptoms, it should be continued with the addition of antibiotics. Broad spectrum antibiotics, such as Bactrim and Flagyl, used continuously, at half the usual antibiotic dose, are often very effective. Trials of different antibiotics may be needed to find the right combination. In addition to Bactrim and Flagyl, we have found Augmentum and Keflex to be beneficial. Our most severe case of small bowel bacterial overgrowth was a child with short bowel syndrome who suffered severe d-lactic acidosis with seizures. He went through several treatment regimes before we identified oral Vancomycin, a potent antibiotic, as an effective measure to control his overgrowth. After the acute overgrowth has been controlled, antibiotic therapy may be required only for a few days out of every month or may be so severe as to require prolonged continuous therapy. If symptoms reappear after a few months, switching antibiotics is often necessary. We have seen no development of antibiotic resistant complications utilizing this therapy over prolonged periods of time, probably because of the lower doses utilized.

I also asked Carolyn about neuropathy and resistance concerns with the long-term use of Flagyl and she had this to say:

"The acute lethal dose of metronidazole in humans is not known. Neurotoxic effects, including seizures and peripheral neuropathy, have occurred in individuals who received 6–10.4 g of metronidazole orally every other day for 5–7 days for the treatment of malignant tumors. Nausea, vomiting, and ataxia without serious resultant toxicity have been reported in individuals who ingested up to 19.5 g of metronidazole in a single dose. The oral LD₅₀ of metronidazole exceeds 5 g/kg in albino rats.

If acute overdosage of metronidazole occurs, symptomatic and supportive treatment should be initiated.

Above quoted from Medscape.

Please note neurotoxic dose is more than 12 times the usual prophylactic DS dose (250-500mg 3X a week). Your body processes it so that it is unlikely to "build up" to a toxic dose, unless you are in liver failure, in which case you would have other, more pressing concerns.

Intestinal flora that become resistant due to regular use of Flagyl is possible but not likely. Even if you were to develop a resistant strain of c. diff from regular routine use of Flagyl, for example, it would still be susceptible to and treatable with vancomycin. 

Currently the only known resistance to Flagyl is some strains of trichomoniasis, an STD. It may reassure those of you who may be exposed to STD's that resistant strains of that bug can be treated with Tinadazol.

My advice is to use whatever means of gas amelioration works for you, that you are comfortable with, and that you can afford. Flagyl is not

I flew to Denton, TX on 1/19/09. Checked into my hotel at around 6pm.  The following morning I attended the seminar conducted by Dr Stewart and his bariatric coordinator, Leah. I was really glad that I chose to stay in the same hotel the seminar was held in because it started at 8am. The hotel, Holiday Inn Hotel and Suites, was really nice. I mean really really nice. It is brand new and some kind of flagship hotel for the company. It looked like a luxury hotel. The staff was so friendly and accommodating. I had a nice sized room with a king sized bed. The bed was the most comfortable hotel bed I have ever slept in. The room also had a small fridge and microwave. I paid the Denton Regional rate which came to $100 a night after taxes, not too bad for the room I got. . I plan on staying here with my family when I have surgery.

The seminar was informative. I don't think I learned anything I hadn't heard before but it was a nice refresher course. With the information presented my decision to have the DS was justified in my mind. There were probably 30 or so people that attended. I was ever so lucky to have the narcoleptic snoring lady next to me. And, unfortunately for me, she smelled really bad. I kept getting this gawd awful odor. I would hold my breath and turn away to quietly gasp for air. I wanted to move to another table but was afraid to hurt her feelings. Between the smell and the snoring. and I mean loud snoring, I was distracted, to say the least. Dr. Stewart spoke until 12:30. No breaks. Most of that time was spent answering peoples questions.

Following the seminar I had an appointment with Dr. Stewart in his office. The office was really nice, clean and well decorated with very large chairs :).  I was really anxious because I had a flight out at 4:30. My appointment was at 1:30. I had about a 40 min drive back to the car rental company and then they drove me to the terminal. I was cutting it close. It was a nail biting experience, literally! I met with Dr Stewart and unfortunately because things were so rushed I didn't get to spend all the time I wanted with him. I had my list of questions (posted in blog) and I scanned over them to ask the questions I thought would need to be answered by him and skipped the ones I figured could be answered by his coordinator. I was impressed with him. He seems very reserved but confident and competent. In the seminar he mentioned that he had only done around 50 DSs. He had years of experience with other types of bowel surgery however, and has a low mortality/morbidity rate. I was also impressed with how open and honest he was about any issues or mistakes he had made. He stated in the seminar that there was a period of time that, related to the advice of other WLS Drs, he did not repair the defect made in the greater omentum during surgery. Apparently there were issues with those patients getting hernias. He now always repairs the defect. I was satisfied with him and comfortable with him as a surgeon. 

As soon as my appointment was over I rushed back to the airport and flew home. Leah the coordinator was supposed to submit my paperwork by that Friday 1/23/09. She had to wait until the Dr's dictation from my visit was transcribed. I don't know what the hold up was but my paperwork was not submitted until the following Friday 1/30/09. To make a long story short my paperwork was supposed to be addressed by Cigna and I was supposed to have a nurse assigned within 48 hrs. I called on Wed. and none of that had been accomplished. I am not sure what the delay was but when I called the woman at Cigna said she was making my request urgent. She said I could  have an answer in as soon as 24 hrs. I called several times over the next couple of days. I really was getting psyched. I wanted so badly for my request to be approved. I imagined it. I even dreamed about it, literally. I was expecting a denial but really  hoping for an approval. I got my expected answer when I called Friday afternoon while I was driving to Orlando to attend the support group there. DENIED. I expected that but still was disappointed. I was told there would be a peer to peer review on the following Tues between Dr Stewart and the Cigna medical director.

I attended the seminar that Sat. which was wonderful. There were around 20 people there. All were DSers. There were two of us pre ops there. I was happy to meet the other pre op, joslim, who I had met on the boards and introduced to the DS. In her last message to me she seemed pretty set on getting the RNY. Apparently, after I introduced her to the DS, she did some research and came to the same conclusion as me. The DS is the best WLS available and that's what we want. I was happy to know I had that kind of affect on someone. I am already paying it forward. lol.

