Introduction And General Q's

Hello. I'm a 69 year old man who had the lap band 11 years ago. It was a real disappointment as I could never get the fill amount just right and, ultimately, after leaving it completely unfilled for a number of years, had it removed because I was starting to experience some minor stomach distress. At the time, my surgeon asked me if I wanted to have this revised into the sleeve and I (foolishly) declined as my overall experience with bariatric surgery had been such a disappointment. Now I realize that this is my only option to a better life.

I'm hoping that Medicare covers this (anyone who has information about this and could post it would be greatly appreciated) and that the approval process is not too unwieldy. I see that many are talking about a daily caloric intake of 700-800 calories. This seems amazingly low. Is the combination of the smaller stomach size and the (vast) reduction of gherin that helpful that people can actually do this over an extended period of time without losing their minds or climbing the walls?

Any tips for a sleeve newbie?

Any advice or information, including your own personal experiences would be greatly appreciated.

TIA

Hello and Welcome!

I had a very similar experience approximately 12 years ago with the band, and it ultimately ended in emergency surgery/removal of my band. Subsequently, I swore off bariatric surgery until I heard about the sleeve. I think it is a great, lower risk option. GERD is usually contraindicated so if you have GERD you may want to discuss this with your surgeon. I'm new in my journey, I am able to eat about 1000 calories per day @ 3 mnths out, and I could actually eat more if I ate the wrong things. The sleeve has similarities to the band in that you can sabotage your progress with slider foods like ice cream, concentrated sweets, and basically junk! I have even less restriction than I did with the band and can tolerate food pretty well. However if I stick with the protein 1st concept this prevents overeating. I can see where one can fall back into old habits though, especially if you are into junk food. Keep in mind, like your band, it is a tool. It is very helpful but you have to be ready to put in the work. I'm not sure about Medicare. You should be able to call the number on the back of your card to check your coverage and plan criteria. Wishing you the best.

Thank you for your reply and good wishes, Shannon. Due to the issues I had with the band I don't think I ever had reasonable restriction. I'm hoping that the sleeve provides significantly more help in this regard. I'm also wondering if your ability to avoid overeating has been helped by the limitation of ghrelin going into your system as this is supposed to regulate feelings of hunger and satiety. Is it true that with the removal of that part of your stomach which produces this hormone, you feel significantly less hungry?

I would say yes. I don?t typically feel hungry. I had a hunger like feelings in the beginning, but realized this was from over production of acid. That feeling has passed thank goodness. Again, no hunger feelings but definitely a lot of head hunger, which for me is half the battle.

For Medicare coverage, your best bet is to call the number on the back of your card and ask. It'll depend on which Part(s) you have, etc.

As for the daily caloric intake, I agree, it does seem amazingly low - until you get there. And then it's not so bad!

My advice is to read as many of the old forum posts here as you can. There is an astonishing wealth of information and reading here really helped me to prepare when I was pre-op :)

Here's the Medicare.gov info page on bariatric surgery -- https://www.medicare.gov/coverage/bariatric-surgery.html

Medicare did cover my original sleeve surgery 9 years ago and they covered my revision to RNY 2 years ago. I do have a medicare advantage program. I don't know if straight medicare covers it for sure yet, but I know it was headed in that direction at one time. As another poster pointed out, the best way to know for sure is to call the number on your card.

If you have any GERD issues, it's really best to have the RNY. Not everyone has GERD problems with the sleeve, but it does seem to be more of an issue coming to light.

I didn't have any GERD problems originally, but by 7 years out I had severe GERD requiring the revision to RNY.

I will be 70 this year and feel a thousand times better than I did before surgery. The sleeve worked really well for me untiI began having problems with the GERD issue.

I wish you the best and please feel free to ask me if you have more questions.

If you had told me a year ago that I would be eating 600 to 800 calories a day and would be satiated and able to stick to an eating plan, I would have told you that you were nuts. This coming from a woman who would order a combo meal (double or triple) upsized and also order another sandwich (or two) to eat on the way home to 'tide me over' till we ate our meals.

This surgery is the tool that allows this to be real. It does require work on your part as it is possible to continue to eat the kinds of foods that got us to our surgery weight. But, if you stick to the protein forward, low or moderate carbs and low to moderate fat. (Basically, change your eating choices). Then you won't lose your mind nor will you climb the walls.

This is not starvation or deprivation. You are literally satisfied eating 3-4 ounces of food at a time. In the beginning, most of us are not even hungry. Use the early time to get over the head issues that most of us deal with. Once you change your habits and develop new ones (and get your family and friends used to the new way you are eating), it is easier to maintain going forward.

There is nothing I can't do and no where I can't go. For example, I can eat at any fast food restaurant or social event. Even if I just order a burger no bun, no condiments or at an Italian place I can order spaghetti and meatballs and just eat the meatballs. Taco bell? Order a couple of tacos and just eat the insides. Point is, if you want to make it work you can. I don't make it a habit to eat fast food anymore, but any port in a storm, if necessary. I have not been in a situation where I couldn't find something that fit my plan. We went to Applebees and I ordered a Thai chicken salad. I left most of the salad and ate the chicken with a bit of dressing. You can ge****er with or without lemon anywhere.

My struggles with food have not ended, there is still the little voice in the back of my head that whispers to me that eating this or that will not hurt me and don't I deserve it? I have learned to take that inner spoiled child gently shut her down. The struggles do not end, but the tool makes it possible to alter our behavior.

But, you have to want it. I want it. To date, I have lost over 220 pounds from my highest weight of 585. And here is a picture to prove it. My husband weighs 220 and we both now fit in a dress I used to wear when I was my heaviest.

Hello and welcome!

I don't know if Medicare covers it, your best bet is to call the number on the back of the card and find out. (I know you will have a wait time on the phone, but it is the only way.) Also, you want to ask what the prerequisites are for your having the surgery. Such as, do you need to follow certain steps, such as classes, meet with nutritionists, etc, before surgery.

Second question, you won't realize how low your calorie intake is until you start to log it. At first, I think I was only doing about 400 calories a day (in the post-op liquid phase). There is a reduction in gherin that helps, BUT, also knowing when you are truly hungry verses "Brain hunger" or eating out of boredom, or emotional eating.

The other advice I would give is to make certain you FOLLOW THE DIET, religiously! You just have to face the fact that certain things are "no longer allowed" and mentally deal with it. It is tough, I know. But, you just have to do it, or the weight will not come off or stay off.

Good luck!

The adjustment to 600 - 800 calories per day is actually not bad at all. Your sleeve is so small that you feel completely physically satisfied after a small amount of food, which really does help the head game. The immediate reward of serious weight loss in the first month is also a good motivator get get used to this.

There are people on these boards who're 5+ years out from VSG and maintaining their loss. It's not easy, and most successful folks weigh, measure, and log every bite every day; constant vigilance is required for success. Because it can be mentally difficult, many people get help from a therapist as well.

Read as much of the boards as you can and you'll have many of your questions answered.