Shot down again

Well BCBS didn't care for my appeal as I received my 2nd denial letter on Nov. 21st stating that there was not enough evidence to support the sleeve as being non investigational , therefore it is considered non-medically necessary and the denial will be upheld. Uggghhh!!! So what did I do? Went to bed, sulked, ate a whole bunch, then got mad at myself becuase that is why I am fat to begin with. Decided to do nothing for a few days, then I got busy on my 2nd level appeal letter and some more documentation. I planned on mailing it that Wed. before Thanksgiving but I forgot so I mailed it yesterday. It is posted below along with the research links. Keep your fingers crossed!
Speaking of Thanksgiving, it is my favorite time of the year because after spending time with family, my sister in law and I sit up all night going through papers and head out about 3am to go Black Friday shopping. I absolutely love doing this! But this year I was afraid because of the back pain I had been experiencing and I had every reason to be afraid come that morning. My back and feet ached so bad. At one point, I had to go sit in the van, I was so angry at myself and the fat and the Graves Disease for being this way. It was all so clear once again of why I need this surgery.

2nd level appeal letter

To Whom It May Concern:

This letter comes in response to my recent denial dated November 21, 2008 for Weight Loss Surgery (WLS). I am writing this letter to implore that you reverse the decision not to approve Vertical Sleeve Gastrectomy (VSG) surgery on the basis it is considered investigational, therefore not medically necessary. In this letter I will explain why VSG is the best surgery for me and dispute BCBSNC’s assessment that VSG is investigational by asking you to review my Level 1 Appeal packet documentation as well as offering additional facts to dispute this claim. I am confident that you will reverse denial upon reviewing this additional information.

It has been established that WLS is medically necessary per my doctors, surgeon and BCBSNC’s medical policy (Attached in Level 1 Appeal packet) and I am grateful WLS is an option for me. I am even more appreciative of the fact that there is more than one WLS to choose from to accommodate a person’s medical and psychological needs. I have spent years researching different types of WLS; the side effects, lifestyle changes, the risks, the pros and the cons. I have read story after story of Gastric Bypass (RNY) and Lap Band being the perfect surgery for one individual, but not the next. I have read how one person’s body adapts to the changes from RNY or Lap band and the next person is continually sick from throwing up, dehydration, diarrhea, malnutrition, band slippage, band erosion; as well as suffering embarrassing moments in public by an abrupt exit because they ate too fast or ate the wrong food and had to make it to a restroom quick.
This is one of the many reasons I feel VSG is the best option for me and my lifestyle. It is the one WLS available that offers the most normalcy post op. There is no re-routing of my intestines so there is less malnutrition risk and complications; the stomach stays in tact, it remains a fully functioning stomach so there is minimum chance of dumping and complications. If you take a look at the attached surgery comparison chart you will see that VSG is the optimum choice. I do realize it is still a tool and as with all other WLS, I have to do my part in order to succeed. As I stated in my initial appeal letter, I am a morbidly obese female weighing 379 lbs with a BMI of 61 with mostly obese related co-morbidities that will improve or go away completely with weight loss. This surgery will open the door for a new life for me. I will no longer feel like a kid being punished sitting at their bedroom window watching the other kids play outside.

Partial Gastrectomies have been done on patients suffering from stomach cancer and peptic ulcers for well over 100 years so we know a patient can live successfully with part of the stomach removed. The first gastrectomy was performed by Theodor Billroth in 1881 on a patient with antral carcinoma. The procedure itself has been of course modified and improved over the years just as the original Vertical Gastroplasty of the 1970’s and 1980’s has made the pathway for the significantly improved Vertical Sleeve Gastrectomy. VSG was first performed in 1993 by Dr. Jamieson in England and has since been refined and improved into the VSG we know today by Dr. Gagner in 2001. The VSG has been performed for 15 years and as we know it today for the last 7 years. This is a far cry from an investigational surgery. The results from the studies submitted in my initial appeal packet speak for themselves as well as the people I correspond with on a daily basis on Obesityhelp.com forum ( http://www.obesityhelp.com/forums/vsg/ ) that are real life examples of the success of the VSG with weight loss in excess of 100 lbs with no major complications post op. Laparoscopic Associates of San Francisco has a two year study that can be viewed at www.facs.org/education/gs2004/gs33lee.pdf as a slideshow. I am confident the information provided is significant enough to disprove VSG as an investigational surgery. More insurance companies including BCBS Carefirst and Federal BCBS are adapting VSG in with their policies; this is further clarification this surgery is no longer considered investigational.

