I mainly stick to the Pound of Cure eating plan. I found that that just works really well for me. And when I stick to mainly whole foods, I find that the food noise because I've always still had that even after surgery and like the drama surrounding food it's so much less.
Zoe:All right, welcome back everyone to the Pound of Cure Weight Loss Podcast. We are super excited to welcome Beth Ann with us today. Beth Ann, nice to connect with you today. Nice to see you. Yeah, nice to see you. So we would love to have you just kind of start by telling us your story. Go back to maybe before you got surgery, and what kind of led you to that decision.
Bethann:So weight has been a lifelong struggle for me and since I was young and I did all the diets with my mom, we did deal a meal with Richard Simmons and I. Even when I was 18, I did OptiFast when it was just a liquid diet, absolutely no sensible meal, just all. And I was able to. Through those diets and lean cuisine and all the things I gained and lost like 150 pounds and got to my goal weight but gained it all back at least seven different times in my life.
Dr. Weiner:Seven times.
Bethann:Yeah, oh yeah, I would get to a healthy weight, stay there for a year, maybe two. I never made it to the golden five year. I think when they say you made it five years, you're good. I never quite did five years, but a couple of years, and then I'd gain it back. And so when I had reached my late forties I was just like it is what it is, I'm going to live as healthfully as possible and, whatever my weight is, I'm just not going to fight it anymore. Life's too precious to be in this constant battle.
Bethann:But I had a complete hysterectomy at the time, and the way my weight was distributed was before then in my lower half, but at that time it really moved to my middle section and so I started to see problems with high blood pressure. My cholesterol was trending up, so was my blood sugar, and I was like, oh wow, how do I get the discipline and the drive to lose weight within my head, knowing, oh, I'll just gain it back, and I just couldn't do that. So I was searching for something to help me and I saw a lot of people on social media talking about VSG mainly, and you know the same thoughts of oh well, that's the easy way. That's cheating popped in my head, but fortunately I had the aha moment of, well, so what If this is something that can help me have a longer, healthier, happier life? When I'm looking back on my life, am I going to be proud that I took every opportunity, utilized every tool to live my best life, or am I going to be like, well, you struggled your whole life but you didn't take the easy way out?
Bethann:And to me, once I framed it that way, I was very confident in my decision to go ahead with bariatric surgery. And so I saw, I started researching and I saw Dr Weiner's video series and I went through that and I even had a notebook and I took notes and everything. And when I realized I was going to be a self-pay patient, I was in Las Vegas at the time and you were in Tucson and I realized, oh, that's doable with a car ride. And so I reached out to you and we went through the process and I had surgery with you and it went really well. So how long ago was your surgery? About two and a half years ago.
Dr. Weiner:Okay, and what was your starting weight and what's your weight now and just kind of how's, how was life after surgery?
Bethann:So I actually my weight was relatively low. I was like I'm 5'4" and I was just below 200 the day of surgery and then right now my weight is. It fluctuates between like 115 to 120. And so it went off. For me it was a fairly consistent small decline. I had the three-week stall, but other than that, once I got to around a healthy-ish weight, it really just declined the whole time and then around there it started to fluctuate slightly, but still, if you looked at a month it was always going down until about this weight.
Dr. Weiner:And I think you've had skin reduction surgery. So why don't you talk to us about that decision to have the skin reduction surgery and where you know what surgeries you had, if you feel comfortable sharing that, even if you how you researched it, how much it cost, all of that stuff would be, I think, really helpful for everybody.
Bethann:Yeah, and the recovery process OK so I had been at my absolute heaviest in high school and so you can imagine fluctuating that much. I had a lot of loose skin. It was very. It wasn't one of those things like, oh, if I angle a certain way you can see it. It was visible very obviously. And so I really wanted to have skin removal surgery. And I would say this I noticed some people I would still, if you told me I couldn't have skin removal surgery, I still would have gone ahead with a gastric bypass. Granted it's much to me. I am much more comfortable with my body after the skin removal, but I still absolutely 100% would have weight loss surgery even if I could not have had skin removal.
