October 24, 2024 • 31 mins
In this episode of the Pound of Cure Weight Loss Podcast, we sit down with BethAnn, whose journey through bariatric surgery has completely transformed her life. From struggling with weight her entire life, trying countless diets, and facing health challenges, to finally achieving long-term success after surgery, BethAnn's story is one of determination, resilience, and self-care.
BethAnn didn’t just stop at weight loss—she took additional steps to feel comfortable in her new body, including skin removal surgery. She also navigated the self-pay bariatric surgery route, making informed decisions to get the best results for her personal situation.
Let’s dive into her incredible journey and learn how bariatric surgery can change not just your body, but your entire outlook on life. Whether you're exploring bariatric surgery for yourself, curious about skin removal after weight loss, or considering self-pay options, BethAnn’s story is packed with insights that may guide you on your own path.
Bariatric Surgery Success Story: BethAnn's Lifelong Weight Struggles
BethAnn’s story is one that many can relate to. She had been battling her weight since childhood, trying everything from Richard Simmons’ Deal-a-Meal to more extreme options like OptiFast, a liquid-only diet. While she did experience short-term weight loss success with these diets—losing as much as 150 pounds—BethAnn found herself regaining the weight over and over.
By the time she reached her late 40s, BethAnn had resigned herself to living with the constant weight struggle. After undergoing a hysterectomy, she noticed her weight began to redistribute to her midsection, leading to additional health concerns like high blood pressure and rising cholesterol. She knew she needed a long-term solution.
"I’d done this seven times—lost the weight, gained it back," BethAnn explains. "The real battle for me was not losing the weight, but keeping it off."
That's when she began to seriously consider bariatric surgery. Initially, like many, she hesitated, thinking of it as "cheating" or "taking the easy way out." But as she reframed the narrative, it became clear that bariatric surgery was a tool that could give her a second chance at a healthier life.
After researching extensively and watching Dr. Weiner's video series, BethAnn decided to move forward with a gastric bypass procedure. This decision would turn out to be the start of her success story.
Choosing Gastric Bypass Over VSG
BethAnn’s success with bariatric surgery didn’t happen overnight, and her choice to go with gastric bypass rather than VSG (Vertical Sleeve Gastrectomy) was strategic. For her, avoiding weight regain was the ultimate goal. She was determined to pick the surgery that gave her the best long-term chance of success, and after careful research, she saw that gastric bypass offered better outcomes for maintaining weight loss over the years.
"I was less concerned about losing the weight and more focused on keeping it off," she says. "I knew that gastric bypass had better stats when it came to avoiding weight regain, and I’d been through enough yo-yo dieting to know that was my biggest challenge."
At the time of her surgery, BethAnn weighed just under 200 pounds—making her a lower BMI patient for bariatric surgery. Still, her choice of gastric bypass was a decision based on her history of weight regain, not just her starting weight.
Skin Removal After Weight Loss: A Necessary Next Step
After her weight stabilized at around 115-120 pounds, BethAnn faced another challenge that many post-op patients encounter: loose skin. This is a common side effect of significant weight loss, especially after bariatric surgery. Skin doesn’t always “snap back” into place after the weight is gone, and for BethAnn, it was more than just a cosm
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Bethann (00:00):
I mainly stick to the Pound of Cure eating plan.
I found that that just worksreally well for me.
And when I stick to mainlywhole foods, I find that the
food noise because I've alwaysstill had that even after
surgery and like the dramasurrounding food it's so much
less.
Zoe (00:21):
All right, welcome back everyone to the Pound of Cure
Weight Loss Podcast.
We are super excited to welcomeBeth Ann with us today.
Beth Ann, nice to connect withyou today.
Nice to see you.
Yeah, nice to see you.
So we would love to have youjust kind of start by telling us
your story.
(00:41):
Go back to maybe before you gotsurgery, and what kind of led
you to that decision.
Bethann (00:49):
So weight has been a lifelong struggle for me and
since I was young and I did allthe diets with my mom, we did
deal a meal with Richard Simmonsand I.
Even when I was 18, I didOptiFast when it was just a
liquid diet, absolutely nosensible meal, just all.
(01:11):
And I was able to.
Through those diets and leancuisine and all the things I
gained and lost like 150 poundsand got to my goal weight but
gained it all back at leastseven different times in my life
.
Dr. Weiner (01:27):
Seven times.
Bethann (01:28):
Yeah, oh yeah, I would get to a healthy weight, stay
there for a year, maybe two.
I never made it to the goldenfive year.
I think when they say you madeit 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 mylate forties I was just like it
is what it is, I'm going to liveas healthfully as possible and,
(01:50):
whatever my weight is, I'm justnot going to fight it anymore.
Life's too precious to be inthis constant battle.
But I had a completehysterectomy at the time, and
the way my weight wasdistributed was before then in
my lower half, but at that timeit really moved to my middle
(02:11):
section and so I started to seeproblems with high blood
pressure.
My cholesterol was trending up,so was my blood sugar, and I
was like, oh wow, how do I getthe discipline and the drive to
lose weight within my head,knowing, oh, I'll just gain it
back, and I just couldn't dothat.
(02:32):
So I was searching forsomething to help me and I saw a
lot of people on social mediatalking about VSG mainly, and
you know the same thoughts of ohwell, that's the easy way.
That's cheating popped in myhead, but fortunately I had the
aha moment of, well, so what Ifthis is something that can help
(02:55):
me have a longer, healthier,happier life?
When I'm looking back on mylife, am I going to be proud
that I took every opportunity,utilized every tool to live my
best life, or am I going to belike, well, you struggled your
whole life but you didn't takethe easy way out?
And to me, once I framed it thatway, I was very confident in my
(03:15):
decision to go ahead withbariatric surgery.
And so I saw, I startedresearching and I saw Dr
Weiner's video series and I wentthrough that and I even had a
notebook and I took notes andeverything.
And when I realized I was goingto be a self-pay patient, I was
(03:35):
in Las Vegas at the time andyou were in Tucson and I
realized, oh, that's doable witha car ride.
And so I reached out to you andwe went through the process and
I had surgery with you and itwent really well.
So how long ago was yoursurgery?