Please take a closer look at my initial Appeal Packet as well as the additional documentation attached. I am excited to begin a new life with the surgery that will most benefit me. I look forward to hearing from you soon with good news of a reversal of the initial denial. Thank you for your time.


Sincerely,

Research links:

http://www.obesityhelp.com/forums/vsg/cmsID,8874/mode,content/a,cms/

http://www.lapsf.com/vertical-gastrectomy-weight-loss-surgery.php

Old Medic's advice from OH

Old Medic posted this and i thought it was very informative so I am posting it so I can come back and read it when I have surgery....

Post Date: 11/11/08 10:00 am There have been a number of notes lately along the lines of: I am so tired; I haven't lost a lot of weight; I can't drink much at a time; I'm losing so slowly; etc. These are mostly from newly sleeved patients, most of them within two weeks of their surgery.You are undergoing MAJOR SURGERY. This is a shock to your body, and you will be tired and listless at first. Your energy level will not be very high (there are exceptions, but they are rare). It may well take 3-6 weeks for you to get all of your stamina back. That is normal.Immediately after your surgery, your new stomach is swollen. You will not be able to drink much at all. It is not at all uncommon for people to be able to drink 1/2 an ounce or so, and they are full. This will change, so don't worry about it.You will likely NOT lose much in the first week or two. This is also normal, and don't get all freaked out about it. They pump you full of IV fluids, and you will lose that first.Gas - They fill your belly with CO2 during surgery. This gas remains inside you, until it is absorbed through your intestines and can escape from the body. This means burping and passing gas will happen, no matter what. You will feel bloated, and think you are the Goodyear Blimp! Not to worry, this too will pass.You will only be able to eat tiny amounts at first. That is also very, very normal. Over time, you will be able to eat more, but don't be in a rush.Weighing yourself - This can become a problem. My program recommends weighing yourself once a week, beginning two weeks after surgery. No more often than that. Your body will do its own thing, and if you try weighing yourself daily, you will drive yourself crazy. Weigh yourself on the same day of the week, and preferably in the morning before eating.What size is my new stomach? Frankly, what difference does it make what size it is? If it works for you, then it is the right size. Trust that your surgeon knows what he/she is doing (or why did you let them cut on you in the first place).DO NOT COMPARE YOURSELF TO ANYONE ELSE. Everyone loses at their own pace. On the whole, men lose faster than women. But there are so many factors involved, you will drive yourself nuts if you get into the "She's losing faster than me, what am I doing wrong" syndrome. IF you follow your program, you will lose weight. It may be faster, or slower than others, but so what?This is a tool for you. It is NOT a miracle, it is just a tool to help you lose the weight you couldn't keep off any other way. If you follow the program, everything will work out. If you know that you will regularly cheat, eat all the wrong stuff, etc., then you probably shouldn't have the surgery in the first place.QUESTIONS - QUESTIONS - QUESTIONS So many are afraid to adsk their doctors questions. Remember, the ONLY stupid question is the one you do not ask.Your doctor is YOUR EMPLOYEE. You hired them to do this work for you. Therefore, you are entitled to ask any, and all, questions that may come to mind. If they don't want to answer, or appear to be offended/upset by your questions, or make you feel stupid for asking, THEN GET ANOTHER DOCTOR!Any doctor that will not willingly answer any and all of your questions should be avoided. It is YOUR body, and you have the complete and total right to know everything you want to know about what hw/she is proposing to do to it.Lots of people are intimidated by physicians. Well, remember, their bodily functions are the same as yours, they get dressed the same way as you do, and I have yet to see any of them capable of walking on water.

Deny Deny Deny!

