Insurance Companies Suck

My husband wants to have this surgery too. We went to the information meeting (see post http://fat-chronicles.blogspot.com/2006/11/informational-meeting.html ) together and he got scared. I knew when he saw how well I was doing that he would want to do it too, and that is exactly what happened. Because he is a school teacher, he wanted to wait until the summer to have the surgery.

He knew the drill as far as all of the tests that you have to do before you see the surgeon and so he started doing all of that in April. He made his appointment with the surgeoun for July 5th. After the meeting, the surgeon will give you a surgery date and then they will secure the authorization for the surgery with the insurance company.

After his meeting, my husband was told that he would not be approved by the insurance company because the insurance company added a new stipulation for approvals last week! In order to be approved for surgery you now had to have 6 months of supervised weight loss with a nutritionist & physician. Our insurance company is Horizon Blue Cross/Blue Shield. They had been the easiest of the insurance companies to get the approval for bariatric surgery.

The insurance companies are trying to dissuade people from having the surgery because it costs them too much money. I think the surgery costs around $35,000 and since it has been so successful in weight loss, people are lining up to get it. The more obstacles the insurance companies put in your way, the less likely people will follow through to have the surgery.

He was so disappointed. He was really counting on having the surgery this summer. He is following up with his new PCP, Dr. Fink, who was going to do all of his post-op routine visits. Dr. Fink is going to set him up with a nutritionist. He is also starting a work-out regime at a gym that is affilaited with the hospital. It has lot better hours than the re-hab hospital gym that he was going to. It is like a regular gym and opens at 5:30 and closes at 9:00 pm. Gym memberships for men are pretty limited. At least women have women only gyms, but men pretty much have things like Gold's Gym or Bally's and they are clubs that you dodn't feel comfortable being at when you are overweight.

Anyway, I say screw the insurance companies. Follow their requisites to the letter so that they will have to pay for your surgery. Make them pay!

I am Fat

My BMI is down to 35. This still puts me in the obese catageory. I need to drop 5 more points and then I will only fall into the overweight category. Somehow that just doesn't seem fair. I mean, I lost 70 pounds and I am still obese? Yeah, okay, so when I started this journey I must have been super obese, if that is a category, but you know what I am saying.

I am going to buy new pants this weekend. The old ones are really just too big. It was so windy yesterday and my pant legs were flapping like flags in the wind. Everyone has been telling me how great I look and all. I know I am losing weight, but when I look in the mirror, I still see a fat person. And according to my BMI, I am still fat, but I wonder when I will stop feeling like a fat person. When does that happen? Does it ever happen? Will I always think of myself as fat?

6 Month Post-Op Follow-up

Went to see Dr. Bypass this morning. I wasn't feeling all that optimistic. since my doctor appointments are stretched out to every two months now, it is harder and harder to keep off the scale until the next appointment. As a result, I have started weighing myself once a week. As I have been hopping on the scale for the past three weeks I have become concerned that the scale doesn't seem to be moving, which has unfortunately led to my jumping on the scale every single day. It has become my mania.

In addition, when I replenished my vitamin stock two weeks ago, I could not find the iron pills that I had been taking, so I purchased another brand. The new brand has constipated me to the point of extreme discomfort. I resorted to taking 6 Fibercon pills and two ex-lax pills with minimal results. I have now thrown out these new iron pills and will be on the hunt for the Slo Fe brand.

Dumping Syndrome

http://www.mayoclinic.com/health/dumping-syndrome/DS00715/

Dumping syndrome A condition that occurs when food moves too fast from the stomach into the small intestine. Symptoms are nausea, pain, weakness, and sweating. This syndrome most often affects people who have had stomach operations.

Yeah, I read a lot about it prior to my surgery. I waited and waited, but it didn't happen and so I forgot most of what I had read about it. Then it happened to me and I thought I was going to DIE.

Once it happens you will never forget the sensation. I was at work when it occurred. Every morning I make myself a cup of tea when I get to the office. This one particular morning I saw a box of Swiss Miss hot chocolate. I decided that hot chocolate might be nice for a change of pace. Because I only buy diet drinks at home, it never occured to me to check to see if the hot cocoa was diet or not. I boiled the water and took a sip. Then I took another sip. Then I thought I was going to DIE.

Seriously. I didn't know what was happening. I ran to the bathroom and promptly threw up. Not a pretty chocolaty sight. Normally, when I have puked when not feeling well I immediately felt better. Not this time. I was nauseous. I was sweating. My stomach was in turmoil. I looked at the packet of hot cocoa. It was not diet. Too much sugar all at once, I guess. Not a good feeling. I will not be drinking that again.

