a few questions

January 21, 2004

Can you give me the exact reference from Obesity Surgery re protein

requirements?

A few questions >Date: Wed, 21 Jan 2004

14:01:30 -0500 > >I'm sure some of these things have been addressed before

but I am just >wondering: > >We recommend supplementation of iron for

menstruating women, a complete >multivitamin and B complex, 1000-1200mg

calcium, B12 and protein >supplementation from .8(maintenance) - 1.2g/kg

(immediately post-op). > >What are you all recommending? > >Marisa ,

RD.LD. > >Dekalb Medical Center Outpatient Diabetes Education >2701 North

Decatur Road >Decatur, GA 30033 >PHONE (404) 501-5398 FAX (404) 501-1773

>moore_marisa@... >

>***************************************************************************

********* >This communication, including any attachments, is confidential

and may be >legally privileged. Access to this e-mail or its content, in

whole or in >part via any method or medium, by anyone other than the

intended recipient >is unauthorized. If you received this message in error,

please contact the >sender and permanently delete the original from any

computer and destroy >any printout thereof. > >DeKalb Regional Healthcare

System, 2701 North Decatur Rd., Decatur, >Georgia, 30033, USA,

http://www.drhs.org

>***************************************************************************

*********

_____

High-speed users-be more <http://g.msn.com/8HMBENUS/2728??PS=> efficient

online with the new MSN Premium Internet Software.

_____

January 21, 2004

I have misplaced the journal at the moment. When I find it, I'll definitely let you know.

Kate Alie, M.S., R.D., L.D. Director of Nutrition Services Medabolix 400 Court Street Suite 203 ton, WV 25301 (304) 347-4317 (304) 347-4316 (fax)>From: "Larue, " >Reply- >"' '" >Subject: RE: A few questions >Date: Wed, 21 Jan 2004 12:44:03 -0800 > >Can you give me the exact reference from Obesity Surgery re protein >requirements? > > > A few questions >Date: Wed, 21 Jan 2004 >14:01:30 -0500 > >I'm sure some of these things have been addressed before >but I am just >wondering: > >We recommend supplementation of iron for >menstruating women, a complete >multivitamin and B complex, 1000-1200mg >calcium, B12 and protein >supplementation from .8(maintenance) - 1.2g/kg >(immediately post-op). > >What are you all recommending? > >Marisa , >RD.LD. > >Dekalb Medical Center Outpatient Diabetes Education >2701 North >Decatur Road >Decatur, GA 30033 >PHONE (404) 501-5398 FAX (404) 501-1773 > >moore_marisa@... > > >*************************************************************************** >********* >This communication, including any attachments, is confidential >and may be >legally privileged. Access to this e-mail or its content, in >whole or in >part via any method or medium, by anyone other than the >intended recipient >is unauthorized. If you received this message in error, >please contact the >sender and permanently delete the original from any >computer and destroy >any printout thereof. > >DeKalb Regional Healthcare >System, 2701 North Decatur Rd., Decatur, >Georgia, 30033, USA, >http://www.drhs.org > >*************************************************************************** >********* > > _____ > >High-speed users-be more efficient >online with the new MSN Premium Internet Software. > > _____ > >

May 6, 2005

see below for my responses - in cap locks next to the individual questions you

posed.

Randi

>

> From: barbara hodges <bhodgesrd@...>

> Date: 2005/05/06 Fri PM 01:04:45 EDT

>

> Subject: a few questions

>

> Hello

> I am looking to make some improvements to our clinic and I was wondering if

anyone would be able to share:

> 1. How long do you take with a new bariatric patient visit (i.e. how many

minutes)60-75 MINS.

> 2. How many preop visits do you have with a patient1-2

> 3. How many support groups are required prior to surgeryNONE, BUT I STRONGLY

ENCOURAGE PTS TO ATTEND, SINCE THE FACILITY HAS A EXCELLENT GROUP AND LEARNING

ENVIRONMENT

> 4. How long do you take with a follow up bariatric patient30-60 MINUTES

> 5. Do you see patients requiring medically supervised weight loss in a group

or one on oneINDIVIDUAL

> 6. Do you coincide your nutrition visits with the MD visit (i.e. your note

requires an MD signature for a higher rate of reimbursement) or do you see the

patient on your own.ACTUALLY, AT ANOTHER FACILITY WHERE I WORK (NOT BARIATRIC)

WE DO USE MD SIG. I SEE PATIENTS WITH CHRONIC DISEASES

> Thanks in Advance!!