About two and a half years ago.
Dr. Weiner (03:55):
Okay, and what was your starting weight and what's
your weight now and just kind ofhow's, how was life after
surgery?
Bethann (04:03):
So I actually my weight was relatively low.
I was like I'm 5'4" and I wasjust below 200 the day of
surgery and then right now myweight is.
It fluctuates between like 115to 120.
And so it went off.
(04:24):
For me it was a fairlyconsistent small decline.
I had the three-week stall, butother than that, once I got to
around a healthy-ish weight, itreally just declined the whole
time and then around there itstarted to fluctuate slightly,
but still, if you looked at amonth it was always going down
(04:46):
until about this weight.
Dr. Weiner (04:48):
And I think you've had skin reduction surgery.
So why don't you talk to usabout that decision to have the
skin reduction surgery and whereyou know what surgeries you had
, if you feel comfortablesharing that, even if you how
you researched it, how much itcost, all of that stuff would be
, I think, really helpful foreverybody.
Bethann (05:07):
Yeah, and the recovery process OK so I had been at my
absolute heaviest in high schooland so you can imagine
fluctuating that much.
I had a lot of loose skin.
It was very.
It wasn't one of those thingslike, oh, if I angle a certain
way you can see it.
It was visible very obviously.
(05:29):
And so I really wanted to haveskin removal surgery.
And I would say this I noticedsome people I would still, if
you told me I couldn't have skinremoval surgery, I still would
have gone ahead with a gastricbypass.
Granted it's much to me.
I am much more comfortable withmy body after the skin removal,
(05:51):
but I still absolutely 100%would have weight loss surgery
even if I could not have hadskin removal.
So when I decided to have it, mymedical practice they have a
lot of different sections.
You know people with differentspecialties.
So I started there with theplastic surgery specialty just
(06:13):
because that's what who mydoctors recommended, and I went
for an appointment and I feltvery comfortable right away.
So I didn't do exhaustiveresearch.
I kind of it was a one and done, fortunately for me.
But I had a lot of people who Itrusted recommend this practice
.
So that's the way I went aboutit and surgery didn't pay for it
(06:35):
.
I had to pay for it.
I had a tummy tuck with ahernia repair and they were able
to fudge some of the costsbecause they were fixing my
hernia at the same time they didmy tummy tuck and I forget how
that number, those numbers,worked out.
I want to say it was like the6,000 range.
(06:58):
I don't have the exact numbers6,000 bucks.
I want to say it was I hope I'mcorrect, maybe I'm totally off,
maybe I haven't seen thatthere's kind of two different
types of plastic surgerypractice.
Dr. Weiner (07:17):
I'll just talk a little bit about insurance
coverage for the plastic surgery.
Then I want to hear the rest ofyour story about recovery and
everything like that.
But there's when you getinsurance, so a lot of people
will say, oh, my insurancecovers it if I lose over 100
pounds, and you have to submitthe pictures and all that kind
of stuff, and so you can getinsurance coverage.
(07:41):
Now when you have any kind ofsurgical procedure and this is
something you encountered withyour self-pay surgery the
majority of the fee for theself-pay surgery goes to the
hospital.
The hospital is way moreexpensive than the surgeon,
right or wrong.
Actually, it does kind of makesense because the hospital has a
lot more costs than the surgeon.
But anyway, the same is truefor plastic surgery.
(08:02):
And so sometimes what plasticsurgeons will do is they'll
essentially look at the cost andbe like, okay, we're going to
do the hernia, insurance willpay this much, and then we're
going to do the plastic surgeryand it's this much, and they can
break it up and they can usethe insurance payment to kind of
augment their reimbursement andthen they can lower the fees
(08:24):
and there's definitely practicesthat are out there.
There's actually very few inTucson, unfortunately, that will
do it that way.
When I practiced in Detroit,there was a lot more practices
that did it that way and Ialways liked that.
First of all, I would bereferring like crazy to any
practice in Tucson that did that, because it's so much better
(08:45):
for the patients.
We have patients paying 15, 20,25,000 bucks for their surgery
and that's just kind of crazyand what happens is it puts skin
removal surgery out of theprice range for 90% of our
patients patients.
And so if you can find aquality plastic surgeon who will
(09:07):
work with your insurancebecause they will get some
payment, now you're never goingto find a plastic surgeon who's
like oh, your insurance coversit, I'll do it for what your
insurance will pay.
Bethann (09:21):
Because it's like they're going to do it right.
How long is your surgery?
Four hours five hours.
Dr. Weiner (09:25):
The tummy tuck, I want to say around that amount
of time.
It takes a long time to dothese procedures correctly.
If you want to kind of lop offsome skin and put some stitches
in, you can get it done a lotquicker, but it's not going to.
It's going to be all lumpy andbumpy.
It takes a long time to do thisright, and so the insurance
(09:46):
company pays a relatively smallamount and you're not going to
find a quality plastic surgeonwho's like I'll do this
four-hour surgery and provide 90days of wound care coverage and
treatment for all thepostoperative care, which is
generally a lot for you know,$800 that your insurance company
will pay.
(10:06):
It's just the math.
Just it doesn't even come close.
So there's always going to besome additional charge.
But if they can take thatcharge and reduce the hospital
fee, that makes a hugedifference.
So it sounds like you foundsomeone who did that.
Were they in Vegas or were theyin Iowa?
Bethann (10:23):
They were in Iowa and it was at a surgical clinic.
I for the tummy tuck.
I didn't spend the night, I letlike basically I woke up and
they were like, all right, getout.
It was a little abrupt but buteverything everything went well
when they released me.
So yeah, for the tummy tuck,that was the case and I had that
(10:45):
in August and it was I don'twant to say it's this case for
everyone, but it was a very easyrecovery for me.
It was, oh, I would say I tookthe pain meds maybe just three
days and then I was, I moved toTylenol and I was fine and
moving around, and then that wasin August.
And then I was, I moved toTylenol and I was fine and
moving around, and then that wasin August.
(11:08):
And then in that December I hada bilateral thigh lift.
Now that was closer to 14,000because that was like an eight
hour surgery.
They tend to in your innerthighs they just make a.
Normally they just make a linedown the middle and they close
the skin back up.