The following Tuesday came and the peer to peer review ended up as I expected. Cigna upheld its denial. I immediately started preparing for an appeal . At least mentally. To be very honest I don't know how to proceed. I spoke with Kelley Lindstrom of obesitylaw.com. She was nice but when asked directly if they have fought and won this type of case before she was evasive. She said this is not a type of case that they get very often. She also stated that usually when they get an unusual denial like this it usually means there had been a change to an insurances policies and she will get multiple calls for the same type of denial. I know that the policies at my insurance company have been in place for several years at least. Anyway, her evasive answer, and the fact that I had to pony up $950 to hire them, caused me to look at other resources. I got the name of an appeal advocate from someone on the DS boards. Karlene Dittrich is apparently a pit bull when it comes to the insurance companies. She had been successful at assisting 2 OH members to overturn denials. These were for circumstances completely different from mine though. When I spoke with her I was a bit unimpressed. She just didn't sound that competent to me. She also seemed to skirts some of my questions with very general answers, and never seemed to give a direct answer. Her fee was $95 to prepare the appeal letter. She would then assist, if needed for subsequent appeals. The clincher for me was when I asked if I would be able to review the letter she would be submitting on my behalf. Her answer was a flat out "no". She said this was related to proprietary information. I really don't feel comfortable with relinquishing all control to someone. Especially if this someone cannot say " I have fought and won this exact type of case". 

It was at this point that i realized that no one will fight my case as passionately as me. No one else will have the same vested interest. I can gather information, studies, and articles and write my own letter. I have decided this is the route I am going to  take. I have to say though, the task of putting this appeal "letter" together is a rather daunting task. The letter is really a book. It will consist of my personal information regarding my application, subsequent denial, medical records, and many studies and articles. I have been feverishly gathering information to support my case. I have lots of STUFF  but don't exactly know what to do with it. CaliMom was nice enough to share a draft of her appeal letter. She was denied for the same reason and had it overturned. She was in CA though, and they have an external review board  that is pretty WLS friendly. Or that's what I heard anyway. Part of my frustration is just not being able to understand my insurance appeal process. I can't determine from my summary plan description if there is an external review, after I exhaust the internal review process, or not.

So that's where I am now. In limbo. Not sure exactly how to proceed. I have at least decided that I will pursue the appeal on my own. I just feel like I would be my best advocate. I have lots of articles to substantiate my case and a sample appeal letter. Now if I could just get a few hours to myself, with no kids to interrupt, to get all this stuff together. Sigh......I think I can.....I think I can..........I think............

What is the pre-op diet?

Will I be tested for H. Pylori bacteria? And, is there anything I can do to prevent it?

In your practice, is there a surgeon on call 24/7, 365 days a year in case of emergency?

Will this on-call surgeon be available for telephone consultations with out of town physicians?

What year did you begin performing WLS?

Are you a general surgeon, or is your practice limited only to bariatric surgery?

When did you begin performing the DS? How many DS surgeries have you performed?

What is your overall mortality rate?

To what do you attribute these deaths?

When did these deaths occur?

How many DS patients lost? When did these deaths occur?

What is your complication rate? What sorts of complications have your patients had?

How many of your patients have lost their spleens?

How many of your patients have had leaks?

How many of your patients have had serious post-operative infections?

Have you ever started a DS and could not complete it?

What is the youngest/oldest person you on which you would perform this surgery?

How soon can I get scheduled for surgery?

Do you perform the surgery alone or will you have a surgeon assisting you? Who will that be? Can I review his/her credentials?

What are the preparations for the surgery? (i.e. diet, bowel prep, special soaps, etc)

How long will my common channel be?

Do you use the Hess method?

How big will my stomach be?

Will my surgery be open or laparoscopic?

How long is the incision with an "open" procedure? How is this different with a laparascopic procedure?

How will the incision be closed? Stitches, Steri-Strips, Glue or Staples? When will staples or stitches be removed?

How long should the surgery take, barring complications?

Will I have a choice of anesthesiologists?

Will I meet the anesthesiologist before the day of surgery?

Will I have an epidural?

How will you manage my post-operative pain while in the hospital? PCA?

Generally how long do your patients stay in the Recovery Room?

Do all of your patients routinely go to ICU after leaving the Recovery Room for the first day?

How will you prevent blood clots? Will I get injections of Heparin to prevent blood clots? Will I give myself heparin (lovenix) injections after I leave the hospital?

Will I have the leg compression devices that help prevent blood clots?

After surgery, how do you detect for leaks? When do you do the leak test?

Will I have a Foley? If so, how long will it stay in?

Will you remove my gallbladder and/or appendix removed during surgery?

Will you do a liver biopsy?

If I am nauseated or vomiting after surgery, what will you do for me?

If I have adhesions from past surgeries will you remove these during DS surgery?

Will I have a drainage tube? For how long? Will I go home with it? Who will remove it?

Will I have a feeding tube? For how long? Will I go home with it? Who will remove it?

How soon will I be able to shower after surgery? Wash my hair?

How long after the surgery will I be at an increased risk of developing blood clots or leaks?

Will I get a binder in the hospital or do I need to provide my own?

How long will I be in the hospital?

Can someone stay with me IN the hospital?

How long do you require out of town patients to stay in the area after discharge from the hospital?

What are my odds of developing a hernia?

What is an internal hernia? Does having the DS increase my chances of getting one?

Does having a DS put me at greater risk than the general population for developing intestinal/bowel blockages?

What type of pain medication will I be given for home use after surgery?

If I am nauseated or vomiting after discharge from the hospital what will you do for me?

How long before I will be 100% healed from the surgery, barring any complications?

How much protein should I be consuming per day? 30/60/90

Can I use a protein drink/bar as a supplement?

Can I /should I drink milk after surgery? Sugar? Fats? Sugar-Free Soda?

What will my diet be at discharge from the hospital? One week after surgery? Six Weeks after Surgery?

How long will I not be permitted to eat solid foods?

How strict will my diet be for the rest of my life. What is the required post-op diet?

How often will I need lab work completed (blood tests)?

Do you have records on your patients weight loss statistics?

What do you think my goal weight should be? What is this goal based on?

Can lab work be ordered by my PCP and faxed to your office for analysis?

Will you order my medications pre-op? Post-op? How long will you consider me your patient?