>

> Barbara Hodges, RD, MPH

> Baystate Medical Center

> Springfield, MA

>

> wrote:

>

> There are 18 messages in this issue.

>

> Topics in this digest:

>

> 1. Re: insurance

> From: jeremaih elizondo

> 2. reference for GBP and Calcium

> From: " walterslm38 "

> 3. Re: Re: leak

> From: Beth Taschuk

> 4. Re: insurance

> From: " Beverly "

> 5. OOPS

> From: " walterslm38 "

> 6. oral iron therapy vs. IV therapy

> From: Carla Evers

> 7. Summer support

> From: " Townsend, R. "

> 8. RE: Summer support

> From: " Gregoline, L. "

> 9. Re: Bariatric Centers of Excellence

> From: Kathleen Roehling

> 10. Re: Insulin requirements after weight loss surgery

> From: Kathleen Roehling

> 11. Re: beth

> From: melissa miceli

> 12. RE: liver enzymes

> From: Jill Gorton

> 13. RE: liver enzymes

> From:

> 14. RE: liver enzymes

> From: jeremaih elizondo

> 15. Re: insurance

> From: " jrsagator "

> 16. Breath Hydrogen Test

> From: tina musselman

> 17. new member

> From: " le Paciera, LDN, RD "

> 18. RE: Summer support

> From: Elina Schwartz

>

> ________________________________________________________________________

>

> Message: 1

> Date: Wed, 4 May 2005 06:25:28 -0700 (PDT)

> From: jeremaih elizondo

> Subject: Re: insurance

>

> We bill using the codes - 97802 - Medical Nutrition Therapy Initial

assessment, and 97803 Medical nutrition Therapy re-assessment - it varies with

how much we get reimbursed depending on the insurance company.

>

> Jerry

>

> kiwi_razz wrote:

> I have been told by the director of the bariatric center that the

> nutrition component is NOT reimburseable. I was under the impression

> taht insurance companies DO reimburse for counseling when specified

> for medical reason. I work in a VA setting and do not deal with

> insurance companies (lucky me!)- but now it seems I need to do some

> research!

> Does anyone get reimbursed, and if so HOW and what CODE/S do you use?

>

> Thank you!

>

> ---------------------------------

>

May 6, 2005

barbara hodges <bhodgesrd@...> wrote:

Hello

I am looking to make some improvements to our clinic and I was wondering if anyone would be able to share:

1. How long do you take with a new bariatric patient visit (i.e. how many minutes)

we usually spend about 1 hour

2. How many preop visits do you have with a patient

it depends on the insurance- for bcbs we see the pt monthly for 12 months,for aethna we see the pt for 3 months (3 visits) and for everyone else we like to have at least 2 visits preop

3. How many support groups are required prior to surgery

none are required- we have our information seminar as a requirement

4. How long do you take with a follow up bariatric patient

we have 30 min slots but it usually takes 45 mins

5. Do you see patients requiring medically supervised weight loss in a group or one on one

right now 1 on 1 but we are starting the learn program next month so that will be groups up to 16 people

6. Do you coincide your nutrition visits with the MD visit (i.e. your note requires an MD signature for a higher rate of reimbursement) or do you see the patient on your own.

we do both

hope this helps

melissa

Thanks in Advance!!

Barbara Hodges, RD, MPH

Baystate Medical Center

Springfield, MA wrote:

May 6, 2005

Each Pt has an 1 hour pre-op consultation on an individual basis. I only have one pre op visit. No support groups but all pts must attend a seminar before the pre-op consult.

Jerrybarbara hodges <bhodgesrd@...> wrote:

Hello

I am looking to make some improvements to our clinic and I was wondering if anyone would be able to share:

1. How long do you take with a new bariatric patient visit (i.e. how many minutes)

2. How many preop visits do you have with a patient

3. How many support groups are required prior to surgery

4. How long do you take with a follow up bariatric patient

5. Do you see patients requiring medically supervised weight loss in a group or one on one

6. Do you coincide your nutrition visits with the MD visit (i.e. your note requires an MD signature for a higher rate of reimbursement) or do you see the patient on your own.