(11:28):
For this he made the line downthe middle and also up through
my hips and kind of pulled me upas well as going horizontally
or vertically, and horizontallytoo Vertically, and horizontally
(11:48):
, horizontally too.
So that was, in fact, he had afellow surgeon work with him at
the same time because he was hewas.
You know, eight hours is a longtime, so he had someone another
surgical surgeon assisting himso they could make sure that
everything was done really well.
And this actually was the firsttime.
This was the same surgeon whodid my tummy tuck, so I had a
lot of faith in him and he didit a different way that he's
(12:13):
never done before, and so he hadme come in a couple of extra
times to go over it and makesure he had everything he needed
.
And he also did a really goodjob of making sure my
expectations were clear.
And I would say for me I'm andit definitely.
(12:35):
It's not as if.
When I look at the results, Ithink 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'sprobably not realistic for most
people.
I'm 50.
So you know I had to take thatinto account.
And if you're younger I'm surethe younger you are, the better
it will be but it's never like,oh, you were never heavy and
(13:02):
overweight.
There's always like I stillhave like a little bit of loose
skin over my knees and stuff,but to me it exceeded my
expectations and I'm very happywith it.
The thigh lift I did have aseroma that got infected, so
they did have to go back in andput in a tube, another draining
(13:25):
tube, and so that extended myrecovery time, but it wasn't
particularly painful.
There were complications, butthey still went smoothly Nothing
that I had to go to theemergency room or anything like
that.
So in both cases it was fairlysmooth.
I recovered on time, like I wassupposed to, and yeah, I'm
(13:49):
personally thrilled with theresults and I'm very fortunate
that I was able to do it.
And yeah, like, if you're ableto do it, that's great, but I
also would.
If you don't think you'll beable to afford to, which I
completely understand I wouldstill say weight loss, at least
(14:10):
from my point of view, wasdefinitely still worth it, even
if I had to still have the looseskin.
Zoe (14:16):
So why don't we hear a little bit about what your life
looks like now in terms of thehabits that you've created,
maybe with your nutrition oryour movement?
What does living andmaintenance in your new body
that you've been now able tomaintain for longer?
Bethann (14:35):
than the other times that you've done it.
Zoe (14:37):
What does that look like for?
Bethann (14:38):
you, it is so night and day.
From my other attempts I mainlystick to the Pound of Cure
eating plan.
I found that that just worksreally well for me.
And when I stick to mainlywhole foods I find that the food
noise because I've always stillhad that, even after surgery
(15:00):
and like the drama surroundingfood, it's so much less I won't
say non-existent, but so muchless.
If I stick to whole foods and Idon't measure, I really rely on
my food or my hunger cues, andI'm able to.
(15:21):
I do have like I don't callthem rules, I call them
guidelines.
I make sure every time I eat Ihave protein, fiber and a
healthy fat and I sort of thinkabout well, if I had to make
this meal from scratch back inmy grandmother's day, would I
have all the ingredients in mykitchen?
I'm all about convenience.
I'll get something pre-choppedand all that sort of stuff.
(15:42):
But if I had to and if I kindof have that mindset of you know
, I have these whole foods tomake up my meal.
If that's like 98 plus percentof the time, I find that I don't
really have to.
Percent of the time, I findthat I don't really have to
(16:02):
count calories or measure oranything like that.
So eating is so much less dramaand so much less concern.
In terms of movement, I wasdoing really well and I've
prioritized weightliftingThrough my surgeries I couldn't
my skin removal surgeries Icouldn't work out and I could
(16:23):
tell I lost quite a bit moreweight, and I think a lot of it
was just muscle mass, because Iwasn't able to move around.
And as soon as I got healthyenough to move around, then I
had my neck surgery and so itwas a while before I got back to
working out again.
And so now, um, I work out andI prioritize weightlifting.
(16:48):
Um, this summer I've beenwatching my two year old great
niece and we, like I, beforesurgery, 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 myselfback up?
And now I realize one day I waslike, oh my gosh, I couldn't
even count how many times I'vegotten on and off the ground to
(17:10):
take care of her.
We go to the zoo almost everyweek and she doesn't like
strollers, so I carry her aroundthe zoo and I realized, oh,
this is nothing to me, I don'teven have to like, oh, we have
to sit down for a little bit.
I just, you know, pick her upand we go.
It's a small zoo, it's DesMoines Zoo, but we go around and
(17:31):
we have a lot of fun and Idon't even have to.
I was getting to the pointbefore surgery I had to think
about like, okay, how far isthis?
Are there going to be placesfor 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 itmakes working out better,
(17:54):
because I realized, oh, to havethis life to be able to walk
around the zoo with my niece.
That's why I'm working out, notto necessarily lose weight or to
look a certain way.
I mean, that's fun too.
You know, I like wearing cuteclothes and things like that.
It's totally fun.
But the main reason is and whenyou can actually see it in play
(18:16):
and know how much fun it is, itmakes working out easier.
It makes sticking like I wouldmuch rather stick to the diet
I'm doing now than have moreultra processed food but not be
able to do those things with myniece and I can say also going
back to the diet a bit.
I truly enjoy everything I eat.
(18:37):
I've just discovered thingscalled cherry plums and, oh my
gosh, they're the greatest thingI've ever eaten in my life and
I have like at least one a day.
And I if, when I mix an ultraprocessed food, I don't those
fruits and vegetables don'ttaste as good to me.
But when I keep them mainly outand I'm not saying I can't or
(18:59):
never, but when I don't, whenthey're an occasional thing, not
a frequent thing I truly enjoythe food I'm eating so much more
, and so right now I mean, knockon wood, things are going
really well and really smoothlyso, and I see this being
sustainable past the five yearsand beyond, you know.
(19:20):
So I'm very happy with mydecision and excited.
Zoe (19:25):
Well, I think you really nailed the nail on the head with
the mindset shifts, thelifestyle shifts, the focus off
of exercise for aesthetics and,more so, movement for quality of
life and for quality time withthose that you love, and just
(19:45):
the experience of living throughthis different lens that you're
now not having to think of someof those things that you used
to have to, and it just is sucha beautiful time of life that
you're in and I'm so gratefulthat you shared it with us.