After surgery, when can I resume my normal activities? How soon will I be able to drive?

Do I have a limit on how much I can carry or lift? For how long?

How soon can I begin an exercise regimen, other than walking?

Do you have a list of medications that I can/cannot take?

Will all my subsequent pregnancies be considered high risk? Will I need a specialized OB/GYN?

What supplements/vitamins do you recommend to help prevent/lessen/ hair loss?

How often are post-op follow-up visits scheduled? Will I see you or someone else at these visits?

Will any future GI diagnostics tests (upper GI, endoscopy, colonscopy) need to be performed because of DS?

I am going to start archiving a list of my fav recipes so I will have them to refer back to.

ENJOY!!!



Maddie's Tomato Pie

1 1/4 cup flour
2 Teaspoons of baking powder
1/4 Teaspoon of crushed basil
1/2 Teaspoon of salt
1/2 Cup of solid shortening (I use butter Crisco)
1/2 Cup Sour Cream
5 large tomatoes peeled and sliced
3/4 - 1 cup of mayo
1 Tablespoon of chopped onions
1 Cup shredded white cheddar cheese (I think I'm a little more generous)
1/2 pound of Bacon fried and patted and cut into pieces

Combine flour, baking powder, salt and basil. Add in shortening. I use a pastry cutter and cut till it crumbly. Add sour cream and mix until dough is moist enough to hold together. Spread or pat dough into greased 9" pie pan (along bottom and sides) to form a crust. Place the sliced tomatoes on the crust. Sprinkle with salt and pepper. Put the bacon on top. Combine mayonnaise, cheese, onion and spoon over top. Spread to cover the tomatoes/bacon.

Bake at 355 degrees for 30-35 minutes until golden brown.

Julie R's Chicken Cordon Bleu Cassarole
2 c. cubed cooked ham
4 c. cooked chicken (or turkey)
1 c. (4 oz) swiss cheese, shredded
1 large onion, finely chopped
1/3 c. butter, cubed
1/3 c. all-purpose flour
1/8 t. ground mustard
1/8 t. ground nutmeg
1 3/4 c. milk (or half and half)

TOPPING: (I forgo the bread crumbs and just sprinkle cheese)
1 1/2 c. soft bread crumbs
1/2 c. shredded swiss cheese
1/4 c. butter, melted

Saute ham for 4-5 mins or until brown, drain, pat dry.   In a greased baking dish, layer the turkey, cheese and ham, set aside.
Saute onion in butter until tender.  Stir in the flour, mustard, nutmet until blended.  Gradually stir in milk, bring to boil, cook and stir for two mins until thickened.  Pour over ham.  Combine topping ingredients and sprinkle over top.  Bake, unocvered at 350 for 25-30 mins.



BROK"S CHEESE CRUST PIZZA

Thin and Crispy Pizza Crust
Heat oven to 450 degrees
In a bowl thoroughly combine
3 eggs
3 cups shredded mozzarella cheese
1 tsp garlic powder
1 tsp basil
press evenly into Pam sprayed pizza pan or cookie sheet
(this makes one 16 inch pizza crust)
Bake at 450 degrees until golden brown (about 10 to 15 minutes)

Here is what your crust looks like after baking




It will completely lift off your cookie sheet. I patted the grease off of it, but that step is optional





add toppings of your choice

This one has the following toppings~

1/4 cup low carb marinara
1 cup Mozzarella cheese
2 links Italian sausage (browned and crumbled)
1/4 cup sliced back olives

After adding toppings, run the pizza under the broiler until cheese is melted and toppings are bubbly






This slices up beautifully and the crust is crispy and thin




Yes, you can hold it in your hand!





PIG CANDY

I just laid some thick cut bacon on a cooling rack set in a cookie sheet. I patted on a thin layer of brown sugar and baked it for about 30 mins at 400 degrees. Wow was it good!!! I know the brown sugar kinda ruins it  as a DS freindly food. Remember, I am still pre-op so I can get away with it for now.  It might work with the Splenda brown sugar. I might just try that. Anyway here is a photo of the wonderful stuff. If you want a treat and can tolerate the sugar I would highly recommend the PIG CANDY.....






Kerry's Marinated Grilled Chicken


This is the best BBQ chicken; although it's low fat, it's soooo good. 

First mix up the following marinate:

2 cups Sprite (use the sugar kind, diet doesn't work as well)
1 Cup Soy sauce
1 Cup oil (I think crisco works best)
1/2 teaspoon garlic powder.
1/2 teaspoon horseradish powder.

Mix it up in a big bowel and add a couple of pounds of chicken strips and stir so that all the chicken is coated. Put in the fridge for at least 4 hours. (I usually let it soak for 8)

Fire up the barbie and cook the strips; DO NOT OVERCOOK; they cook real fast so try a few to get the timing before you fill the grill.




Chicken Spaghetti

Boil some chicken breasts, let cool, pinch & shred 'em
Chop a green bell pepper, some celery & an onion, saute that in butter
Add 1 pint of half & half to your veggie-butter-saute pan, keep on low heat & stir
Cut up 1 box of Velveeta Cheese (the cheese, not the box) and add to your pan, low heat, stir
*seriously nurse this stuff because you'll burn it in a heartbeat, believe me, i KNOW
Add 3 cans of Rotel Tomatoes (mild b/c you Yankees will complain that you're on fire)
Add salt, pepper & crushed red pepper to taste
Have a box of spaghetti boiled & drained, add this to your cheesy mixture & serve!




LOW-CARB BAKED MACARONI & CHEESE

3 eggs
8 oz cream cheese
1/2 cup butter
1/2 cup heavy cream
1 lb grated sharp Cheddar
1 lb grated Mozzarella
1 box Dreamfields brand low carb elbow macaroni

Preheat oven to 350°F. Prepare a 2 quart baking dish with spray oil. Cook Dreamfields pasta as directed on box, drain and set aside to cool slightly.

In a blender, combine eggs, cream cheese, butter and heavy cream until smooth. Fold this mixture into the cooked macaroni until well coated.

Place 1/2 cooked macaroni noodles evenly in baking dish. Top with mozzarella cheese. Add remaining macaroni and top with cheddar. Bake for 1 hour. The top layer of cheese should be browned slightly.