Thanks in Advance!!

Barbara Hodges, RD, MPH

Baystate Medical Center

Springfield, MA wrote:

May 9, 2005

Barbara,

Hope this helps!!

Joan

a few questions

Hello

I am looking to make some improvements to our clinic and I was wondering if anyone would be able to share:

1. How long do you take with a new bariatric patient visit (i.e. how many minutes) I usually plan for 90 minutes. We have a monthly class that goes over the post op protocol that we just changed to weekly, and are requiring that they go to that before they see me. I was finding that if a person comes to see me before they have gone to the class, then I spend more time working on the post op info vs. past eating habits, changes to implement, healthy eating. So far, it's working out well. Those group classes are not reimbursable, but we do have a $400.00 program fee.

2. How many preop visits do you have with a patient At least 2 unless there are unresolved issues. Sometimes it is driven by the insurance co.

3. How many support groups are required prior to surgery 3 which also includes the open house info night. We find people get hooked on the meetings and come to more than 3. Our group meetings are about 40 minutes of some type of educational session, then about 20 minutes of questions/sharing/etc. We try REALLY hard not to let a few individuals "control" the room.

4. How long do you take with a follow up bariatric patient I plan any where from 30-45 minutes, but am finding 45-60 minutes is more realistic. We find that "something" happens to them while they have been in the OR and they seem to "forget" a lot of info! Just kidding...I think it is more that they are actually having to live it everyday and it now becomes a reality.

5. Do you see patients requiring medically supervised weight loss in a group or one on one One on One, although I do a LOT of nutrition teaching in the support groups.

6. Do you coincide your nutrition visits with the MD visit (i.e. your note requires an MD signature for a higher rate of reimbursement) or do you see the patient on your own. We try NOT to for reimbursement purposes, our notes don't require MD signature. We also feel that the contact with them throughout the first year with all of us at different times really helps. Sometimes we have people that blow off the nutrition end of it, but the NP and RN co-ordinator are on their tails to get them in. I have great back up from them. If it's an insurance issue and they can't come, we make sure we work it out so they don't go without.

Thanks in Advance!!

Barbara Hodges, RD, MPH

Baystate Medical Center

Springfield, MA wrote:

May 26, 2005

Remember to top up your electrolytes afterward.

Saul do you have recommendations on products for doing so?

There is so much out there it is confusing.

Thank you kindly

Christel

May 26, 2005

Re: A Few Questions

> Dear ,

>

> The rash being gone means that the release of toxins is at a rate that

> your

> detox capacity (read liver) can handle, so that is a good sign.

>

> You are still having Herxheimer reactions, so that shows you still have a

> ways to go.

>

> For the ozone to penetrate your skin, the pores need to be open. So a

> light

> sweat is necessary. However, a heavier sweat is better for detoxing

> metals,

> and resetting the thyroid, so if you can handle it, and stay in for 30

> minutes, then go for the higher heat.

>

> Remember to top up your electrolytes afterward.

>

> Best of Health!

> Dr. Saul Pressman

> ---------------------------------------------------------------------

Saul,

As long as you mentioned resetting the thyroid, I have one thing to add

about some studies I found when researching my book on sauna therapy.

It was discovered that the contrast of showering or bathing in cold water

after a really intense sweat reset the thyroid more efficiently than simply

the heat alone.

Best,

Nenah

Nenah Sylver, PhD

http://www.nenahsylver.com

* The Handbook of Rife Frequency Healing

* The Holistic Handbook of Sauna Therapy

* products and services for wellness

Some studies done on

May 26, 2005

If I can ask a question...Does anyone know anything about oxygen curing

lung cancer orany cures for lung cancer...

I don't remember where i read it?

Re: A Few Questions

Remember to top up your electrolytes afterward.

Saul do you have recommendations on products for doing so?

There is so much out there it is confusing.

Thank you kindly

Christel

May 26, 2005

Hi Nenah. I wonder if a short stint with some cold water after a hot shower

would be helpful for this also? Do you know?

Thanks

Donna

Re: A Few Questions

Saul,

As long as you mentioned resetting the thyroid, I have one thing to add

about some studies I found when researching my book on sauna therapy.

It was discovered that the contrast of showering or bathing in cold water

after a really intense sweat reset the thyroid more efficiently than simply

the heat alone.