It's, it's truly incredible andyou should be so proud of
yourself.
Dr. Weiner (20:04):
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 youwere 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 throughthat decision making.
It clearly has worked out very,very well and, honestly, that's
(20:26):
been my experience is thatlower BMI patients get to like
that low 20 BMI, that kind ofreally like great high school
weight that they, you know, oncethey kind of dreamed of being.
And so just kind of walk usthrough that decision.
Did you get some criticism fromother people?
How did that go for you, justin terms of your own decision
(20:49):
making and then how other peopleviewed that decision?
Bethann (21:00):
Well, when I did my research on what possible
surgery I would have, I saw thatthe outcomes for VSG versus
gastric bypass were like similarin the initial weight loss, but
regain it was so much betterwith the gastric bypass.
And, like I said before, I haddone this seven times and I knew
that the real battle for mewasn't losing the weight Not
that that would be easy but itwasn't losing weight.
(21:23):
The real battle for me was notregaining it.
So my whole focus was on what'sgoing to give me the best
outcome in terms of notregaining.
And so I did look at surgeonsin the Vegas area, but all of
them were really pushing the VSGsurgery and without having a
(21:45):
conversation with me andunderstanding.
And you know I would ultimatelydefer to a surgeon's expertise
I, you know, wouldn't overridethat but I wanted to at least
feel that gastric bypass was onthe table and we were having a
discussion and for me as anindividual, they really thought
VSG was better, for whateverreason, and I would be open to
(22:08):
that conversation.
But it was no.
Based on my numbers, you shoulddo VSG, not taking into account
how many times I had done this.
Based on my numbers, you shoulddo VSG not taking into account
how many times I had done thisthat I was at a relatively low
weight for me.
I had been much higher before,and so that was another reason I
(22:29):
decided to go with.
Your program is our firstmeeting.
You actually sat with me and wehad a discussion and we talked
about my history and what Iwould want, and then you gave me
your recommendations or youdiscussed them.
Then we had the conversationabout it.
It wasn't.
You didn't have like, well,this is the surgery you should
do.
End of discussion.
And so that's what I was lookingfor, and I'm very happy that
(22:50):
that's what I chose to do,because I think for most people,
losing weight is the first partof the battle, but the really
hard, long one is keeping thatweight off, and gastric bypass,
yeah, gives you a better chancewith that statistically.
So even peace of mind that letme know like, oh, I have this
(23:13):
really powerful tool.
And when you know in your headyou have this really powerful
tool or something, it makes youeven more motivated to try,
because you know you havesomething working with you.
So the work you put in isreally the work you're going to
get out, and when you know thatyou even work harder.
At least my personality is thatway, yeah.
Dr. Weiner (23:35):
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 everybodycomes to me and for me it's
like you know, sometimes I'llsee eight, 10 new patients in an
afternoon or a day.
Usually I can't see it in theafternoon, but each visit takes
a while.
But I'll sometimes see eight or10 new patients in a day and I
(23:57):
you know each.
For me it's like just anothervisit, but for that patient
there's been a lot of thoughtand energy that's gone into
getting them there.
And so one thing I always tryto figure out is like, like
don't take this the wrong way.
But it's like what's your angleright?
Like what is the thing?
Like why are you here?
What is it that you reallyreally want?
(24:19):
Some people are likedevastatingly afraid of any type
of complication and afraid ofsurgery, and we need to make
sure that we honor that, thatconcern and that there's that
request.
And you know, for you it was Ineed 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 theweight again.
Some people now with the medsit's like I don't want to take
(24:40):
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.
Some people are like I want tocheck these meds out.
I'm okay with it, maybe we worktogether on it, maybe I don't
need surgery at all, and so Ithink everybody kind of brings
their own shtick to the partyfor lack of a better term.
(25:01):
And I think it's so importantwhen you're meeting with a
surgeon that you feel like yourconcerns, that the things that
are most important to you, arebeing addressed, and that your
procedure choice is going toreflect the those values that
you have.
And that's that's where I thinkeducation and and it's really
(25:21):
both the surgeon who's going tokind of listen to you, but it's
also that pre-operativeeducation, 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 allthe time with something that
they think and I'll be like well, actually that's not really
correct because and I'll explainwhy, and so there has to be
(25:42):
that conversation too but butyou have to make sure that that
your needs are met by thissurgery and it sounds like
that's.
That's what drove you to havethe surgery.
Zoe (25:55):
So I think that's fantastic .
Yeah, yeah, absolutely so.
If somebody listening wants tolearn more about potentially
becoming a self-paced surgerypatient, dr Weiner, do you want
to explain how they might beable to get in contact with an
appointment with you?
Dr. Weiner (26:09):
Yeah, so I mean our self-paid price.
We're certainly not thecheapest in the country, but
we're also pretty reasonablypriced, probably a little bit
less than the average price.
But I think what we don'tnumber one is the surgery is
done in a real hospital.
I don't think ambulatorysurgery centers are wrong for
(26:30):
everybody, but I think if you'relooking for the safest possible
option, there's no questionthat spending the night in a
hospital is the safest way torecover from the surgery, and so
we have all of our self-paypatients spend the night in a
real hospital.
There's 24-7 medical support.
It's a 500-bed hospital, so youknow, in any given night there
might be 20 or 30 differentdoctors in the hospital.
(26:53):
As an ambulatory surgery center,sometimes it's a nurse and four
patients, and that's.
There's just a very differentlevel of support from those two
scenarios.
And so I think that's the firstthing.
And then I think also it's youknow who is the anesthesia team?
(27:15):
Is this an experienced team?
And so you know we obviouslyhave all that at our hospital,
tucson Medical Center.
But if you're interested, we doaccept patients from all over
the country.
Bethann came to us from Vegas.
We had people come from theEast Coast, whatever, and they
can sign up for our surgery.
There's actually a self-paysurgery link on our website
(27:36):
directly, so feel free to checkthat out and reach out to us if
your insurance doesn't cover itand you had an exclusion on your
insurance, right, bethann?
Bethann (27:48):
Yeah, I didn't qualify under my insurance um, yeah, my
sir, I didn't qualify under myinsurance.