Total Net Carbohydrates = 66.72
Net Carbs For 1/8 Serving = 8.34

Makes 8 servings


CHICKEN & BACON SHISH KABOBS

INGREDIENTS (Nutrition)

• 1/4 cup soy sauce
• 1/4 cup cider vinegar
• 2 tablespoons honey
• 2 tablespoons canola oil
• 10 large mushrooms, cut in half
• 2 green onions, minced
• 3 skinless, boneless chicken breast halves - cut into chunks
• 1/2 pound sliced thick cut bacon, cut in half
• 1 (8 ounce) can pineapple chunks, drained
• skewers

• Add to Recipe Box   DIRECTIONS

1. In a large bowl, mix the soy sauce, cider vinegar, honey, canola oil, and green onions. Place the mushrooms and chicken into the mixture, and stir to coat. Cover, and marinate in the refrigerator at least 1 hour.
2. Preheat grill for high heat.
3. Wrap the chicken chunks with bacon, and thread onto skewers so that the bacon is secured. Alternate with mushroom halves and pineapple chunks.
4. Lightly oil the grill grate. Arrange skewers on the prepared grill. Cook 15 to 20 minutes, brushing occasionally with remaining soy sauce mixture, until bacon is crisp and chicken juices run clear.

SHARI and SIG OT's Man-Oh-MANICOTTI!

Start with a pretty basic post RNY pancake recipe:

EGG CREPES: 3 egg whites and one whole egg  (we were out of Egg Beaters) 1/2 cup fat-free ricotta  4 tbsp whole wheat flour A small amount - two tablespoons tops - of skim milk, to thin it out (you could use water) 1/2 tsp kosher salt FILLING:  Whatever was left of the ricotta - 1 1/2 cups 1/2 package frozen chopped spinach - squeezed dry, dry, dry 6 ounces Perdue chicken (Italian flavor), chopped very fine (processor's good) A couple of tablespoons Parmesan cheese 1/4 cup 2% mozzerella sauteed minced onion & garlic and oregano ALSO: 1.5 cups marinara sauce 2/3 cup 2% mozzarella _______________________________________________ Use a saute pan and make 7 very thin pancakes..stack on paper towels to absorb excess moisture as they finish. Pour 1/2 cup marinara in the bottom of a small casserole dish (9x12"). Put a good sized blob of filling on each "pancake" and roll, place into casserole.   Top with more marinara & 2/3 cup 2% mozzerella Bake @ 350 degrees for 20-30 minutes until golden brown & delicious. * Note: egg crepes will not absorb sauce like pasta does, so you may wish to serve with additional sauce on the side.

NUTRITION PER SERVING-- Each serving is 2 "manicotti" rolls--

135 calories
4.5 g fat
7 carbs
1.5g fiber
16g protein






BACON EXPLOSION

http://www.bbqaddicts.com/bacon-explosion.html

Bacon Explosion: The BBQ Sausage Recipe of all Recipes

by Jason on December 23, 2008[edit]

 

The other day the guys from BaconToday.com contacted me in search for some barbecue bacon recipes. Of course I have plenty of great uses for bacon in a barbecue pit, but the longer I thought about it, the more I wanted to step it up a notch and clog a few arteries for those guys. Behold, BACON EXPLOSION!!! Here’s what you’ll need…

 

2 pounds thick cut bacon
2 pounds Italian sausage
1 jar of your favorite barbeque sauce
1 jar of your favorite barbeque rub

To kick off the construction of this pork medley you’ll need to create a 5×5 bacon weave. If the strips you’re using aren’t as wide as the ones pictured, then you may need to use a few extra slices to fill out the pattern. Just make sure your weave is tight and that you end up with a nice square shape to work with.

The next step is to add some barbeque seasoning on top of your bacon weave. Being the barbeque addict that I am, I whipped up a batch of Burnt Finger BBQ’s competition pork rub for this special occasion. Seeing as not everyone has the time, or the expertise, to create a tasty rub of their own, I would recommend trying Bad Byron�s Butt Rub, Rendezvous Famous Seasoning, or Steven Raichlen�s All-Purpose Rub.

Now that you’re pork is well seasoned, it’s time to add more pork. Take two pounds of Italian sausage and layer it directly on top of your bacon weave. Be sure to press the sausage to the outer edges of the bacon creating a patty that is the same thickness all the way across. Most grocery stores carry loose sausage, so just pick out one you like. I chose to go with a mild sausage, but spicy would work just the same. If you really want to get crazy, take a stab at making your own homemade sausage.

Next up is bacon layer number two. Take the remaining bacon slices and fry them up the same way you would for breakfast (or lunch, or dinner, or a midnight snack). If you like soft bacon, make it soft. If you like crunchy bacon, make it crunchy. If you like your bacon burnt to hell so the smoke detectors go off, then burn it to hell so the smoke detectors go off. These pieces are going to be a major part of the inner flavor of our sausage fatty, so cook them your favorite way. Personally, I like my bacon right at the point when it starts to get crispy, but hasn’t quite lost all of the softness yet. Regardless of how well done you like yours, you’ll need to crumble or chop the cooked strips into bite size pieces and place on top of the sausage layer. (Note-It’s okay, and encouraged, to snack on these pieces while your chopping/crumbling. But keep in mind that once those bacon morsels touch the raw sausage, you’ll need to resist all temptations to nibble. This can and will be difficult, but hospital trips are no fun, so stay strong.)

 

Since this is a barbeque recipe, we need to add another layer of barbeque flavor. Take your favorite sauce and drizzle it all over the top of the bacon pieces. Personally, I prefer to use Burnt Finger BBQ’s homemade competition sauce, but if you’re torn on what brand to use I recommend Cowtown, Blues Hog, and Fiorella’s Jack Stack. Once you’ve sauced the bacon, sprinkle on some more of the barbeque seasoning you used on the bacon weave.

 

Now comes the fun part. Very carefully separate the front edge of the sausage layer from the bacon weave and begin rolling backwards. You want to include all layers EXCEPT the bacon weave in your roll. Try and keep the sausage as tight as possible and be sure to release any air pockets that may have formed. Once the sausage is fully rolled up, pinch together the seams and ends to seal all of the bacon goodness inside.