Bethann:So when I decided to have it, my medical practice they have a lot of different sections. You know people with different specialties. So I started there with the plastic surgery specialty just because that's what who my doctors recommended, and I went for an appointment and I felt very comfortable right away. So I didn't do exhaustive research. I kind of it was a one and done, fortunately for me. But I had a lot of people who I trusted recommend this practice. So that's the way I went about it and surgery didn't pay for it. I had to pay for it. I had a tummy tuck with a hernia repair and they were able to fudge some of the costs because they were fixing my hernia at the same time they did my tummy tuck and I forget how that number, those numbers, worked out. I want to say it was like the 6,000 range. I don't have the exact numbers 6,000 bucks. I want to say it was I hope I'm correct, maybe I'm totally off, maybe I haven't seen that there's kind of two different types of plastic surgery practice.
Dr. Weiner:I'll just talk a little bit about insurance coverage for the plastic surgery. Then I want to hear the rest of your story about recovery and everything like that. But there's when you get insurance, so a lot of people will say, oh, my insurance covers it if I lose over 100 pounds, and you have to submit the pictures and all that kind of stuff, and so you can get insurance coverage. Now when you have any kind of surgical procedure and this is something you encountered with your self-pay surgery the majority of the fee for the self-pay surgery goes to the hospital. The hospital is way more expensive than the surgeon, right or wrong. Actually, it does kind of make sense because the hospital has a lot more costs than the surgeon. But anyway, the same is true for plastic surgery. And so sometimes what plastic surgeons will do is they'll essentially look at the cost and be like, okay, we're going to do the hernia, insurance will pay this much, and then we're going to do the plastic surgery and it's this much, and they can break it up and they can use the insurance payment to kind of augment their reimbursement and then they can lower the fees and there's definitely practices that are out there.
Dr. Weiner:There's actually very few in Tucson, unfortunately, that will do it that way. When I practiced in Detroit, there was a lot more practices that did it that way and I always liked that. First of all, I would be referring like crazy to any practice in Tucson that did that, because it's so much better for the patients. We have patients paying 15, 20, 25,000 bucks for their surgery and that's just kind of crazy and what happens is it puts skin removal surgery out of the price range for 90% of our patients patients. And so if you can find a quality plastic surgeon who will work with your insurance because they will get some payment, now you're never going to find a plastic surgeon who's like oh, your insurance covers it, I'll do it for what your insurance will pay.
Bethann:Because it's like they're going to do it right. How long is your surgery? Four hours five hours.
Dr. Weiner:The tummy tuck, I want to say around that amount of time. It takes a long time to do these procedures correctly. If you want to kind of lop off some skin and put some stitches in, you can get it done a lot quicker, but it's not going to. It's going to be all lumpy and bumpy. It takes a long time to do this right, and so the insurance company pays a relatively small amount and you're not going to find a quality plastic surgeon who's like I'll do this four-hour surgery and provide 90 days of wound care coverage and treatment for all the postoperative care, which is generally a lot for you know, $800 that your insurance company will pay. It's just the math. Just it doesn't even come close. So there's always going to be some additional charge. But if they can take that charge and reduce the hospital fee, that makes a huge difference. So it sounds like you found someone who did that. Were they in Vegas or were they in Iowa?
Bethann:They were in Iowa and it was at a surgical clinic. I for the tummy tuck. I didn't spend the night, I let like basically I woke up and they were like, all right, get out. It was a little abrupt but but everything everything went well when they released me. So yeah, for the tummy tuck, that was the case and I had that in August and it was I don't want to say it's this case for everyone, but it was a very easy recovery for me.
Bethann:It was, oh, I would say I took the pain meds maybe just three days and then I was, I moved to Tylenol and I was fine and moving around, and then that was in August. And then I was, I moved to Tylenol and I was fine and moving around, and then that was in August. And then in that December I had a bilateral thigh lift. Now that was closer to 14,000 because that was like an eight hour surgery. They tend to in your inner thighs they just make a. Normally they just make a line down the middle and they close the skin back up. For this he made the line down the middle and also up through my hips and kind of pulled me up as well as going horizontally or vertically, and horizontally too Vertically, and horizontally, horizontally too.