Oh so your b, it was your lowbmi, it was my low bmi and I was
um getting off of bloodpressure medication, so that was
also so I didn't wait to haveto have surgery.
Dr. Weiner (28:05):
It didn't make sense to me if your bmi is between 35
and 40, then you need to have acomorbid condition.
Now that's what the insurancecriteria are for most policies.
However, our society hasreleased its own set of policies
based on the data, and the dataclearly shows that there's a
huge amount of benefit and asolid safety factor for patients
(28:28):
with a BMI of 35 and above,without a comorbid condition, to
have either a sleeve or agastric bypass.
So we run into an issue whereour scientific data says, hey,
this is a safe and smart thingfor you to do.
The insurance company says,sorry, we're going to go by the
1998 criteria before laparoscopyis even a thing, that's what
we're going to use.
And so you know, the patient,of course, is caught in the
(28:50):
middle.
Insurance company doesn't wantto change because it's just
going to cost them more money.
So anyway, yeah, so if you, ifyou're not, if you don't have
coverage, if you're a lower BMIpatient or if you have a
bariatric exclusion that's themost common reason why we see
people come in from out of outof state for surgery.
Zoe (29:11):
Yeah, we'll be sure to put the link to the self-paced
surgery page in the description.
Dr. Weiner (29:15):
For sure.
All right.
Well, bethann, great to see youagain and congrats on your
success.
It sounds like you've reallygotten the most out of this
surgery.
Bethann (29:24):
So great seeing you, nice seeing you, and I'll be
making an appointment with yousoon.
Sounds good.
Dr. Weiner (29:29):
All right.
I mainly stick to the Pound of Cure eating plan.
I found that that just worksreally well for me.
And when I stick to mainlywhole foods, I find that the
food noise because I've alwaysstill had that even after
surgery and like the dramasurrounding food it's so much
less.
Zoe (00:21):
All right, welcome back everyone to the Pound of Cure
Weight Loss Podcast.
We are super excited to welcomeBeth Ann with us today.
Beth Ann, nice to connect withyou today.
Nice to see you.
Yeah, nice to see you.
So we would love to have youjust kind of start by telling us
your story.
(00:41):
Go back to maybe before you gotsurgery, and what kind of led
you to that decision.
Bethann (00:49):
So weight has been a lifelong struggle for me and
since I was young and I did allthe diets with my mom, we did
deal a meal with Richard Simmonsand I.
Even when I was 18, I didOptiFast when it was just a
liquid diet, absolutely nosensible meal, just all.
(01:11):
And I was able to.
Through those diets and leancuisine and all the things I
gained and lost like 150 poundsand got to my goal weight but
gained it all back at leastseven different times in my life
.
Dr. Weiner (01:27):
Seven times.
Bethann (01:28):
Yeah, oh yeah, I would get to a healthy weight, stay
there for a year, maybe two.
I never made it to the goldenfive year.
I think when they say you madeit 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 mylate forties I was just like it
is what it is, I'm going to liveas healthfully as possible and,
(01:50):
whatever my weight is, I'm justnot going to fight it anymore.
Life's too precious to be inthis constant battle.
But I had a completehysterectomy at the time, and
the way my weight wasdistributed was before then in
my lower half, but at that timeit really moved to my middle
(02:11):
section and so I started to seeproblems with high blood
pressure.
My cholesterol was trending up,so was my blood sugar, and I
was like, oh wow, how do I getthe discipline and the drive to
lose weight within my head,knowing, oh, I'll just gain it
back, and I just couldn't dothat.
(02:32):
So I was searching forsomething to help me and I saw a
lot of people on social mediatalking about VSG mainly, and
you know the same thoughts of ohwell, that's the easy way.
That's cheating popped in myhead, but fortunately I had the
aha moment of, well, so what Ifthis is something that can help
(02:55):
me have a longer, healthier,happier life?
When I'm looking back on mylife, am I going to be proud
that I took every opportunity,utilized every tool to live my
best life, or am I going to belike, well, you struggled your
whole life but you didn't takethe easy way out?
And to me, once I framed it thatway, I was very confident in my
(03:15):
decision to go ahead withbariatric surgery.
And so I saw, I startedresearching and I saw Dr
Weiner's video series and I wentthrough that and I even had a
notebook and I took notes andeverything.
And when I realized I was goingto be a self-pay patient, I was
(03:35):
in Las Vegas at the time andyou were in Tucson and I
realized, oh, that's doable witha car ride.
And so I reached out to you andwe went through the process and
I had surgery with you and itwent really well.
So how long ago was yoursurgery?
About two and a half years ago.
Dr. Weiner (03:55):
Okay, and what was your starting weight and what's
your weight now and just kind ofhow's, how was life after
surgery?
Bethann (04:03):
So I actually my weight was relatively low.
I was like I'm 5'4" and I wasjust below 200 the day of
surgery and then right now myweight is.
It fluctuates between like 115to 120.
And so it went off.
(04:24):
For me it was a fairlyconsistent small decline.
I had the three-week stall, butother than that, once I got to
around a healthy-ish weight, itreally just declined the whole
time and then around there itstarted to fluctuate slightly,
but still, if you looked at amonth it was always going down
(04:46):
until about this weight.
Dr. Weiner (04:48):
And I think you've had skin reduction surgery.
So why don't you talk to usabout that decision to have the
skin reduction surgery and whereyou know what surgeries you had
, if you feel comfortablesharing that, even if you how
you researched it, how much itcost, all of that stuff would be
, I think, really helpful foreverybody.
Bethann (05:07):
Yeah, and the recovery process OK so I had been at my
absolute heaviest in high schooland so you can imagine
fluctuating that much.
I had a lot of loose skin.
It was very.
It wasn't one of those thingslike, oh, if I angle a certain
way you can see it.
It was visible very obviously.
(05:29):
And so I really wanted to haveskin removal surgery.
And I would say this I noticedsome people I would still, if
you told me I couldn't have skinremoval surgery, I still would
have gone ahead with a gastricbypass.
Granted it's much to me.
I am much more comfortable withmy body after the skin removal,
(05:51):
but I still absolutely 100%would have weight loss surgery
even if I could not have hadskin removal.