 

At this point we can start to see the final shape of our Bacon Explosion, but we’re missing one key item. To complte the constuction process, roll the sausage forward completely wrapping it in the bacon weave. Make sure it sits with the seam facing downward to help keep it all sealed up.

 

Sprinkle some barbeque seasoning on the outside of the bacon weave, and now this bad boy is ready for the smoker. Cook your Bacon Explosion at 225 degrees in a constant cloud of hickory smoke until your Thermapen gives an internal temperature reading of 165 degrees. Normally this will take about 1 hour for each inch of thickness, but that could vary depending on how well you maintain your fire and also how many times you open the smoker to take a peek. Mine took about 2.5 hours, which was right on target with its 2.5 inch diameter.

 

Now that our Bacon Explosion is fully cooked, we need to add some finishing flavors. Remember that barbecue sauce we used for inner flavor? We’ll be using that same sauce to glaze the cooked bacon weave. Using a basting brush, coat the entire surface with a thin layer of sauce. Sweet sauces are loaded with sugars, so they’ll give your fatty a nice glossy finish. Spicy and vinegar based sauces don’t contain as much, so they won’t set up as well. If you’re dead set on using those sauces, just cut them with a bit of honey and you’ll get the same effect.

 

Slice the Bacon Explosion into quarter to half inch rounds to serve. If your roll was good and tight, you should now see a nice bacon pinwheel pattern throughout the sausage. Obviously pork is best served by itself, but if you feel the need to make this meat monster into a sandwich, try placing a couple Bacon Explosion slices on a warm Pillsbury’s Grands Biscuit. You’ll reach pork Nirvana is no time flat!

 

Be sure to send us stories and photos of your Bacon Explosion experience. Who knows, you may see your ugly mug on BBQ Addicts.






CHEESECAKE CUPCAKES

Cupcake:
3 - 8 oz. packages of cream cheese
1 cup of Splenda
5 eggs
1 1/2 tsp Vanilla

Filling:
8 oz Sour Cream
2 TBSP Splenda
1/4 tsp Vanilla

Bring cream cheese to room temperature. Place cream cheese in a bowl, and add one egg at a time, beating with a hand mixer. Slowly add the Splenda and vanilla. (The batter will be thin.)

Pour into paper cupcake liners. (Makes approx. 12 very full cupcakes.) Bake in a 300 degree oven for 30 - 35 minutes (until large cracks appear on the top). Remove from oven and cool for 5 minutes.

Combine filling ingredients and add a tsp on top of each cupcake and return to the oven for 5 minutes.

Cool and then keep refrigerated.





Bronwen's mmmm nom nom chicken fingers

2 lbs chicken fingers (enough for 3 dinners and 2 lunches the next day)
3 eggs

beat the eggs in a 8x8 baking dish and toss the chicken fingers around in there to get them all coated with the egg slime.

Then, in another 8x8 baking dish, combine the following and stir really well to combine:

1.5 c. almond meal/flour
1 t. dry mustard powder
1 t. garlic powder
3 t paprika
salt & pepper
2-3 t. rotisserie chicken spice (McCormick's makes it)

dredge the slimed chicken tenders in the almond meal mixture, slap 'em on a baking sheet sprayed with Pam, and bake for 15-20 minutes at 425 degrees, turning once during baking.





Philly Cheesesteak Casserole

2 lbs chip steak or cube steaks, cut into strips
1 green pepper, cut into strips
1 red pepper, cut into strips
1 onion, thinly sliced
1/2 lb mushroom, sliced more to taste
1 tablespoon olive oil
3/4 teaspoon kosher salt
3/4-1 teaspoon fresh ground pepper
1/4 lb pepperoni, thinly sliced
8 ounces provolone cheese, thinly sliced
 

Directions

1. saute mushrooms in olive oil until softened and light brown, about 5 minutes.
2. add to crockpot along with the rest of the ingredients, except the provolone.
3. cook on low for 6 hours.
4. stir well, add to 6 bowls.
5. cover with provolone and add some cooking juices to each bowl to melt the cheese.

 

Low Carb Cracker with Chive Spread

 

Crackers:
1 cup parmesan cheese - grated
1/4 cup soy flour
2 tbsp. olive oil
1 egg white
2 tsp. caraway seed

Chive Spread:
1 pkg. cream cheese
1/4 cup sour cream
3 tbsp. fresh chives
1 tsp. garlic powder
1 tsp. red pepper flakes
3 tsp. minced dried onions
1 tsp. grated white pepper

Cracker Preparation:(approximately 6.6 net carbs for entire batch)
Preheat oven to 300 degrees. Mix all ingredients in bowl with wooden spoon until ball forms. Cut ball in half and place each half between two pieces of greased wax paper. Roll dough with rolling pin until dough is about 9" x 11" in size and thin like a cracker. Remove top piece of wax paper and discard. Grease two cookie sheets and place one sheet of cracker dough on each. Make 2 crisscross lines in dough with pizza cutter or knife. Bake each sheet of cracker dough for 20-25 minutes until evenly browned and crisp. Remove from oven and peel off other piece of wax paper being careful to not break crackers. 

Spread Preparation: (approximately 15.3 net carbs for entire recipe)
In food processor grind onion, red pepper and garlic powder. Add cream cheese and sour cream and pulse until all ingredients are incorporated. Cut ends off of fresh chives and chop. Add to food processor with grated white pepper and pulse. Remove spread from processor and serve in bowl with crackers.



Mellysarah03's Parmesan Chicken Wings, OR Chicken Parm


pre-cook chicken wings (preferable in the oven)
wisk up some eggs (i used 3 for about a dosen wings)
in another bowl add Parmesan cheese and whatever else you want (i used garlic, salt, pepper, oregano)
cover wings in egg and then in "breading"
Flash or pan fry on a low heat with some canola or olive olive.
Drain on paper towel and ENJOY!!! YUMMY!!


Julie R's Parm or Onion crusted chicken (variation of above)

I make these often, but call them "heroin wings" and I bet you can guess why!!   I bake them in the oven till crispy though.

Another great breading idea?   Crush french fried onion rings (ya know, like you put in green bean casserole) and dip chicken in egg, then in the onion.   Yum!