Best,

Nenah

Nenah Sylver, PhD

http://www.nenahsylver.com

May 26, 2005

Re: A Few Questions

> Hi Nenah. I wonder if a short stint with some cold water after a hot

> shower would be helpful for this also? Do you know?

>

> Thanks

> Donna

I would think it has some benefit, Donna, though I don't think it's as good

as an all-out sweat and cold shower. (Unless you sweat a lot in the hot

shower.) Before there were fancy ozone steam saunas ;-), hydrotherapy was

used a lot for all kinds of ailments. That's discussed in Chapter 1 of my

book on sauna therapy.

You're welcome.

Nenah

September 6, 2005

I don't post very often, but as a pregnant BFLifer, I know that if she is

planning on becoming pregnant it would be a really good idea to go ahead &

start taking a prenatal vitamin, or a regular multi & then take extra folic

acid on top of that. Folic acid helps prevent so many birth defects it

would be a good idea for her to take it!

A few questions

> I have a friend who wants to start BFL - she won't read the damn book,

> so I'm having to answer all her questions - it's

> exhausting...anyway...there are a few things I'm not sure about (for

> her) - she's 37 and in very good shape already but

> 1) She wants to know what multi-vitamins to take...I told her she

> shouldn't need one b/c of all the good foods she'll be eating, but she

> argues that she is prepping her body for the baby she wants to have

> (pregnant in 6 months is the goal). Any thoughts?

> 2) Also, what info can I give her about flabby skin around the middle?

> She already works out - ALOT and you'd never know she had the loose

> skin, but when I took her before and after pics, it became a topic of

> discussion. Are there any solid resources I can give her about what to

> do for this? I know there are alternatives to surgery, I just don't

> know what they are...

>

> Thanks, guys

>

September 6, 2005

I don't post very often, but as a pregnant BFLifer, I know that if she is

planning on becoming pregnant it would be a really good idea to go ahead &

start taking a prenatal vitamin, or a regular multi & then take extra folic

acid on top of that. Folic acid helps prevent so many birth defects it

would be a good idea for her to take it!

A few questions

> I have a friend who wants to start BFL - she won't read the damn book,

> so I'm having to answer all her questions - it's

> exhausting...anyway...there are a few things I'm not sure about (for

> her) - she's 37 and in very good shape already but

> 1) She wants to know what multi-vitamins to take...I told her she

> shouldn't need one b/c of all the good foods she'll be eating, but she

> argues that she is prepping her body for the baby she wants to have

> (pregnant in 6 months is the goal). Any thoughts?

> 2) Also, what info can I give her about flabby skin around the middle?

> She already works out - ALOT and you'd never know she had the loose

> skin, but when I took her before and after pics, it became a topic of

> discussion. Are there any solid resources I can give her about what to

> do for this? I know there are alternatives to surgery, I just don't

> know what they are...

>

> Thanks, guys

>

September 6, 2005

well, i told her that maybe she should look in to pre-natal vitamins but

she said she had heard they make you gain weight....

Dan & wrote:

> I don't post very often, but as a pregnant BFLifer, I know that if she is

> planning on becoming pregnant it would be a really good idea to go ahead &

> start taking a prenatal vitamin, or a regular multi & then take extra folic

> acid on top of that. Folic acid helps prevent so many birth defects it

> would be a good idea for her to take it!

>

> A few questions

>

>>I have a friend who wants to start BFL - she won't read the damn book,

>>so I'm having to answer all her questions - it's

>>exhausting...anyway...there are a few things I'm not sure about (for

>>her) - she's 37 and in very good shape already but

>>1) She wants to know what multi-vitamins to take...I told her she

>>shouldn't need one b/c of all the good foods she'll be eating, but she

>>argues that she is prepping her body for the baby she wants to have

>>(pregnant in 6 months is the goal). Any thoughts?

>>2) Also, what info can I give her about flabby skin around the middle?

>> She already works out - ALOT and you'd never know she had the loose

>>skin, but when I took her before and after pics, it became a topic of

>>discussion. Are there any solid resources I can give her about what to

>>do for this? I know there are alternatives to surgery, I just don't

>>know what they are...

>>

>>Thanks, guys

>>

September 6, 2005

I've never heard that one before, they're pretty much like a regular

multivitamin with a few things extra like more iron & more folic acid. I

don't think there's anything in them that would cause you to gain weight.