So I was offically denied by my insurance company BCBSNC Oct. 31. My surgeon's office called me to let me know, they consider it investigational, did I want to schedule a different surgery? Uh no! I will appeal. Didn't surprise me they denied but still disappointed. So I hit the boards on OH seeking appeal advice. Put my research together and wrote a kick ass letter, if I do say so myself. The format of the letter came from vsgfaq.com but then i put my own information and thoughts in. I have the letter and research links at the bottom of this blog.
I was slightly perturbed with the ins. coordinator at my surgeon's office because I had asked her on the phone if Dr. Enochs could write a letter for me to go with my appeal. Her response was no because there is nothing medical to substantiate the sleeve over RNY. I told her that in the consult he recommended the sleeve so couldnt he just say that and give his reasons why it shouldn't be investigational...I will ask was her response. So I wrote a nice email explaining I understand Dr. Enochs can not medically give a reason for the sleeve over RNY, being I am a candidate for all surgeries but could he just document in his professional opinion why the sleeve shouldn't be considered investigational. Her response, no again..nothing medical.blah blah. Grrr! Did I not make my point? Did I not pay you a 400.00 consult fee? Are you not going to make killer money off this surgery? You can't write a 5 minute letter to fight for your patient? Really? If I had money lieing around to pay another consult fee to another surgeon, I would because that ticked me off. She made me feel like I was being pushed toward RNY because it was an easier route for THEM and I should just happily go through the production line. I am sorry, this is my body. THEY don't have to live with the choice I make. I know there are plenty of people that RNY and lapband have worked great for them. I am happy for them but the risks and possible complications are not for me. Don't get me wrong, I think Dr. Enochs is a competent surgeon and I like his bedside manner and feel confident he can perform this surgery but his staff make me feel like I am a burden. I was going to wait and submit my appeal after my Nov 18th appt so I could talk to Dr. Enochs personally and try to get my point across in person since maybe my message was garbled by a 3rd party but decided to go ahead and submit. I feel confident in my letter and research alone at this point. I will cross that bridge if I have to do a 2nd appeal.
They have 30 days to respond to my appeal. We shall see if my letter dazzles them. Hopefully my next post will say Approved!!

Here is the letter:

Name
Address

November 7, 2008

Blue Cross Blue Shield of North Carolina
Member Rights and Appeals Department – Level 1 Appeal
Address

To Whom It May Concern:
I’m hereby requesting a reversal of the initial denial for the bariatric procedure known as the Vertical Sleeve Gastrectomy/Gastric Sleeve (VSG-CPT code 43843) by Blue Cross Blue Shield of NC (BCBSNC). This request is made due to BCBSNC’s assessment that the VSG is experimental/investigational as well as preference of surgery choice VSG being considered investigational is at best, misguided, and at worst, a knowing endangerment of my health that could have risk management consequences if I have to have another procedure and there is an adverse outcome. I agree with the experts and my surgeon; that the Vertical Sleeve Gastrectomy (VSG) or Gastric Sleeve (GS) surgery is the safest and best weight loss route for me. I’m confident that after reviewing the attached documentation the committee will agree and grant approval for the VSG.
My doctors consider weight loss surgery as ‘medically necessary’ and I have met all the requirements to establish medical necessity per BCBSNC medical policy (attachment 1). I am a 36 year super morbidly obese female with mostly obesity related co-morbidities that will improve or go away entirely with WLS. My current weight is 381 lbs with a BMI of 61 and have been 300 plus for more than ten years. My co-morbidities are sleep apnea, GERD, edema onset, hiatal hernia, difficulty breathing, trouble sleeping, joint pain and back pain, I can not walk or stand for more than 10 minutes; the excess weight causes tremendous pressure on my back, legs and joints. This has caused me to not be able to fully function in daily activities, enjoy life or exercise presenting a more sedentary lifestyle just waiting for additional co-morbidities to set in. Not only am I at a health risk for heart disease, diabetes, heart attack, stroke, hypertension because of my weight alone, these co-morbidities are all in my blood line, which puts me at a greater health risk. My father and mother both have type II diabetes. My father also has hypertension, neuropathy, has had heart bypass surgery as well as numerous strokes. I am volume eater, portion control and continuous hunger are my issues which is why I strongly believe VSG is the perfect WLS choice for my life without having to re-route my intestines, subject myself to increased dumping and possible higher risk of complications, malabsortption issues and possible future side effects that many RNY patients have seen that include malnutrition, bowel obstruction, hernia, depression,
gastritis, increased GERD plus many more minor and major complications including death. This was seen in study after study during my research.