Star Jones Cajan Seafood Pasta

I kinda tweaked this recipe from one on Recipezaar.com. I love that site! It's cajun seafood pasta, but I didn't make it real cajun-y but you can add more Old Bay and make it spicier. I also changed the cheese- the original recipe calls for 3/4 C swiss and 1/4 C parm. I wanted it cheessier!!! For all the herbs I used dried so I used half the amount. I've made it w/o the scallions and mushroooms too. Taste the same really with it or w/o it.

2 Cups heavy cream
1 Tbsp fresh basil
1 Tbsp fresh thyme
1 tsp salt
1 tsp pepper
1/2 tsp red pepper flakes
1 Tbsp Old Bay
1 Tbsp parsely flakes
1/2 lb shrimp
1/2 lb scallops
1/2 lb fish fillets
1 pkg parmesan cheese (2 cups I think?)
1 cup swiss cheese
cup of scallions
cup of mushrooms
box of Dreamfields penne pasta

Pour the cream in a skillet and cook over med heat until just boiling. Add the spices and veggies. Simmer for 8 minutes or until thickened. Add seafood and cook till shrimp is no longer transparent. Stir in cheese. And whalah!!!! Cajun seafood pasta


Taylor D's Diet Coke Sloppy Joes   

Ingredients

16 oz. 96% ground beef
1 cup diet coke
10 tbsp heinz one carb reduced sugar ketchup
1 tbsp worcestershire sauce
2 tbsp white vinegar
2 tsp dry mustard

Nutritional Info



    Fat: 4.5g
    Carbohydrates: 2.5g
    Calories:152.5
    Protein: 23.0g
   


Brown ground beef in skillet. Drain beef and add back to skillet. Add remaining ingredients and stir well. Cook on low for 30 minutes uncovered so sauce can thicken. You can also add onions or green peppers if you'd like.

Number of Servings: 4




Lori Black's list of cheap protein packed dinners:


Chicken Thighs

(I have to give total credit for this one to Elizabeth N.  I've been making it since I read you talking about it on the Renegades board quite some time ago!)

Ingredients:

8 Chicken thighs
1/2 stick butter
1-2 onion
Lemon pepper seasoning (or favorite seasoning of your choice)

Directions:

I place the butter and chicken thighs in first, season with the lemon pepper, place one to two onions cut into slices on top, cover and cook on LOW for 6-8 hours. (I do not use water at all in my crock pot, the natural juices from the chicken are MUCH tastier)!  The longer it cooks the juicier it is.  It's ready at 6 hours, it's even better at 8.

Pot Roast

(I wait for my stores to put it on a super low price, like $5-$6 for a 3 pound roast and buy as many as my freezer can hold)

Ingredients:
Pot Roast, Rump roast, chuck roast (whatever is on sale.  You're going to cook it so long it will be tender no matter what!)
1-2 pounds baby carrots
5-6 potatoes, skinned and cut in half length-wise  (I only used potatoes now at goal, before I only cooked the meat and carrots to cut back on carbs...and would only eat one or two baby carrots usually).
1 can cream of mushroom soup

Place potroast in crockpot.  Cover roast with mushroom soup.  I then season mine with garlic and basil, this is totally your own preference.  I then cover the crock and cook on low for 4 hours.  After four hours I add in the baby carrots and potatoes and cover and cook for 5-6 more hours on low.  Moist, delicious, and AWESOME!!!

Pulled Pork

Ingredients:

Pork Picnic Roast
(These go on sale all of the time and I get them for $5-$7 for a huge hunk of meat)
1 can of coke
1-2 onions sliced
Bottle (or 2) of your favorite bbq sauce

Place pork roast in crockpot and cover with coke. I add pepper and garlic powder as well.  Cook on low for 8-12 hours.  The longer the better in my opinion.  Remove pork from crock and drain juices.  Use two forks to shred and pull the meat apart.  Onions remain in the mix and will pull and shred with your meat.  Add bbq sauce of choice and taste. You can always add garlic, pepper, salt or whatever you like to adjust the taste.  Cook for another 30 minutes on low and you'll have the perfect pulled pork. 

Variation:  If you'd rather do BBQ chicken, just use chicken instead.  You can cook it in the crock the same way I did in the chicken recipe above and then add BBQ sauce.

Country Style boneless ribs:

These are cooked almost identically to the way I cook the pork roast above for pulled pork.  Leslie and others have posted this as well.

Ingredients:

Country Style boneless ribs
can of coke
bbq sauce of choice
seasonings

Place bbq ribs in crock and cover with can of coke.  I also add garlic powder pepper and about 1/2 of a bottle of bbq sauce at this point.  Cook for 8-12 hours on low.  (Again, the longer the juicer in my opinion).  After they are cooked, drain and place meat in casserole dish or pan that can be placed in oven.  Add desired amount of bbq sauce on top of your ribs and cook under your broiler in your oven on low until the sauce gets all carmelized looking.  Usually just takes a few minutes so stay close by. 

Salmon Cakes

2 cans of alaskan salmon, boneless and skinned (Usually around $5-6 for both)
2 eggs
2 T Mayo
1 tsp mustard
seasoned salt
a dash of old bay seasoning
1/2 of an onion.  diced (very small)
8-10 Ritz crackers

Drain salmon and add to large bowl.  Add in egg, mayo, mustard, seasonings, and onion.  Stir well.  Add 8 Ritz crackers and stir again.  Add more Ritz crackers if the mixture seems too "wet" to hold together.  Use spoon to make golf ball sized "cakes" and then smash between your hand to flatten and place in hot oil in skillet.  Cook each side until it is golden brown and crispy.  I place my salmon cakes on paper towels to soak up the excess oil.  My family absolutely LOVES these!  

Ham, Potatoes, and Green beans

(I just had this tonight, YUM!)

Ingredients:

1 ham shank (or whatever cooked cheap ham you can find would work)
potatoes (new potatoes are great, but regular ones can be used)
frozen green beans
1 can cream of mushroom soup

I cut around the bone of the ham shank and also removed some of the thicker skin and placed large chunks (size of a baseball to size of a softball) of ham in the crockpot.  I then peeled 6 potatoes and poured the can of cream of mushroom over it all.  I cooked that for 3 hours before adding the green beans.  2 hours before we ate I added the green beans, probably could've cooked those much less...but the taste was amazing!  I stirred it all several time thru the day and also added pepper and a bit of salt as time went on. 