Bethann:So that was, in fact, he had a fellow surgeon work with him at the same time because he was he was. You know, eight hours is a long time, so he had someone another surgical surgeon assisting him so they could make sure that everything was done really well. And this actually was the first time. This was the same surgeon who did my tummy tuck, so I had a lot of faith in him and he did it a different way that he's never done before, and so he had me come in a couple of extra times to go over it and make sure he had everything he needed. And he also did a really good job of making sure my expectations were clear. And I would say for me I'm and it definitely.
Bethann:It's not as if. When I look at the results, I think they're great, but if you're expecting it to look like, oh, you're a 20-year-old who never had weight issues, that's probably not realistic for most people. I'm 50. So you know I had to take that into account. And if you're younger I'm sure the younger you are, the better it will be but it's never like, oh, you were never heavy and overweight. There's always like I still have like a little bit of loose skin over my knees and stuff, but to me it exceeded my expectations and I'm very happy with it.
Bethann:The thigh lift I did have a seroma that got infected, so they did have to go back in and put in a tube, another draining tube, and so that extended my recovery time, but it wasn't particularly painful. There were complications, but they still went smoothly Nothing that I had to go to the emergency room or anything like that. So in both cases it was fairly smooth. I recovered on time, like I was supposed to, and yeah, I'm personally thrilled with the results and I'm very fortunate that I was able to do it. And yeah, like, if you're able to do it, that's great, but I also would. If you don't think you'll be able to afford to, which I completely understand I would still say weight loss, at least from my point of view, was definitely still worth it, even if I had to still have the loose skin.
Zoe:So why don't we hear a little bit about what your life looks like now in terms of the habits that you've created, maybe with your nutrition or your movement? What does living and maintenance in your new body that you've been now able to maintain for longer?
Bethann:than the other times that you've done it.
Zoe:What does that look like for?
Bethann:you, it is so night and day. From my other attempts I mainly stick to the Pound of Cure eating plan. I found that that just works really well for me. And when I stick to mainly whole foods I find that the food noise because I've always still had that, even after surgery and like the drama surrounding food, it's so much less I won't say non-existent, but so much less.
Bethann:If I stick to whole foods and I don't measure, I really rely on my food or my hunger cues, and I'm able to. I do have like I don't call them rules, I call them guidelines. I make sure every time I eat I have protein, fiber and a healthy fat and I sort of think about well, if I had to make this meal from scratch back in my grandmother's day, would I have all the ingredients in my kitchen? I'm all about convenience. I'll get something pre-chopped and all that sort of stuff. But if I had to and if I kind of have that mindset of you know, I have these whole foods to make up my meal. If that's like 98 plus percent of the time, I find that I don't really have to. Percent of the time, I find that I don't really have to count calories or measure or anything like that. So eating is so much less drama and so much less concern. In terms of movement, I was doing really well and I've prioritized weightlifting Through my surgeries I couldn't my skin removal surgeries I couldn't work out and I could tell I lost quite a bit more weight, and I think a lot of it was just muscle mass, because I wasn't able to move around. And as soon as I got healthy enough to move around, then I had my neck surgery and so it was a while before I got back to working out again. And so now, um, I work out and I prioritize weightlifting.
Bethann:Um, this summer I've been watching my two year old great niece and we, like I, before surgery, I was having trouble. I had to think about like, ok, if I go down on the ground, how exactly am I going to get myself back up? And now I realize one day I was like, oh my gosh, I couldn't even count how many times I've gotten on and off the ground to take care of her. We go to the zoo almost every week and she doesn't like strollers, so I carry her around the zoo and I realized, oh, this is nothing to me, I don't even have to like, oh, we have to sit down for a little bit. I just, you know, pick her up and we go. It's a small zoo, it's Des Moines Zoo, but we go around and we have a lot of fun and I don't even have to.
Bethann:I was getting to the point before surgery I had to think about like, okay, how far is this? Are there going to be places for me to sit and rest, things like that? And now that's not even. I don't even think about it, it's not a concern. So that's so exciting and it makes working out better, because I realized, oh, to have this life to be able to walk around the zoo with my niece.
Bethann:That's why I'm working out, not to necessarily lose weight or to look a certain way. I mean, that's fun too. You know, I like wearing cute clothes and things like that. It's totally fun. But the main reason is and when you can actually see it in play and know how much fun it is, it makes working out easier.