Re: A few questions

> well, i told her that maybe she should look in to pre-natal vitamins but

> she said she had heard they make you gain weight....

>

September 6, 2005

I've never heard that one before, they're pretty much like a regular

multivitamin with a few things extra like more iron & more folic acid. I

don't think there's anything in them that would cause you to gain weight.

Re: A few questions

> well, i told her that maybe she should look in to pre-natal vitamins but

> she said she had heard they make you gain weight....

>

September 6, 2005

---i second the folic acid.... if she doesn't want to take prenates

than make sure she takes a multi and folic.... they didn't make me

gain weight..

val

In , " Dan & "

<dangela4@s...> wrote:

> I've never heard that one before, they're pretty much like a

regular

> multivitamin with a few things extra like more iron & more folic

acid. I

> don't think there's anything in them that would cause you to gain

weight.

>

> Re: A few questions

>

> > well, i told her that maybe she should look in to pre-natal

vitamins but

> > she said she had heard they make you gain weight....

> >

September 6, 2005

I'm going to be quite blunt here... your friend has some fairly

strange ideas. First, she wants to do a program without having a

clue what's in it? It really isn't a hard book to read! But, I know

I'm preachin to the choir there, right? Second, pre-natal

vitamins are vitamins... there's less vitamin A and more Folic Acid

than normal ones, but they are VITAMINS, not hormones or any other

weird thing that would make you gain weight. You need to start

taking Folic Acid AT LEAST three months before you plan to get

pregnant to gain the best protective effects from it. It helps to

prevent Spina Bifida and a bunch of other things, especially in older

mothers.

On the skin front... is it really loose skin? or just tummy flab? If

she's never been very overweight and hasn't had babies it's more

likely to be flab, which BFL will take care of. If it is loose skin,

there's not a lot that can be done. Flax oil is good for skin, so are

vitamins, some people swear by Bio-oil (brand name), but I didn't

find it useful. I'm saving for the abdominoplasty once I've lost all

the fat from under my raisiny belly.

Phoenix

> > I don't post very often, but as a pregnant BFLifer, I know that

if she is

> > planning on becoming pregnant it would be a really good idea to

go ahead &

> > start taking a prenatal vitamin, or a regular multi & then take

extra folic

> > acid on top of that. Folic acid helps prevent so many birth

defects it

> > would be a good idea for her to take it!

> >

> > A few questions

> >

> >>I have a friend who wants to start BFL - she won't read the damn

book,

> >>so I'm having to answer all her questions - it's

> >>exhausting...anyway...there are a few things I'm not sure about

(for

> >>her) - she's 37 and in very good shape already but

> >>1) She wants to know what multi-vitamins to take...I told her she

> >>shouldn't need one b/c of all the good foods she'll be eating,

but she

> >>argues that she is prepping her body for the baby she wants to

have

> >>(pregnant in 6 months is the goal). Any thoughts?

> >>2) Also, what info can I give her about flabby skin around the

middle?

> >> She already works out - ALOT and you'd never know she had the

loose

> >>skin, but when I took her before and after pics, it became a

topic of

> >>discussion. Are there any solid resources I can give her about

what to

> >>do for this? I know there are alternatives to surgery, I just

don't

> >>know what they are...

> >>

> >>Thanks, guys

> >>

September 6, 2005

Do you think your friend would read the message boards here? I have

read the book (twice), but I love the information and support here -

I'm thinking if I did not like to read I would still love a board like

this.

Regardless of BFL, I hope your friend gets the right info about

prenatal vitamins. Neural tube defect is such an awful, deadly problem

- and so easily prevented by the right amount of folic acid in a

prenatal vitamin (best started before a pregnancy occurs). My son was

born missing a structure in his brain - not caused by anything I did

or didn't do (as far as anyone knows), but it's such heartache to wonder.

Keep giving her the right kind of support, Fuzzy, and perhaps she'll

join us here.

Sherry

> > > I don't post very often, but as a pregnant BFLifer, I know that

> if she is

> > > planning on becoming pregnant it would be a really good idea to

> go ahead &

> > > start taking a prenatal vitamin, or a regular multi & then take

> extra folic

> > > acid on top of that. Folic acid helps prevent so many birth

> defects it

> > > would be a good idea for her to take it!