I kept it in the crockpot on warm because I wasn't able to eat much and I'm going to have some more later!  YUM!

Pizza Biscuits (For those at goal or who can afford the carbs for the day)

1 roll of Pillbury Grands ( I like the butter tastin' ones)
1-1.5 pounds ground beef
1/2 onion
1 jar favorite spaghetti sauce OR 1 can tomato sauce and italian seasonings (cheaper!)
shredded mozzarella

Brown ground beef and onion until cooked through.  While that's cooking, open the biscuits and separate each biscuit into two in the middle of all of the flakey layers.  (A roll of 8 biscuits will turn into 16 after you've separated them).  Flatten and spread dough and form into a muffin tin leaving plenty of room for the insides.  Place a small amount of mozz cheese into each biscuit.  Once meat and onion is done, drain and return to pan.  Pour in just enough spaghetti or tomato sauce to cover the meat, you don't want too much.  Now spoon the meat sauce evenly into each biscuit and top with more mozzarella.  Cook at 350 degrees for 12-17 minutes.  I like to cook mine a little longer because when they are crunchier they hold their form better!  Here's a picture of how they turn out!

 

Lo-Carb Layered Egg Casserole

I have changed this thing a thousand times to get the perfect flavor and I think I have it now!  This makes 12 servings and is a really easy way to get a protein packed breakfast every morning!

Ingredients:

2 8oz pkgs of Philly cream cheese
1 roll of ground sausage (I like Bob Evan's Sage flavored sausage, but any will do)
Onions
Mushrooms
1 can Rotel tomatoes with chili's, drained
Mexican blend shredded cheese
12 eggs
Heavy whipping cream

Here's how I make it:

Soften cream cheese and spread evenly as the crust of your casserole in the bottom of a greased 9X12 pan. 

After browning ground sausage, spread this as the next layer in your casserole. 

While my sausage is cooking, I have a separate pan sauteeing my onions and mushrooms in butter.  Once that is cooked, place the onion and mushroom as the next layer in your casserole. 

Drain the juice from the Rotel tomatoes and spread evenly as the next layer.  (I spoon mine on to get it even). 

The next layer is a BUNCH of Mexican blend shredded cheese.  I don't measure this, I just put about a 1/2 inch thick of the shredded cheese all over the top of the casserole

In separate bowl, mix 12 eggs, about 1/2 cup heavy whipping cream, a dash of garlic powder and salt and pepper to desired amount.  Whisk that until smooth and then pour on top of your casserole. 

Bake this at 375 degrees for about an hour.  The middle will not be runny when you slice a knife through it like you're cutting it.  I cut this into 12 servings and I haven't done a nutrition breakdown on it.  But I will claim that it's the perfect DSer food and it reheats wonderfully! 




Val's cheap pasta dish 
Okay, here's the scoop on the best cheap pasta dish in the world.  The ricotta gives you a lasagna taste without all of the hassle.

1--Brown ground Italian sausage (I like sweet and mild) with some onions and whatnot (peppers and mushrooms if desired. 

2--Add a can of Italian diced tomatoes and a can of Hunts spaghetti sauce (whatever flavor you want - I like the 4 cheese), with a pinch of sugar to cut the tartness if you wish.  Let simmer while you prepare the pasta.

 

vals recipes Fabulous Ricotta Fluff Stuff 1 large container of ricotta cheese 1 box  SF jello instant cheesecake pudding dollop or two of sour cream (to taste) A little bit of milk to lighten it up (about a cup-add last and gradually) Mix it all up and enjoy however you want it.  I love it with strawberries!  It's a great fruit dip or just eating straight out of the bowl.  Fabulous Trail Mix Base mix 1 jar peanuts 1 jar sunflower kernels 1/2 bag raisins or "berries and cherries" 1/2 small bag chocolate chips. 1 small bag macadamia pieces 1 small bag pecan halves To this, I might add other nuts depending on what's on sale (walnuts, cashews, more pecans).  I've also varied the fruit, too, so play around.  Try to keep the proportions the same.  It's so easy to load up the sweet stuff, but it's the nuts that are so valuable here.  The balance makes the perfect sweet and salty snack and my daily breakfast.  If proportions are kept, it's about 32g of protein for 8 oz. Fabulous Custard -- full of protein, easy on new post-ops ~delicious! 3 cups milk 3/4 cup splenda 4-5 eggs (depending on size) 2 tsp vanilla 1/2 tsp nutmeg (optional) handful of coconut (optional) Preheat oven to 375'.  Beat eggs, nutmeg and vanilla together in baking dish.  On the stove, bring the milk and splenda just to a boil, then stir together to the eggs.  Bake for 25 min NOTE:  when the milk is coming near to a boil, you'll get a little foam on the top.  Remove this foam before stirring into the eggs, or it will get a weird texture on top. God Bless Paula Deen for flourless peanut butter cookies! 1 cup peanut butter 1 egg 1 tbsp vanilla 1 cup Splenda Mix and roll into balls (about walnut sized) and flatten with fork dipped in Splenda.  Bake at 350 for 12 minutes.   TIPS -Do NOT overocok -- they will get crumbly since there's no gluten -Peanut butter is naturally low sugar - the low sugar kind only reduces it by 1g per serving. -If you're picky about artificial sweeteners, I've done a 3/1 with splenda and sugar to cut the after taste and it's good.  Presently, I do full-splenda in the cookies, and roll in regular sugar and that's good too.  I've also added semi-sweet chocolate chips to shake things up.      Catnip's seafood chowder posted 12 hours ago 2 lbs of mussels 2 lbs of frozen raw shrimp (any size not cooked) 1/2 lbs bay scallops (the really small ones) 1 tbsp butter 1 tbsp olive oil 1.5 cups of white wine 2 large schallots 2 cloves garlic 1.5 cups cream 3/4 cup 2% milk 1/2 - pound cheese (brie, havarti, gouda, camebert) - Rince mussels and shrimp under cold water for a few mins - Finely chop shallots and garlic, add to large pot with butter and olive oil, cook till just soft. - Turn heat up to high - Add seafood in this order, mussels, scallops, shrimp (do not stir) - Add 3/4 cup white wine and cover pot. Let cook for 5 mins turn heat down to med high and then - Let cook for another 5 to 7 mins - Check seafood, mussels should be open, scallops firm and shrimp pink, if not cook for a few mins more - Remove seafood for pot with a slotted spoon and reserve the liquid. - Turn heat back onto high add the rest of the white wine to reserved liquid from cooking and let it boil. - Remove mussels from shells and throw out shells. - When liquid has reduced by about 1/4 turn heat down to medium - Add items in this order,  cream, cheese and then milk. stir until cheese is melted. - Add seafood and tomato and some fresh ground pepper - Stir well, heat till it is just starting to steam and serve. I usually get 6 -8 servings out of this recipe. The whole recipe has 490 grams of protien and 120 grams of carbs (130 grams of fat but who cares) (to boast the protein add more seafood or cheese) You can reduce the carbs in this by not using mussels and using more shrimp or scallops, you could also use whipping cream instead of the milk and half and half. Serve it to your family  with crusty bread and a salad, they will love it too. Maryc543's Stovetop mac n Cheese This is a recipe I adapted from Cooks Illustrated....  they got it from J. Thorne, who is apparently a master of mac and cheese.....If you use Dreamfields, you wind up with these counts: Calories:  576 Fat:  35g Carb 10 Protein 25 Fiber 5 It's recipe 71944 if you use BigOven.com (I skipped the toasted breadcrumbs on top) 12 oz can evaporated milk 2 large eggs 1/2 tsp hot red pepper sauce 2 tsp salt 1/4 tsp black pepper 1 tsp dry mustard 1 tsp water 1 box dreamfields elbow macaroni (13.25 oz) 6 tbsp butter   (recipe called for unsalted, but I only had salted!  Tasted fine) 16 oz shredded Wisconsin cheddar Mix eggs, 1 cup of the evaporated milk, pepper sauce, 1/2 tsp salt, the pepper, and mustard in a small bowl.  Use a heavy bottomed pot or Dutch oven.  Add the box of pasta to 4 quarts of boiling water.  Add the rest of the salt to the water, and cook for 8 minutes, until almost tender, but still firm to the bite.  Drain and return to pot over low heat.  Add butter,  toss to melt.  Pour egg mixture over buttered noodles, add three quarters of the cheese.  Stir constantly until cheese melts.  Gradually add the remaining evaporated milk and rest of the cheese.  Keep stirring! until mixture is hot and creamy, about 5 minutes.  Makes 6-8 servings. Counts listed above are for 7 servings.       The cooks illustrated site tried it many different ways, but they think the evaporated milk is key to the creamy goodness!  I'm just excited about eating pasta again!