Mac & Cheese

Macaroni & cheese is the great comfort food. I made this last week for AR and my daughter to eat as a side dish. As the macs were boiling, I tasted one to see if it was done, and it was so I finished up the dish by straining the noodles and adding butter and cheese. As I was stirring it, I decided to take a bite. After all, I had already eaten one macaroni and I felt fine. I quickly swallowed the cheesy mixture. I had a second bite as well. It was hot so I drank some water.

Two no-nos right there. I'm not supposed to be eating solid food yet and I had two forkfuls. In addition, I am not supposed to drink while I am eating. It fills you up too quickly and pushed the food through my system too soon. Uh, oh. My stomach did not like this. No, it was rebelling because I ate something I should not have eaten.

I sat there and watched while the rest of my family ate. I sipped my iced tea and ate nothing. Immediately after dinner, I felt like I had better lie down. I wasn't on the bed for more than two minutes when I felt the water forming in my mouth. I just knew that I was going to throw up. Would I make it to the bathroom in time? I dashed down the hall and made it just as my stomach heaved up the mac & cheese. It did it again and again. I swear that I threw up way more than I had eaten.

I felt instantly better after it was over. Why did I do it? I wasn't hungry. It just looked so good and creamy and yummy. Now that it is done, I could see that part of the problem is that I really didn't chew the macaroni properly. That, coupled with eating too fast and drinking just was a bad combination. I learned my lesson. I will not be doing this again.

Poo Day

I am happy to announce that poo has commenced. That was a relief because I was stressing a little about it, and now I don't have to worry. Another hurdle achieved.

I have removed two of my bandages. Dr. Bypass said I could start removing them in 4 days. He told me this on Wednesday so I wasn't clear on whether he meant 4 days from surgery or 4 days from Wednesday. It doesn't matter because after my shower one of the bandages started coming off on its own, so i helped it. The incision is about 3/4 of an inch wide. The area is very bruised and yellow/purple coloring, but the incision itself is healing fine. I showed AR and he nearly fainted. Chicken! Yeah, he'll be doing the lap band surgery for sure.

Went out for another ride, this time to the supermarket. We just had to pick up some cards, so I tagged along for the ride. I waited in the car with my daughter while AR did the shopping. I have to take my very own sippy cup with me wherever I go. I always need to be sipping on liquid, so I have to take it to go. No soda either! Well, I could drink soda if its flat, which I actually do not mind, but I've been sticking to tea, water and crystal lite.

AR is amazed that I am not hungry. He was afraid to eat in front of me for the first few days, and I told him that was ridiculous. For 1, I'm not hungry anyway and for 2. I can't eat solid foods yet anyway or I will get sick, so I cannot be tempted. I am craving hot chocolate. I bought some diet hot chocolate, but I'm not sure it qualifies as clear liquids. I may try some later tonight to see how I make out with it.

Surgery Day November 6, 2006

We dropped our daughter off at the babysitter's house at 8:30. She was so upset at my decision to have the surgery. She had been crying too. "Are you sure you want to do this?" she asked. I answered that I was sure. She hugged me and wished me well and said, "I think you look great just the way you are." I kissed my daughter goodbye and we got back into the car. By this time, I was crying. I just wasn't expecting that sort of reaction from the babysitter. She rattled me, but I quickly calmed down. As I mentioned before, I had total faith in this surgeon. I know that I would be fine.

We got to the hospital and checked in at the surgery floor. I got changed into a hospital gown while AR sat looking very nervous. The nurse could not get an IV into me. She tried twice and then said they would have to get it in the OR. Hope this isn't a sign of things to come. I went to the bathroom about 7 times. Nervous pee I guess.

The anesthesiologist came in and said not to worry about the IV. Dr. Bypass and his assistant came by to see me. Wanted to know if I had any last minute questions. Briefly, the thought crossed my mind to ask if it was too late to change my mind and get the lap band. I knew it was too late, and I also didn't want that surgery, so the fleeting thought passed by quickly. He said it should take about 2.5 hours and then another 1.5 hours in the recovery room.

AR kissed me goodbye and they wheeled me to the OR. Dr. Bypass and his assistant were sitting in the hallway. He said, "They usually make the bariatric patients walk to the OR. You must have some pull because you're getting the royal treatment." It made me laugh. He probably tells all of his patients this joke, but I still thought it was funny.

Once inside the OR, I noticed how cold and white everything was. I slid onto the operating table, which was pretty narrow. The OR nurse instantly got an IV into my wrist. Not the most convenient of places, but it was in. Another nurse was hooking me up to a blood pressure machine, and I started giggling because I'm ticklish, which in turn made the OR nurses laugh.