> > >

> > > A few questions

> > >

> > >>I have a friend who wants to start BFL - she won't read the damn

> book,

> > >>so I'm having to answer all her questions - it's

> > >>exhausting...anyway...there are a few things I'm not sure about

> (for

> > >>her) - she's 37 and in very good shape already but

> > >>1) She wants to know what multi-vitamins to take...I told her she

> > >>shouldn't need one b/c of all the good foods she'll be eating,

> but she

> > >>argues that she is prepping her body for the baby she wants to

> have

> > >>(pregnant in 6 months is the goal). Any thoughts?

> > >>2) Also, what info can I give her about flabby skin around the

> middle?

> > >> She already works out - ALOT and you'd never know she had the

> loose

> > >>skin, but when I took her before and after pics, it became a

> topic of

> > >>discussion. Are there any solid resources I can give her about

> what to

> > >>do for this? I know there are alternatives to surgery, I just

> don't

> > >>know what they are...

> > >>

> > >>Thanks, guys

> > >>

September 6, 2005

Hey Phoenix! Good luck with that abdominoplasty - I recently had one and I

highly recommend it!

>>> zyth2002@... 9/6/2005 5:29:08 am >>>

I'm going to be quite blunt here... your friend has some fairly

strange ideas. First, she wants to do a program without having a

clue what's in it? It really isn't a hard book to read! But, I know

I'm preachin to the choir there, right? Second, pre-natal

vitamins are vitamins... there's less vitamin A and more Folic Acid

than normal ones, but they are VITAMINS, not hormones or any other

weird thing that would make you gain weight. You need to start

taking Folic Acid AT LEAST three months before you plan to get

pregnant to gain the best protective effects from it. It helps to

prevent Spina Bifida and a bunch of other things, especially in older

mothers.

On the skin front... is it really loose skin? or just tummy flab? If

she's never been very overweight and hasn't had babies it's more

likely to be flab, which BFL will take care of. If it is loose skin,

there's not a lot that can be done. Flax oil is good for skin, so are

vitamins, some people swear by Bio-oil (brand name), but I didn't

find it useful. I'm saving for the abdominoplasty once I've lost all

the fat from under my raisiny belly.

Phoenix

> > I don't post very often, but as a pregnant BFLifer, I know that

if she is

> > planning on becoming pregnant it would be a really good idea to

go ahead &

> > start taking a prenatal vitamin, or a regular multi & then take

extra folic

> > acid on top of that. Folic acid helps prevent so many birth

defects it

> > would be a good idea for her to take it!

> >

> > A few questions

> >

> >>I have a friend who wants to start BFL - she won't read the damn

book,

> >>so I'm having to answer all her questions - it's

> >>exhausting...anyway...there are a few things I'm not sure about

(for

> >>her) - she's 37 and in very good shape already but

> >>1) She wants to know what multi-vitamins to take...I told her she

> >>shouldn't need one b/c of all the good foods she'll be eating,

but she

> >>argues that she is prepping her body for the baby she wants to

have

> >>(pregnant in 6 months is the goal). Any thoughts?

> >>2) Also, what info can I give her about flabby skin around the

middle?

> >> She already works out - ALOT and you'd never know she had the

loose

> >>skin, but when I took her before and after pics, it became a

topic of

> >>discussion. Are there any solid resources I can give her about

what to

> >>do for this? I know there are alternatives to surgery, I just

don't

> >>know what they are...

> >>

> >>Thanks, guys

> >>

September 6, 2005

Thanks! It's gonna take a while for me to save up the 10,000 NZD

to have it done!!! (or 20,000 if I need my boobs shifting back up my

chest as well, which seems likely! lol) I love NZ , but sometimes it

sucks that we are such an itty-bitty country that specialised stuff

like that is really costly. And the surgeons may not be as good

simply because they don't get all the practice that US ones do! So

I'm scared to death, but I hate my wrinkly tummy, it's gross, even

though my two preschoolers think it's great, they like squishing it.

urgh!

Hey, do you think they would repunch my belly ring while they are in

there? I'm too chicken to have it done a THIRD time!

Phoenix

> Hey Phoenix! Good luck with that abdominoplasty - I recently had

one and I highly recommend it!

>

September 6, 2005