Given the VSG’s track record it is the best option when compared to other bariatric choices, such as the Gastric bypass (RNY) or Lapband. The VSG procedure has been used successfully for weight loss since 1976 as demonstrated by medical studies (attachment 2) with out the many side affects or complications associated with the RNY or the LabBand. While any surgery carries risks, and I’m well aware of these, this surgery is not riskier than other procedures; in fact statistics show that it is safer. Documented studies show that it will generate between 60 to 80% of Excess Body Weight Loss (EBWL) in 6 to 12 months, many patients have achieved 90 to 100% EBWL during the same time periods with weight loss of 100lbs. to 200lbs. The complication rate of the RNY is 6.5%, and it’s considered the “Gold Standard”, compared to the complication rate of 1.5% for the VSG in the last 10 years and with similar or better weight loss results. See many examples of attached supporting documentation (attachment 3) that shows VSG is less invasive with the same results as RNY and/or Lapband. I have also read many encouraging stories from real people on Obesityhelp.com VSG forum who are 1-4 years out and have no regrets from having chosen this surgery and have had great success in losing 100-200 lbs as well as many documented stories on other Obesityhelp.com forums of RNY and lap band patients having revisions to VSG and DS (Duodenal Switch) because of complications or lack of weight loss and sometimes weight regain. The DS has been around for many years and is approved by BCBSNC in patients with a BMI>50; the VSG is simply the first portion of this surgery minus the malabsorptive portion of the surgery, which can be completed if necessary but why subject your body to malabsorption issues and further complications if a restrictive procedure will accomplish the same goal. The VSG has been proven to perform well as a stand alone procedure.
After reviewing BCBSNC Medical Policies in regard to Bariatric Surgery I would like to point out two items.
First, “When Surgery for Morbid Obesity is not covered”, (page 6, attachment 1) quote:
2. When the procedure is considered investigational, including but not limited to f. Sleeve gastrectomy, either as the sole procedure or as one step in a staged procedure
How long does a procedure have to be studied before it is no longer considered investigational? The LapBand gained approval for general use in less than 5 years, it is an approved procedure under our plan .There are a number of studies available dating back to 2001 and 2002 that lasted at least 3 years, I have enclosed several (attachment 3) Just these examples alone that I could find show that studies have been performed longer than 3 years for VSG. One study measuring Anemia on patients having this surgery dates back to 1976, only back then the procedure was called Gastric Exclusion (attachment 3).
Second: Surgery types (page 2, attachment 1) quote:
6. Sleeve gastrectomy (no specific CPT code). A "sleeve" gastrectomy is an alternative approach to gastrectomy that can be performed on its own, or in combination with malabsorptive procedures (most commonly biliopancreatic diversion with duodenal switch). In this procedure, the greater curvature of the stomach is resected from the angle of His to the distal antrum, resulting in a stomach remnant shaped like a tube or "sleeve". The pyloric sphincter is preserved, resulting in a more physiologic transit of food from the stomach to the duodenum, and avoiding the "dumping syndrome" (overly rapid transport of food through stomach into intestines) that is seen with distal gastrectomy. This procedure is relatively simple to perform, and can be done by the open or laparoscopic technique. Some surgeons have proposed this as the first in a two-stage procedure for very high-risk patients. Weight loss following sleeve gastrectomy may improve a patient’s overall medical status, and thus reduce the risk of a subsequent more extensive malabsorptive procedure, such as biliopancreatic diversion.
I’m in complete agreement of this statement. BCBSNC’s own medical policy makes positive affirmation of the VSG surgery, which further solidifies my choice in surgery.