So when I decided to have it, mymedical practice they have a
lot of different sections.
You know people with differentspecialties.
So I started there with theplastic surgery specialty just
(06:13):
because that's what who mydoctors recommended, and I went
for an appointment and I feltvery comfortable right away.
So I didn't do exhaustiveresearch.
I kind of it was a one and done, fortunately for me.
But I had a lot of people who Itrusted recommend this practice
.
So that's the way I went aboutit and surgery didn't pay for it
(06:35):
.
I had to pay for it.
I had a tummy tuck with ahernia repair and they were able
to fudge some of the costsbecause they were fixing my
hernia at the same time they didmy tummy tuck and I forget how
that number, those numbers,worked out.
I want to say it was like the6,000 range.
(06:58):
I don't have the exact numbers6,000 bucks.
I want to say it was I hope I'mcorrect, maybe I'm totally off,
maybe I haven't seen thatthere's kind of two different
types of plastic surgerypractice.
Dr. Weiner (07:17):
I'll just talk a little bit about insurance
coverage for the plastic surgery.
Then I want to hear the rest ofyour story about recovery and
everything like that.
But there's when you getinsurance, so a lot of people
will say, oh, my insurancecovers it if I lose over 100
pounds, and you have to submitthe pictures and all that kind
of stuff, and so you can getinsurance coverage.
(07:41):
Now when you have any kind ofsurgical procedure and this is
something you encountered withyour self-pay surgery the
majority of the fee for theself-pay surgery goes to the
hospital.
The hospital is way moreexpensive than the surgeon,
right or wrong.
Actually, it does kind of makesense because the hospital has a
lot more costs than the surgeon.
But anyway, the same is truefor plastic surgery.
(08:02):
And so sometimes what plasticsurgeons will do is they'll
essentially look at the cost andbe like, okay, we're going to
do the hernia, insurance willpay this much, and then we're
going to do the plastic surgeryand it's this much, and they can
break it up and they can usethe insurance payment to kind of
augment their reimbursement andthen they can lower the fees
(08:24):
and there's definitely practicesthat are out there.
There's actually very few inTucson, unfortunately, that will
do it that way.
When I practiced in Detroit,there was a lot more practices
that did it that way and Ialways liked that.
First of all, I would bereferring like crazy to any
practice in Tucson that did that, because it's so much better
(08:45):
for the patients.
We have patients paying 15, 20,25,000 bucks for their surgery
and that's just kind of crazyand what happens is it puts skin
removal surgery out of theprice range for 90% of our
patients patients.
And so if you can find aquality plastic surgeon who will
(09:07):
work with your insurancebecause they will get some
payment, now you're never goingto find a plastic surgeon who's
like oh, your insurance coversit, I'll do it for what your
insurance will pay.
Bethann (09:21):
Because it's like they're going to do it right.
How long is your surgery?
Four hours five hours.
Dr. Weiner (09:25):
The tummy tuck, I want to say around that amount
of time.
It takes a long time to dothese procedures correctly.
If you want to kind of lop offsome skin and put some stitches
in, you can get it done a lotquicker, but it's not going to.
It's going to be all lumpy andbumpy.
It takes a long time to do thisright, and so the insurance
(09:46):
company pays a relatively smallamount and you're not going to
find a quality plastic surgeonwho's like I'll do this
four-hour surgery and provide 90days of wound care coverage and
treatment for all thepostoperative care, which is
generally a lot for you know,$800 that your insurance company
will pay.
(10:06):
It's just the math.
Just it doesn't even come close.
So there's always going to besome additional charge.
But if they can take thatcharge and reduce the hospital
fee, that makes a hugedifference.
So it sounds like you foundsomeone who did that.
Were they in Vegas or were theyin Iowa?
Bethann (10:23):
They were in Iowa and it was at a surgical clinic.
I for the tummy tuck.
I didn't spend the night, I letlike basically I woke up and
they were like, all right, getout.
It was a little abrupt but buteverything everything went well
when they released me.
So yeah, for the tummy tuck,that was the case and I had that
(10:45):
in August and it was I don'twant to say it's this case for
everyone, but it was a very easyrecovery for me.
It was, oh, I would say I tookthe pain meds maybe just three
days and then I was, I moved toTylenol and I was fine and
moving around, and then that wasin August.
And then I was, I moved toTylenol and I was fine and
moving around, and then that wasin August.
(11:08):
And then in that December I hada bilateral thigh lift.
Now that was closer to 14,000because that was like an eight
hour surgery.
They tend to in your innerthighs they just make a.
Normally they just make a linedown the middle and they close
the skin back up.
(11:28):
For this he made the line downthe middle and also up through
my hips and kind of pulled me upas well as going horizontally
or vertically, and horizontallytoo Vertically, and horizontally
(11:48):
, horizontally too.
So that was, in fact, he had afellow surgeon work with him at
the same time because he was hewas.
You know, eight hours is a longtime, so he had someone another
surgical surgeon assisting himso they could make sure that
everything was done really well.
And this actually was the firsttime.
This was the same surgeon whodid my tummy tuck, so I had a
lot of faith in him and he didit a different way that he's
(12:13):
never done before, and so he hadme come in a couple of extra
times to go over it and makesure he had everything he needed
.
And he also did a really goodjob of making sure my
expectations were clear.
And I would say for me I'm andit definitely.
(12:35):
It's not as if.
When I look at the results, Ithink 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'sprobably not realistic for most
people.
I'm 50.
So you know I had to take thatinto account.
And if you're younger I'm surethe younger you are, the better
it will be but it's never like,oh, you were never heavy and
(13:02):
overweight.
There's always like I stillhave like a little bit of loose
skin over my knees and stuff,but to me it exceeded my
expectations and I'm very happywith it.
The thigh lift I did have aseroma that got infected, so
they did have to go back in andput in a tube, another draining
(13:25):
tube, and so that extended myrecovery time, but it wasn't
particularly painful.
There were complications, butthey still went smoothly Nothing
that I had to go to theemergency room or anything like
that.
So in both cases it was fairlysmooth.
I recovered on time, like I wassupposed to, and yeah, I'm
(13:49):
personally thrilled with theresults and I'm very fortunate
that I was able to do it.