Bethann:It makes sticking like I would much rather stick to the diet I'm doing now than have more ultra processed food but not be able to do those things with my niece and I can say also going back to the diet a bit. I truly enjoy everything I eat. I've just discovered things called cherry plums and, oh my gosh, they're the greatest thing I've ever eaten in my life and I have like at least one a day. And I if, when I mix an ultra processed food, I don't those fruits and vegetables don't taste as good to me. But when I keep them mainly out and I'm not saying I can't or never, but when I don't, when they're an occasional thing, not a frequent thing I truly enjoy the food I'm eating so much more, and so right now I mean, knock on wood, things are going really well and really smoothly so, and I see this being sustainable past the five years and beyond, you know. So I'm very happy with my decision and excited.
Zoe:Well, I think you really nailed the nail on the head with the mindset shifts, the lifestyle shifts, the focus off of exercise for aesthetics and, more so, movement for quality of life and for quality time with those that you love, and just the experience of living through this different lens that you're now not having to think of some of those things that you used to have to, and it just is such a beautiful time of life that you're in and I'm so grateful that you shared it with us. It's, it's truly incredible and you should be so proud of yourself.
Dr. Weiner:I have one quick question before we, before we, before we leave. You were a low BMI patient, right, Bethann? I mean, your BMI was like you were just barely qualified for bariatric surgery. You chose a gastric bypass, which is a little bit more of an aggressive surgery. Just kind of walk us through that decision making. It clearly has worked out very, very well and, honestly, that's been my experience is that lower BMI patients get to like that low 20 BMI, that kind of really like great high school weight that they, you know, once they kind of dreamed of being. And so just kind of walk us through that decision. Did you get some criticism from other people? How did that go for you, just in terms of your own decision making and then how other people viewed that decision?
Bethann:Well, when I did my research on what possible surgery I would have, I saw that the outcomes for VSG versus gastric bypass were like similar in the initial weight loss, but regain it was so much better with the gastric bypass. And, like I said before, I had done this seven times and I knew that the real battle for me wasn't losing the weight Not that that would be easy but it wasn't losing weight. The real battle for me was not regaining it. So my whole focus was on what's going to give me the best outcome in terms of not regaining. And so I did look at surgeons in the Vegas area, but all of them were really pushing the VSG surgery and without having a conversation with me and understanding. And you know I would ultimately defer to a surgeon's expertise I, you know, wouldn't override that but I wanted to at least feel that gastric bypass was on the table and we were having a discussion and for me as an individual, they really thought VSG was better, for whatever reason, and I would be open to that conversation. But it was no. Based on my numbers, you should do VSG, not taking into account how many times I had done this. Based on my numbers, you should do VSG not taking into account how many times I had done this that I was at a relatively low weight for me. I had been much higher before, and so that was another reason I decided to go with.
Bethann:Your program is our first meeting. You actually sat with me and we had a discussion and we talked about my history and what I would want, and then you gave me your recommendations or you discussed them. Then we had the conversation about it. It wasn't. You didn't have like, well, this is the surgery you should do. End of discussion.
Bethann:And so that's what I was looking for, and I'm very happy that that's what I chose to do, because I think for most people, losing weight is the first part of the battle, but the really hard, long one is keeping that weight off, and gastric bypass, yeah, gives you a better chance with that statistically. So even peace of mind that let me know like, oh, I have this really powerful tool. And when you know in your head you have this really powerful tool or something, it makes you even more motivated to try, because you know you have something working with you. So the work you put in is really the work you're going to get out, and when you know that you even work harder. At least my personality is that way, yeah.
Dr. Weiner:I think that's something. I'm glad that that came through, because that's something I try to do with. Every patient is like everybody comes to me and for me it's like you know, sometimes I'll see eight, 10 new patients in an afternoon or a day. Usually I can't see it in the afternoon, but each visit takes a while. But I'll sometimes see eight or 10 new patients in a day and I you know each. For me it's like just another visit, but for that patient there's been a lot of thought and energy that's gone into getting them there. And so one thing I always try to figure out is like, like don't take this the wrong way. But it's like what's your angle right? Like what is the thing? Like why are you here? What is it that you really really want?