levittown_loser's (Tom's) Alabama White BBQ Sauce







2 Cups Mayonnaise
1 Cup Distilled White Vinegar
1/2 Cup Apple Juice
2 Teaspoons Prepared Horseradish
2 Teaspoons Ground Black Pepper
2 Teaspoons Fresh Lemon Juice
1 Teaspoon Salt
1/2 Teaspoon Cayenne Pepper

Preparation

In a large bowl, combine all ingredients and blend well. Use as a marniade, baste, or dipping sauce. Store refrigerated in an airtight container for up to 2 weeks.




Quick Nacho Party Dip

1 lb ground beef
Few dashes of onion powder
2 lg cloves of minced garlic
2 16 oz jars salsa
15 oz can re fried beans
1 1/2 Cups Sour Cream
3 Cups Shredded Cheddar cheese (divided)
Tortilla chips for dipping

1)  Brown beef in skillet, season with salt, pepper, some onion powder and the minced garlic.
2)  Combine beef, salsa, beans, sour cream, and 2 cups of cheese in slow cooker.
3)  Cover.  Heat on low setting for 2 hours, stirring occasionally.  Just prior to serving, sprinkle with last cup of cheese.  Can also add raw diced onions and/or tomatoes as topper options and other cheese mixes to your liking.




~Chicken Enchilada Soup~

1 can of Cream of Celery
2 cans of Cream of Chicken
2 cans of Cheddar Cheese Soup
1 can of Chicken Enchilada soup (found in the Mexican isle) You could use enchilada sauce or powder if you can find it
1 can of Mild Rotel drained (if tomatoes bother you, sub a can of Fire Roasted Chili's)
1 large Rotisserie Chicken (I get the biggest one I can find) - I use the savory, herb, garlic & herb flavors. Any of them are good.
1 box of Chicken broth (32oz) (I use the organic one, its less salty IMO)
ATLEAST 10 cups of shredded cheese- I use the Mexican blend
3 crushed cloves of garlic
Chili powder- I just sprinkle it on top. Use more if you want it spicy

Pick the chicken apart (putting the skin aside for you to eat after you are done) I make sure I get every nook and cranny. I also take the juice that’s in the bottom of the chicken container and pour it into the pot.
Put in the Cream of Celery, Cream of Chicken, Cheddar cheese soup, Chicken Enchilada soups in the pot and mix with the chicken. It will be very thick. Turn on the heat to high. Continue to stir. Slowly add the chicken broth. When about half of the chicken broth is in the soup mixture, add the Rotel. Let it cook a few min and slowly add the rest of the broth. By now the mixture is hot. Turn down the heat to low and add 4-5 cups of cheese. Mix very well. Let cook for about 15 min. add 2-3 more cups of cheese and stir well. Let cook an additional 5 min. Add the rest of the cheese. Cook 5 more min.




Vicki's Salad in a Clamshell

Mix a chopped boiled egg with bacon, chopped tomato, shredded cheese and a handful of peas.  Mix in your ranch dressing if you like, but I just did some mayo with a little splenda and pepper to mix it together.  I'm telling you -- it's divine!

colene's Grilled Flank Steak

The unique spice combination gives this steak its great flavor! 

Serving: 6
Prep Time: 15 minutes
Cook Time: 15 minutes
Total Time: 30 minutes plus 35 minutes marinating time


1 1/2 to 2 pounds flank steak 
1/4 cup Dijon mustard 
2 tsp dry mustard 
2 tsp garlic salt 
1 tsp coarsely ground black pepper 
2 tbsp melted unsalted butter 
1 tbsp finely minced Italian flat-leaf parsley 
2 tsp fresh lemon juice  0 comments