And yeah, like, if you're ableto do it, that's great, but I
also would.
If you don't think you'll beable to afford to, which I
completely understand I wouldstill say weight loss, at least
(14:10):
from my point of view, wasdefinitely still worth it, even
if I had to still have the looseskin.
Zoe (14:16):
So why don't we hear a little bit about what your life
looks like now in terms of thehabits that you've created,
maybe with your nutrition oryour movement?
What does living andmaintenance in your new body
that you've been now able tomaintain for longer?
Bethann (14:35):
than the other times that you've done it.
Zoe (14:37):
What does that look like for?
Bethann (14:38):
you, it is so night and day.
From my other attempts I mainlystick to the Pound of Cure
eating plan.
I found that that just worksreally well for me.
And when I stick to mainlywhole foods I find that the food
noise because I've always stillhad that, even after surgery
(15:00):
and like the drama surroundingfood, it's so much less I won't
say non-existent, but so muchless.
If I stick to whole foods and Idon't measure, I really rely on
my food or my hunger cues, andI'm able to.
(15:21):
I do have like I don't callthem rules, I call them
guidelines.
I make sure every time I eat Ihave protein, fiber and a
healthy fat and I sort of thinkabout well, if I had to make
this meal from scratch back inmy grandmother's day, would I
have all the ingredients in mykitchen?
I'm all about convenience.
I'll get something pre-choppedand all that sort of stuff.
(15:42):
But if I had to and if I kindof have that mindset of you know
, I have these whole foods tomake up my meal.
If that's like 98 plus percentof the time, I find that I don't
really have to.
Percent of the time, I findthat I don't really have to
(16:02):
count calories or measure oranything like that.
So eating is so much less dramaand so much less concern.
In terms of movement, I wasdoing really well and I've
prioritized weightliftingThrough my surgeries I couldn't
my skin removal surgeries Icouldn't work out and I could
(16:23):
tell I lost quite a bit moreweight, and I think a lot of it
was just muscle mass, because Iwasn't able to move around.
And as soon as I got healthyenough to move around, then I
had my neck surgery and so itwas a while before I got back to
working out again.
And so now, um, I work out andI prioritize weightlifting.
(16:48):
Um, this summer I've beenwatching my two year old great
niece and we, like I, beforesurgery, 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 myselfback up?
And now I realize one day I waslike, oh my gosh, I couldn't
even count how many times I'vegotten on and off the ground to
(17:10):
take care of her.
We go to the zoo almost everyweek and she doesn't like
strollers, so I carry her aroundthe zoo and I realized, oh,
this is nothing to me, I don'teven have to like, oh, we have
to sit down for a little bit.
I just, you know, pick her upand we go.
It's a small zoo, it's DesMoines Zoo, but we go around and
(17:31):
we have a lot of fun and Idon't even have to.
I was getting to the pointbefore surgery I had to think
about like, okay, how far isthis?
Are there going to be placesfor 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 itmakes working out better,
(17:54):
because I realized, oh, to havethis life to be able to walk
around the zoo with my niece.
That's why I'm working out, notto necessarily lose weight or to
look a certain way.
I mean, that's fun too.
You know, I like wearing cuteclothes and things like that.
It's totally fun.
But the main reason is and whenyou can actually see it in play
(18:16):
and know how much fun it is, itmakes working out easier.
It makes sticking like I wouldmuch rather stick to the diet
I'm doing now than have moreultra processed food but not be
able to do those things with myniece and I can say also going
back to the diet a bit.
I truly enjoy everything I eat.
(18:37):
I've just discovered thingscalled cherry plums and, oh my
gosh, they're the greatest thingI've ever eaten in my life and
I have like at least one a day.
And I if, when I mix an ultraprocessed food, I don't those
fruits and vegetables don'ttaste as good to me.
But when I keep them mainly outand I'm not saying I can't or
(18:59):
never, but when I don't, whenthey're an occasional thing, not
a frequent thing I truly enjoythe food I'm eating so much more
, and so right now I mean, knockon wood, things are going
really well and really smoothlyso, and I see this being
sustainable past the five yearsand beyond, you know.
(19:20):
So I'm very happy with mydecision and excited.
Zoe (19:25):
Well, I think you really nailed the nail on the head with
the mindset shifts, thelifestyle shifts, the focus off
of exercise for aesthetics and,more so, movement for quality of
life and for quality time withthose that you love, and just
(19:45):
the experience of living throughthis different lens that you're
now not having to think of someof those things that you used
to have to, and it just is sucha beautiful time of life that
you're in and I'm so gratefulthat you shared it with us.
It's, it's truly incredible andyou should be so proud of
yourself.
Dr. Weiner (20:04):
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 youwere 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 throughthat decision making.
It clearly has worked out very,very well and, honestly, that's
(20:26):
been my experience is thatlower BMI patients get to like
that low 20 BMI, that kind ofreally like great high school
weight that they, you know, oncethey kind of dreamed of being.
And so just kind of walk usthrough that decision.
Did you get some criticism fromother people?
How did that go for you, justin terms of your own decision
(20:49):
making and then how other peopleviewed that decision?
Bethann (21:00):
Well, when I did my research on what possible
surgery I would have, I saw thatthe outcomes for VSG versus
gastric bypass were like similarin the initial weight loss, but
regain it was so much betterwith the gastric bypass.
And, like I said before, I haddone this seven times and I knew
that the real battle for mewasn't losing the weight Not
that that would be easy but itwasn't losing weight.
(21:23):
The real battle for me was notregaining it.
So my whole focus was on what'sgoing to give me the best
outcome in terms of notregaining.
And so I did look at surgeonsin the Vegas area, but all of
them were really pushing the VSGsurgery and without having a
(21:45):
conversation with me andunderstanding.
And you know I would ultimatelydefer to a surgeon's expertise
I, you know, wouldn't overridethat but I wanted to at least
feel that gastric bypass was onthe table and we were having a
discussion and for me as anindividual, they really thought
VSG was better, for whateverreason, and I would be open to
(22:08):
that conversation.
But it was no.
Based on my numbers, you shoulddo VSG, not taking into account
how many times I had done this.