I believe that our plan should adapt this surgery as a covered service not only for its many health related advantages but also because it is a cost effective choice compared to ALL other surgeries that are considered “proven”. A vast number of medical experts on the issue of bariatric surgeries are in agreement that the VSG is quickly gaining acceptance when compared to the RNY and will become the surgery of choice for weight loss, Among them Dr John R. Romanelli, MD FACS in his article Laparoscopic Sleeve Gastrectomy: The newest front in the battle against Obesity, published in WLS Lifestyles, fall of 06. His name can be “Googled”. While the Peer Review Committee has not yet considered this surgery for review, it is acclaimed by experts in the bariatric field and my surgeon, as safe, effective, with less complication, side affects and a viable option for weight loss. Additionally other BCBS policies (attachment 4) including Federal BCBS and Carefirst BCBS are adapting the surgery as medically necessary and I have read instances from other Obesityhelp.com forum members where BCBS insurance companies, including Anthem BCBS are overturning their initial denial of the VSG once supporting documentation was received supporting it being non-investigational. I hope BCBSNC follows the example of fellow BCBS policies.
I was pleased and encouraged to find that my health plan covers bariatric surgery and although this procedure is considered investigational by some, there is a body of undisputable evidence showing it to be sound, safe and successful in achieving it’s goal and probably superior to other weight loss surgery options, with many less side affects and complications; but most importantly, the best procedure for my current medical conditions and future wellbeing.
I trust that the attached information will provide additional information that will make possible a reversal of the initial denial. Attached you will find the documents relating to my appeal for consideration of the VSG for medically necessary weight loss surgery as a covered service under the Bariatric Surgery benefits of our health plan. I encourage this committee to please review the documented experts opinion and recommendations on bariatric surgery and approve this procedure.
Enclosed:
· BCBSNC Medical Policy
· Seven significant studies and stories supporting and documenting Vertical Sleeve Gastrectomy (including misc. documentation and articles)
· BCBSNC denial letter
· BCBS Carefirst Medical Policy/FEP BCBS Medical Policy
· BCBSNC Appeal Form

Thank you for your expedited consideration in this matter as I await a reversal of the initial denial.
Sincerely,

Rearch links:
Misc.
http://www.lapsf.com/weight-loss-surgeries.html

http://www.fepblue.org/benefitplans/2008-sbp/SBP2008Brochure_English.pdf

http://notesnet.carefirst.com/ecommerce/medicalpolicy.nsf/vwwebtablex/b573f47a27838f028525746a00470014?

Attachment 2
The first is a study that was done from 1976 to 1982 to check on vitamin levels and nutrition of "Gastric Exclusion for treatment of Obesity", I was searching under one of the alternative names for VSG and this one came up. I hope it is correct. I could not tell because it did not mention the VSG or RNY. Thanks Mercy Q
http://www.pubmedcentral.nih.gov/articlere...i?artid=1250639

Attachment 3
The next one was done between 2/01 and 5/02 with patient's over 50 yrs old. Thanks Mercy Q
http://www.ssat.com/cgi-bin/abstracts/06dd...T_DDW06_272.cgi

http://www.springerlink.com/content/ur18177j45164773/

http://www.asbs.org/Newsite07/resources/sleeve_statement.pdf

http://www.contemporarysurgery.com/inside.asp?ArtID=6014

http://www.palmbeachpost.com/accent/content/accent/epaper/2007/06/24/a1d_GASTRIC_SLEEVE_0624.html

http://www.medicalnewstoday.com/articles/69889.php

Can I get some cheese with this whine....

Feeling frustrated last couple of days. I am mad at myself that I didn't just have RNY 5 years ago and yet I am thankful that I have found the new WLS's I didn't know about like DS and VSG. I really want to have the sleeve but after going through all the paperwork, seminars, testing and money, I just now start really looking at my insurance policy. (Much thaanks to all the OH folks for all the advice, especially about researching before you choose a surgeon or surgery...wish I had known that before) My insurance policy lists all the surgeries...RNY, DS, VSG, LAP, BPD, GB..then it lists all six requirements of eligibility and gives CPT codes for surgery...flip to the next page...lap is not covered for BMI's over 50, oh and we don't cover sleeve gastrectomy AT ALL annnd, no 2 part surgery requests will be approved. Hmmmm sounds like RNY is all that is left!! Why should the insurance company get to decide??? If my surgeon, myself , PCP and enocrine dr. all think VSG is a good way for me to go then that is how it should be. So I blew the smoking thing out of the water...Bought a pack, smoked them....bought another pack. I just don't understand. My surgeon's office is submitting for VSG anyway, we shall see but my hopes are not very high!! I need to win the lottery so I can self pay and decide what is best for me not the insurance company. My advice to anyone looking into WLS for the first time...Spend months researching WLS options, lurk and ask questions on all forums on OH (obesityhelp.com), know your policy inside and out, choose a surgery, choose a surgeon and then JUMP!! Then again, maybe my subconscious knew I would back out if I didn't get my way so I invested all the time and money so I would do something, whether I wanted RNY or not. Nahhh, that's not it!

