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I was a VA physician (Geriatrics) for 11 years. I hope I wasn't one of those that you felt was rude. I worked with a lot of other physicians and nurses *****ally cared about the veterans they served. Yes, we felt that we "served" you, the veterans who "served" for us. It was our small way of trying to thank you for the sacrifices you made serving in the service so we can enjoy the life we do.

I have been out of VA service since 2015, so the rules may have changed in the VA. (Don't they always!) Does the VA still allow you to go out to the private sector to get medical care if you can't get timely care at a reasonable distance? The VA I worked at was able to do that for other illnesses, but I'm not sure about WLS.

Just something to think about . . .

---Joyce

Thank you Ms. Joyce,

They do in fact make outside referrals, however you have to get your physician to approve that referral. So even though I am service connected for an orthopedic injury my doctor refuses to make the referral to ortho.

It was basically the same with WLS I don't know if Private Citizen has had any luck (didn't sound like it) but based on her distance alone she should be eligible for the Choice program (I believe that's what they call it).

Hopefully she can use this advice to get a second opinion and get the help she needs!

A female needs about 10 calories a day to maintain one pound. So you might need 500 a day to maintain 50 pounds or 2000 a day to maintain 200 pounds.

A man or a woman with higher metabolism might burn 12 calories per pound and stay at 166 on 2000 calories a day.

Age and exercise make a difference.

This is what I heard as well. So right now I would theoretically need about 1,400 calories a day to maintain, which is my experience in practice too.

According to medical research, laproscopic and open surgery are both risky, just in different ways.

"Compared with open GBP, laparoscopic GBP was associated with a decrease in the frequency of iatrogenic splenectomy, wound infection, incisional hernia, and mortality; however, there was an increase in the frequency of early and late bowel obstruction, gastrointestinal tract hemorrhage, and stomal stenosis. There were no significant differences in the frequency of anastomotic leak, pulmonary embolism, or pneumonia."

Source: https://jamanetwork.com/journals/jamasurgery/fullarticle/395 497

Regarding the 5-hour consultation, this is actually pretty standard for civilian patients. Private insurance generally requires quite a bit of paperwork, clearance from a psychiatrist, and such.

If you want a general overview, the book "Weight Loss Surgery for Dummies" is a very comprehensive overview and can give you a good overview of post-op life.

Regarding calories: I did a survey of almost 100 post-op patients here on OH quite some time ago. (I am a professional survey researcher and data nerd). During the weight loss phase, folks averaged 500 - 600 calories per day, and increased calories to 1000 - 1200 during maintenance.

A few points to address your response, in no particular order:

• The majority of posters here are female; the number of active male posters here is certainly less than 10. So remember that you're seeing a biased sample here.
  
  
• Most successful post ops here pair their surgery with therapy. Our saying here is "surgery fixes your stomach, not your head." As you've mentioned, there are HUGE changes to our behavior patterns in order to remain compliant and successful.
  
  
• Most of the people who "need" 2nd and 3rd surgeries do so because they are noncompliant with post-op recommendations, NOT because the surgery failed physically. We see lots of posts here from people posting about revisions, only to learn that they are sliding back into bad habits-- not logging their food, drinking with meals, and not eating a high-protein, low-calorie diet.
  
  
• The physical ability to eat more is certainly part of the reason many people regain. However, "diet fatigue" is also a very real part of it. It's very difficult to maintain the laser focus that many of us have in the first year of the "honeymoon period" and be super vigilant about eating correctly. As a result, people slip-- some more than others-- and that causes the regain.
  
  
• "Transfer addiction" is a very real possibility as WLS patients cannot use food as a coping mechanism. We see it here with alcohol, as well as shopping and (to a lesser extent) other risky behavior like gambling or unsafe sexual activity.
  
  
• I think many of the most successful folks here are the ones who are able to successfully redefine their relationship with food. Hit Google and look for a blog made by a lady named Eggface; she does a great job of adapting "normal" eating patterns for post-op life. She has recipes that taste good and help folks keep eating pleasurable meals, but as a non-morbidly-obese person would.

Another thing that causes complications post-op is smoking.

My perception is the patients that smoke pre or post surgery that experience complications rarely share that they're smokers. So my #1 tip is to quit smoking forever to ensure bariatric surgery safety & success.

(Note that I'm not implying OP is a smoker, just making a general statement.)

"....Yet many successful WL patients are not here to discuss this, they don't need to, but those beginning, and those who have regained are here. I want to understand for myself before I'd commit to the surgery risk to achieve a low BMI...."

I think you are not here, on OH, long enough to make that judgement. If you do - did a lot of research, you should know not to make assumptions. There are a bunch of long term successful WLS people who lost and maintain their loss. Being on OH for over 10 years, being a member here helps me in maintaining my loss. And when I found myself 20 lbs above my happy place, my doc and OH friends motivated me to lose it when I was ready to make a commitment to lose it. Some of us use OH as a online support group, to limit weigh fluctuations. And that is typical for almost anyone, WLS or not, over time. We get older, or we get busy with life, putting our weight management on a back burner.

OH is what the members create. We have a platform to ask questions, get answers.

I am sticking around because I developed connection and friendship with some people on OH. I am sticking around, because when my doc couldn't help me with my issues, some vet on OH took her time to help me find answers. She helped me to find info and understanding of what my body was going through when I had issues. Sometimes docs know how to help us, sometimes - they don't and we have to fight for what we need (i.e iron infusion when I became anemic). I am on OH for my support and to help others. I was always told "Don't return a favor, pass it on".

I know my personal experience, and research helped more than one person to find out what is going on, and helped them dealing with it.

Stick around. Read, learn..

Another unrelated thought: if you are having a difficult time working with the VA health care system, you may want to look into self-pay surgery in Mexico, where the out-of-pocket is FAR lower than it is here in the states. There are many people here who've used that option, and there's an entire section of the forums for people who've found themselves in that situation.