Based on my numbers, you shoulddo VSG not taking into account
how many times I had done thisthat I was at a relatively low
weight for me.
I had been much higher before,and so that was another reason I
(22:29):
decided to go with.
Your program is our firstmeeting.
You actually sat with me and wehad a discussion and we talked
about my history and what Iwould want, and then you gave me
your recommendations or youdiscussed them.
Then we had the conversationabout it.
It wasn't.
You didn't have like, well,this is the surgery you should
do.
End of discussion.
And so that's what I was lookingfor, and I'm very happy that
(22:50):
that's what I chose to do,because I think for most people,
losing weight is the first partof the battle, but the really
hard, long one is keeping thatweight off, and gastric bypass,
yeah, gives you a better chancewith that statistically.
So even peace of mind that letme know like, oh, I have this
(23:13):
really powerful tool.
And when you know in your headyou have this really powerful
tool or something, it makes youeven more motivated to try,
because you know you havesomething working with you.
So the work you put in isreally the work you're going to
get out, and when you know thatyou even work harder.
At least my personality is thatway, yeah.
Dr. Weiner (23:35):
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 everybodycomes to me and for me it's
like you know, sometimes I'llsee eight, 10 new patients in an
afternoon or a day.
Usually I can't see it in theafternoon, but each visit takes
a while.
But I'll sometimes see eight or10 new patients in a day and I
(23:57):
you know each.
For me it's like just anothervisit, but for that patient
there's been a lot of thoughtand energy that's gone into
getting them there.
And so one thing I always tryto figure out is like, like
don't take this the wrong way.
But it's like what's your angleright?
Like what is the thing?
Like why are you here?
What is it that you reallyreally want?
(24:19):
Some people are likedevastatingly afraid of any type
of complication and afraid ofsurgery, and we need to make
sure that we honor that, thatconcern and that there's that
request.
And you know, for you it was Ineed 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 theweight again.
Some people now with the medsit's like I don't want to take
(24:40):
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.
Some people are like I want tocheck these meds out.
I'm okay with it, maybe we worktogether on it, maybe I don't
need surgery at all, and so Ithink everybody kind of brings
their own shtick to the partyfor lack of a better term.
(25:01):
And I think it's so importantwhen you're meeting with a
surgeon that you feel like yourconcerns, that the things that
are most important to you, arebeing addressed, and that your
procedure choice is going toreflect the those values that
you have.
And that's that's where I thinkeducation and and it's really
(25:21):
both the surgeon who's going tokind of listen to you, but it's
also that pre-operativeeducation, 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 allthe time with something that
they think and I'll be like well, actually that's not really
correct because and I'll explainwhy, and so there has to be
(25:42):
that conversation too but butyou have to make sure that that
your needs are met by thissurgery and it sounds like
that's.
That's what drove you to havethe surgery.
Zoe (25:55):
So I think that's fantastic .
Yeah, yeah, absolutely so.
If somebody listening wants tolearn more about potentially
becoming a self-paced surgerypatient, dr Weiner, do you want
to explain how they might beable to get in contact with an
appointment with you?
Dr. Weiner (26:09):
Yeah, so I mean our self-paid price.
We're certainly not thecheapest in the country, but
we're also pretty reasonablypriced, probably a little bit
less than the average price.
But I think what we don'tnumber one is the surgery is
done in a real hospital.
I don't think ambulatorysurgery centers are wrong for
(26:30):
everybody, but I think if you'relooking for the safest possible
option, there's no questionthat spending the night in a
hospital is the safest way torecover from the surgery, and so
we have all of our self-paypatients spend the night in a
real hospital.
There's 24-7 medical support.
It's a 500-bed hospital, so youknow, in any given night there
might be 20 or 30 differentdoctors in the hospital.
(26:53):
As an ambulatory surgery center,sometimes it's a nurse and four
patients, and that's.
There's just a very differentlevel of support from those two
scenarios.
And so I think that's the firstthing.
And then I think also it's youknow who is the anesthesia team?
(27:15):
Is this an experienced team?
And so you know we obviouslyhave all that at our hospital,
tucson Medical Center.
But if you're interested, we doaccept patients from all over
the country.
Bethann came to us from Vegas.
We had people come from theEast Coast, whatever, and they
can sign up for our surgery.
There's actually a self-paysurgery link on our website
(27:36):
directly, so feel free to checkthat out and reach out to us if
your insurance doesn't cover itand you had an exclusion on your
insurance, right, bethann?
Bethann (27:48):
Yeah, I didn't qualify under my insurance um, yeah, my
sir, I didn't qualify under myinsurance.
Oh so your b, it was your lowbmi, it was my low bmi and I was
um getting off of bloodpressure medication, so that was
also so I didn't wait to haveto have surgery.
Dr. Weiner (28:05):
It didn't make sense to me if your bmi is between 35
and 40, then you need to have acomorbid condition.
Now that's what the insurancecriteria are for most policies.
However, our society hasreleased its own set of policies
based on the data, and the dataclearly shows that there's a
huge amount of benefit and asolid safety factor for patients
(28:28):
with a BMI of 35 and above,without a comorbid condition, to
have either a sleeve or agastric bypass.
So we run into an issue whereour scientific data says, hey,
this is a safe and smart thingfor you to do.
The insurance company says,sorry, we're going to go by the
1998 criteria before laparoscopyis even a thing, that's what
we're going to use.
And so you know, the patient,of course, is caught in the
(28:50):
middle.
Insurance company doesn't wantto change because it's just
going to cost them more money.
So anyway, yeah, so if you, ifyou're not, if you don't have
coverage, if you're a lower BMIpatient or if you have a
bariatric exclusion that's themost common reason why we see
people come in from out of outof state for surgery.
Zoe (29:11):
Yeah, we'll be sure to put the link to the self-paced
surgery page in the description.
Dr. Weiner (29:15):
For sure.
All right.
Well, bethann, great to see youagain and congrats on your
success.
It sounds like you've reallygotten the most out of this
surgery.
Bethann (29:24):
So great seeing you, nice seeing you, and I'll be
making an appointment with yousoon.
Sounds good.
Dr. Weiner (29:29):
All right.
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