The Smoking Caterpillar

That was what my dreams were about last night...the smoking caterpillar from Alice in Wonderland. Whoooo Arree Youuuu? I had several other weird dreams...all involved smoking ofcourse. I am attempting to quit. Yes I am such a pessimistic, I said attempting! Part of me really does want to quit..I don't like the hold I feel it has over me. I would rather be able to smoke for enjoyment but I am a true addict so I smoke like a freight chain, like a crack addict who hadn't had a fix in a while. But the other part of me...oh how I miss that first drag in the morning after sipping my coffee. I hate how it smells though...it embarasses me that people complain that their stuff smells like smoke when they leave my house. Wow, that is a great memory to leave behind...My niece saying ..oh smell my blanket, it smells like Aunt Teresa's house....smoke!!! NOOO, you want her to say it smells like baked cookies or my perfume or ANYTHING but smoke. I did pretty good last night with the smoking thing... I slept most of yesterday, I have tried to stay away from triggers like talking on the phone or the internet or driving. I decided not to shower this weekend..I know gross but if I shower I WILL go to the store and buy a pack!! I have to do laundry today so I will try to stay busy...worse case scenario, I just go back to bed. Tomorrow will be tougher because I have to go back to work. Uggghhhh. The caterpillar did turn into a butterfly and left his smokes behind eventually. That is the first and foremost reason I am quitting....to have this surgery so I can release myself from this cocoon of fat and become my own butterfly.

Quote:
Advice from a Caterpillar
The Caterpillar and Alice looked at each other for some time in silence: at last the Caterpillar took the hookah out of its mouth, and addressed her in a languid, sleepy voice.'Who are you?' said the Caterpillar.
This was not an encouraging opening for a conversation. Alice replied, rather shyly, 'I - I hardly know, sir, just at present - at least I know who I was when I got up this morning, but I think I must have been changed several times since then.
''What do you mean by that?' said the Caterpillar sternly. 'Explain yourself!''
I can't explain myself, I'm afraid, sir' said Alice, 'because I'm not myself, you see.
''I don't see,' said the Caterpillar.'I'm afraid I can't put it more clearly,' Alice replied very politely, 'for I can't understand it myself to begin with; and being so many different sizes in a day is very confusing.
''It isn't,' said the Caterpillar.'
Well, perhaps you haven't found it so yet,' said Alice; 'but when you have to turn into a chrysalis - you will some day, you know - and then after that into a butterfly, I should think you'll feel it a little queer, won't you?
''Not a bit,' said the Caterpillar.
'Well, perhaps your feelings may be different,' said Alice; 'all I know is, it would feel very queer to me.
''You!' said the Caterpillar contemptuously. 'Who are you?'