They put a mask over my face and told me to take a few deep breaths. I had to take more than a few, but the next thing I was aware of was waking up in the OR recovery room. I was cold and asked for a blanket, which they gave me. Before I knew it, I was in my hospital room. I was still kind of drowsy.

AR stayed a few hours and I finally told him to go home. I was in no mood for company. All I wanted to do was sleep, but did I get any sleep??? NO. I was inundated with nurses taking my blood pressure, my temperature, my oxygen levels and my blood sugar all night. No rest for the weary.

Informational Meeting

Every bariatric doctor requires that you attend an informational seminar before you can make an appointment with him/her. About 4 years ago AR and I attended one, well sort of. We went to the meeting. We filled out a TON of information and then we went into this room filled with a hundred people. It was so crowded that we could not even sit together. Before the meeting even began, AR signaled to me that he wanted to leave. We left.

He said he was looking around the room and just did not want to be there with all of those people. That night we went online and ordered food from Nutri-system. We did pretty well with that plan too, but it was very expensive to buy the food. It wouldn't have been so bad if we were just buying the Nutri-system food, but we still had to buy all the fruits and veggies that were needed to supplement the NS food. We stopped buying the food. We got fat again.

Fast forward to July 2006. AR wanted to look into weight loss surgery again. He did all of this research to find the best place and the best doctor. He scheduled an informational meeting for August, and he wanted me to go with him. Okay, I figured I would go to support him and to listen to the info that they would tell us about the surgery. I've been thinking about this anyway for the past year. In my mind, I had figured that I would do the lap band surgery. My recollection was that the death rate & complications were less.

The meeting was held in the waiting room of the doctor. You know, it really isn't a good idea to squeeze 30 fat people needing weight loss surgery into a tiny room. There was barely room to breathe. We were packed in pretty tightly. I wanted to sit in the front row so I could get a good look at whatever it was that we were going to see.

This was the first time I saw Dr. Bypass. He is tall and has blondish/gray hair. He wore a crazy pinstripe suit. The lapels were pretty wide and so was the pinstripe. He looked, I don't know, eccentric. He also had an assistant with him. I have seen the assistant on three separate occasions and this kid has never said a word. He just follows Dr. Bypass around holding a cup of coffee, but says nothing. I am not sure of what he actually does. Anyway, his assistant was there.

Dr. Bypass is very passionate about his work. He started explained how both surgeries worked. He explained that the death rate is the same for both. Both are done laproscopically. They both have risk of complications. People who have the lap band do not lose as much weight as those who have the bypass. It is possible to achieve similar weight loss with the lap band, but that requires a deep determination by the patient to work out vigorously.

While Dr. Bypass was drawing how he re-routes the intestines for the bypass, AR leaned over and said he would be back, and left. I figured he had to go to the bathroom. When he came back, his face was pale. I asked if he was okay, and he said yes.

He went on to describe the benefits of the surgery too. Most diabetics leave the hospital no longer needing any medication. You reduce risk factors for contracting various cancers, as well as reducing chance of heart attacks and strokes.

How well you will fare in your weight loss has been tied to how well you follow doctor's instructions and how often you see him for follow up visits. He does not charge a fee for follow up visits. His studies have shown that patients who do not follow through with office visits, gain weight back. A patient has to commit to seeing him One week after surgery, two weeks, after surgery, three weeks, four weeks, once a month for the first year, every three months for the second year and twice a year for the third year. He will tell you at every visit how well you are doing, if you need to change the path you are on to meet your goals, if you need the lap band adjusted etc...People who do not follow up, do not fare well.

Dr. Bypass requires that you have all of this bloodwork done to see what you pre-surgery levels are of everything that you can imagine. The list of things the lab had to test for was so long, it filled two prescription pad pages. Patients also need to see a nutritionist, have a psychological evaluation by a psychiatrist, get an EKG and a chest x-ray, all before you can make an appointment to see him. After the meeting, the receptionist handed out booklets that had all the information for what we needed to do.

While waiting for the elevator to take us down to the garage, AR asked me what I thought. I was pretty excited by everything I heard. I said I wanted to do it. He said that he didn't want to do it! Two completely different reactions to the same information. When AR left the meeting, he went to throw up. He said he was disturbed by the graphic illustration of the surgery. I said not only did I want to do it, but that I wanted the bypass and not the lap band.

It was ironic. I was really only going to this meeting to support AR and then he decided he wasn't going to do it and I decided that I was. AR is frightened at the thought of surgery. He doesn't handle pain too well. He sees how determined I am now and fully supports me. Now he is talking about maybe doing the lap band surgery. As long as I don't croak, I'm pretty sure he'll do it.