Dr. Weiner:Some people are like devastatingly afraid of any type of complication and afraid of surgery, and we need to make sure that we honor that, that concern and that there's that request. And you know, for you it was I need to make sure that we honor that concern and that request, and for you it was I need to make sure I don't regain the weight again. Some people now with the meds it's like I don't want to take medication. That's my whole thing. I don't want to take medication, and so we have to choose a surgery and craft it toward that.
Dr. Weiner:Some people are like I want to check these meds out.
Dr. Weiner:I'm okay with it, maybe we work together on it, maybe I don't need surgery at all, and so I think everybody kind of brings their own shtick to the party for lack of a better term.
Dr. Weiner:And I think it's so important when you're meeting with a surgeon that you feel like your concerns, that the things that are most important to you, are being addressed, and that your procedure choice is going to reflect the those values that you have. And that's that's where I think education and and it's really both the surgeon who's going to kind of listen to you, but it's also that pre-operative education, so you kind of have a sense of what, what things, what you know, what the best choice is for you. You might be wrong, and I'll. Patients will come to me all the time with something that they think and I'll be like well, actually that's not really correct because and I'll explain why, and so there has to be that conversation too but but you have to make sure that that your needs are met by this surgery and it sounds like that's. That's what drove you to have the surgery.
Zoe:So I think that's fantastic. Yeah, yeah, absolutely so. If somebody listening wants to learn more about potentially becoming a self-paced surgery patient, dr Weiner, do you want to explain how they might be able to get in contact with an appointment with you?
Dr. Weiner:Yeah, so I mean our self-paid price. We're certainly not the cheapest in the country, but we're also pretty reasonably priced, probably a little bit less than the average price. But I think what we don't number one is the surgery is done in a real hospital. I don't think ambulatory surgery centers are wrong for everybody, but I think if you're looking for the safest possible option, there's no question that spending the night in a hospital is the safest way to recover from the surgery, and so we have all of our self-pay patients spend the night in a real hospital. There's 24-7 medical support. It's a 500-bed hospital, so you know, in any given night there might be 20 or 30 different doctors in the hospital.
Dr. Weiner:As an ambulatory surgery center, sometimes it's a nurse and four patients, and that's. There's just a very different level of support from those two scenarios. And so I think that's the first thing. And then I think also it's you know who is the anesthesia team? Is this an experienced team? And so you know we obviously have all that at our hospital, tucson Medical Center. But if you're interested, we do accept patients from all over the country. Bethann came to us from Vegas. We had people come from the East Coast, whatever, and they can sign up for our surgery. There's actually a self-pay surgery link on our website directly, so feel free to check that out and reach out to us if your insurance doesn't cover it and you had an exclusion on your insurance, right, bethann?
Bethann:Yeah, I didn't qualify under my insurance um, yeah, my sir, I didn't qualify under my insurance. Oh so your b, it was your low bmi, it was my low bmi and I was um getting off of blood pressure medication, so that was also so I didn't wait to have to have surgery.
Dr. Weiner:It didn't make sense to me if your bmi is between 35 and 40, then you need to have a comorbid condition.
Dr. Weiner:Now that's what the insurance criteria are for most policies. However, our society has released its own set of policies based on the data, and the data clearly shows that there's a huge amount of benefit and a solid safety factor for patients with a BMI of 35 and above, without a comorbid condition, to have either a sleeve or a gastric bypass. So we run into an issue where our scientific data says, hey, this is a safe and smart thing for you to do. The insurance company says, sorry, we're going to go by the 1998 criteria before laparoscopy is even a thing, that's what we're going to use. And so you know, the patient, of course, is caught in the middle. Insurance company doesn't want to change because it's just going to cost them more money. So anyway, yeah, so if you, if you're not, if you don't have coverage, if you're a lower BMI patient or if you have a bariatric exclusion that's the most common reason why we see people come in from out of out of state for surgery.
Zoe:Yeah, we'll be sure to put the link to the self-paced surgery page in the description.
Dr. Weiner:For sure. All right. Well, bethann, great to see you again and congrats on your success. It sounds like you've really gotten the most out of this surgery.
Bethann:So great seeing you, nice seeing you, and I'll be making an appointment with you soon. Sounds good.
Dr. Weiner:All right.