The Nut, The Surgeon and the Shrink

So I had the last of my pre op testing and consultation this week. I met with the nutritionist Monday. I expected a lot of talk about diets and food choices but she was more interested in talking about the surgery itself and why I was doing it, I thought I was at the phychiatrist. Lasted about 30 minutes, it was painless and my inurance didn't pay for it so out of pocket I paid 55.00. At least it wasn't hundreds.
I had my consultation Tuesday. I have heard so many good things about Dr. Enochs, I was excited and nervous. My mom and daughter went with me so we can all have as much information as possible. The receptionist took my 400.00 consult fee...ouch! and a 30.00 co pay. This surprised me because I thought the point of the consult fee was to cover their costs in case you ended up not having surgery and got no money from the insurance company, which is why I didn't mind paying the consult fee but if I had to pay a co pay, that means they billed my insurance too. So they do get paid. I guess I should have asked but I was just so excited to have come this far in the process. I guess in the end, it really is all about money. My appointment was at 3:00, we arrived at 2:45, we were finally called back at 3:45, then sat in the room until 4:45..2 hours! I was irritated! I kept saying I hope they are having an off day because I would hate for them to be the top bariatric office in our area and this is how they operate. The nurse came in to take blood pressure and stuff and ask me what surgery I was looking at and I said possibly lap band or...and she jumped in to say "Your insurance won't cover lap because your BMI is too high" What??? What if that was the ONLY surgery I was willing to have? That would have been a good thing to tell me BEFORE I paid 400.00!! I said or the sleeve...she said oh they might do that but usually they only cover RNY. Well I don't want RNY. Why does it matter, it is my body! This just infuriates me. WLS is a choice I feel for lower BMI's but I think oncve you surpass 50, WLS is a necessity and it bewilders me how the insurance companies can look at it any other way. So Dr. Enochs came in and he was warm and friendly, made me feel very comfortable. He wasn't rushed even though he had to be somewhere by 6:00 and we were pushing 5:30. He skimmed over my chart and said he would recommend the sleeve for me as a surgeon because I don't really have many co-morbidies..I am somewhat healthy for a fat person! I do have a slight hernia and slight acid reflux and a fatty liver. The hurdle will be the insurance company. I know if they deny it, I will appeal...beyond that..I might push for lap band. I don't know what I will do. Try on my own once again I suppose. I didn't get to ask him all my questions, since most of them were surgery related I decided to wait until I was definately going to have surgery, plus he had to be somewhere so I thought I would be nice and not hold him up even though I had to wait for 2 hours but whatever, I am not bitter. LOL Really I'm not. I was a little irritated that day but Dr. Enochs was so nice, I got over it pretty quickly.
I met with the psychiatrist yesterday and she was super nice as well. I might have to meet up with her again. She specializes in bariatrics so I might need her down the road. I had to do a questionaire that asked questions like do I binge, do I closet eat, make myself throw up. Then we talked about the different surgeries and she said she has a lot of patients that are disappointed in their bands because they can cheat it and a lot of RNY's losing hair because they are not following the rules so she emphasized the importance of protein and eating right, lifestyle change. I know all these things but I think it really hit me for the first time in her office. I have just been so excited about what could be. She also helped me confirm my thoughts about not telling anyone at work. She said she has a patient that did tell everyone at work and they are not losing weight and people keep asking why isn't it working or can you get a refund. I don't want to face that pressure. I won't be lieing if they ask how I have lost weight and I say I watch my portions and excercise. A lot of people have surgery or get on medications to help cure a medical problem and end up losing weight. She asked if I was scared and if I thought about the changes I was going to have to make and I said I know the changes but I really don't feel I have a choice, it is kind of like if I had stomach cancer and they had to remove the cancerous stomach. It's a have to for me so "just jump" and figure out the rest later. She wanted to make sure I wasn't obsessed with being skinny...what did I want to weigh? I don't really care what I weigh...I just want to be healthy, to feel good, to be able to walk without hurting, to be able to really clean my house without relying on others, to be able to go places and have fun with my children, go on vacations and not stay in the hotel room or sit on a bench while everyone else around me is living. I want to live!

First Steps

So in order to have surgery, you have to jump through some hoops with paperwork and testing. Ofcourse I attended an informational seminar back in May and filled out all the paperwork for the surgeon. I procrastinated for a couple of months on submitting verification of coverage to my insurance company...not sure why other than being scared of change. But I submitted it late August and then set up appointments. I saw my PCP first and talked about surgery, she was all for it. I came back in on 9-22 to do the EKG and bloodwork...piece of cake, I was in and out in 30 minutes. I went on 9-24 to do an ultrasound of my gall bladder..easy, a chest xray..easy, and a barium swallow...not so easy but not horrendous either. First they had me stand on this platform that was connected to a table in upright position against my back with an xray machine in front of me. I had to swallow these crystals that looked like pop rocks and I immediately had an overwhelming feeling to burp but I was told not to. Then I had to drink barium, this thick white chalky stuff, I had to gulp it while they took pics of it going down. Had to stop once, felt like I was going to spew! Then the table laid back...I had to literally roll around on the table to coat the barium on my stomach and lay in all kinds of positionsso they could take pictures and then drink some more barium and take more pictures. Talk about awkard! The next week, I felt a lot of gas and bloatiness, burped alot, had constapation, then diarhea, then constipation again. A co-worker gave me a nexium the following Wednesday and wheww..relief! Wish I had thought of that sooner!!! I scheduled my nutritionist and psychologist appointments and my consultation with my surgeon is October 14th. From there hopefully I can have surgery pretty quick since all should be done. I just have to quit smoking. My PCP prescribed me zyban..seemed to work the first day, last 2 days I couldn't get enough cigarettes but I made a quit date of Oct 20th...the plan is to put them down. I have had weird dreams last couple of nights on this med...real weird, like twisted stuff. I dreamnt I had a brain tumor, that I kicked my daughter out of the house and that someone broke in my house and we were fighting with knives. I told ya..weird!

Not promised tomorrow...Thank you God for today

Have you ever been scared to death to move forward, yet scared to death to stay where you are? That's how I have felt for 10 years. Scared to leave my comfort zone and move onto a different life and make changes yet scared to stay in my comfort zone because it is miserable and will only lead to an untimely death carrying around all this extra weight. I thought I might had met my untimely death today...I had chest pains like I have never had before and then I threw my guts up. It scared me..bad! I thought I was having a heart attack. My daughter even wanted to call 911. It finally eased off and I have felt fine since so I am hoping it was something I ate yet still kinda scares me because if it was something I ate...shouldn't I still be sick? What if it was a minor heart attack and the massive one is lurking around the corner! So today my thoughts have been reflective...What if I had died? Who would take care of my kids? I don't want people to say, "It's a shame she died but no wonder she had a heart attack, look how fat she was" How would my parents pay for my funeral? Not to mention, the pall bearers mumbling under their breath at how heavy the casket is. I would miss out on my children's weddings, my nieces weddings, my grandchildren! All the trips we are supposed to take after our kids are grown. I would never meet the man of my dreams. I have too much left to do. I am thankful to be alive and I am angry at how much time I have wasted. Why have I waited so long...what exactly am I scared of? Even if this surgery doesn't happen...it is time for a change. I have to make a change. It is a matter of life and death at this point. I am playing Russian Roulette and my luck is not very good.

Covering the basics

I have a lot of ground to cover in this first blog. As I said in my About me, I have been overweight most of my life. I started putting on weight at age 11 and it just escalated through the years. I have done all the fad diets and tried Phen -Fen, and with each success I put on more weight than I lost when I would go back to eating normal. I became a closet eater and food was my best friend. I was always known as the easy going , happy go lucky "friend" of the group. All the guys went for my friends so you can imagine what that did for my self-esteem.
I first heard of weight loss surgery (WLS) back in 1998, I saw an infomercial for Fobi Pouch which was only done in California. I was so desperate, I was willing to travel to Cali. I went through the whole process and insurance denied it. I went through a major depression and packed on about 70 lbs. During this time, I lost my job, my girls were becoming teenagers, my ex husband passed away and I pretty much became a hermit because I was scared to go anywhere out of fear of not being able to fit in a booth, or movie theater seat or people staring at me. At this point, I had escalated up to about 300 lbs. In 2002 I had no choice but to get back in the world because I had to make a living and provide for my girls so I forced myself to function. I landed a good job with the state in 2003 and started looking into WLS again. This time I went to a Duke seminar and Lap-Band was now an option but my insurance only covered Gastric Bypass. This surgery scared me to death so I passed besides my weight wasn't a physical hinderance at this time just an appearance issue. I teeter tottered between 300-330 up until 2007 when I was diagnosed with hyperthyroidism and Graves disease. Now most people with this disease lose weight because their metabolism is on overdrive but I maintained my weight, lucky me I was in the 2% that weight loss was not a side effect.... but with the meds, my doctor told me I would most likely put on some weight and I did! Over the next year I packed on 50lbs...I am now at a womping 378, and it is a physical issue now. My knees hurt, my back hurts, I can't breathe, walk, do household chores. I am miserable! So once again I check into WLS and my insurance says "Yes" with the proper paperwork, they would most likely cover the Lap Band. Woo hoo! This go round is so different for me because it's not about getting the guy or looking good, all those are nice but I want to be healthy. I want to ride rides with my kids at amusement parks and walk and play and laugh. I have missed out on the past 10 years of their lives and mine! So I embark on this journey to find the skinny woman trapped inside.