Robyn A.
Until now
Feb 04, 2007
Starting weight (preop appt): 313
Current weight (7/30/06): 190.5
RNY: 1/30/06
October 25, 2004 - I called Dr. Facundus' office to make my initial appointment this morning after I got home from the pet store. My heart was pounding because I had no idea what I was going to say "Hi, I'm fat and I need surgery. Help!"? I'm just not very good on the phone. I have a phone phobia, if I haven't mentioned it. When the call was answered and a woman said "Alabama Surgical Associates", I said "Um, hi. I need to make an appointment?"
Without batting an eyelash (or at least I didn't hear any batting), the woman asked for my insurance type, contract number, group number, height, weight, home phone number, cell phone number, and address.
I guess she's done this before, huh?
Then she gave me an appointment for November 15th at 8:00 and told me they'd send me paperwork to fill out, and that the first appointment would be $100 up front.
I hung up the phone and called my husband to tell him, which is when I realized that the 15th was a Monday. Monday mornings I volunteer at the pet store, and I usually don't get done there until 9:30 or so. I dithered about whether or not to reschedule the appointment and then decided I would. I called Dr. Facundus' office back and they transferred me to the scheduler. Since it had only been five minutes since I made the appointment I wasn't in the system yet so she had to go up to the front desk to talk to someone, and then she came back on and asked if Tuesday at 8:00 was okay. It was, so she signed me up for that, and no doubt put a "Warning: This patient is already a pain in the ass" note by my name. Heh.
Three weeks! I am just excited beyond belief. To be honest I thought that I might start having doubts once I made the appointment, but if anything, I'm even more certain that this is what I want to do.
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November 2, 2004 - I'm so peeved. No sooner had I made the appointment with Dr. Facundus' office than I find out Blue Cross and Blue Shield is changing their requirements so that if you want to have the surgery, you have to have documentation that you've been morbidly obese for at least five years (not a big deal for me - I know at one point in my past I maxed out the 350-pound scale at my doctor's office) and you have to have been on a weight loss program under your doctor's supervision for a period of at least six months in the past two years. This is a problem for me because I've never ever been under a doctor's supervision during the many times I've lost weight.
I'm so mad! I mean, I kind of understand why they're doing it, but still! Grrr!
I have an appointment tomorrow with my primary care physician to talk to her, to basically let her know that I want to have the surgery and get her blessing. That way if I find out that I do have to do the six-month supervised dieting thing, she won't be all surprised that I want to have the surgery. And in two weeks, I'll be seeing the coordinator at BWI (good thing I wrote it on my calendar - I thought my appointment was next week, not the week after. Darn!). Hopefully she'll have good things to tell me...
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November 3, 2004. - I saw my PCP today to let her know that I'm pursuing the surgery. I'm such a dork - I got all worked up before I went for my appointment, worrying that she would say "Oh, you don't want to have WLS!" and then suggest one of the ten thousand diets I've been on in the past. But I told her and she was so sweet and supportive and understanding. She went back through my records and pointed out things that might help with the insurance company. Basically, she said she'd help out any way she could, and she was behind me 100%. Then she ordered blood tests - I've had elevated blood sugar in the past; my previous PCP (at the same practice - she moved a few months ago and I switched to my current PCP) considered it pre-diabetic, but Dr. M told me that she's a little more aggressive about that stuff and would have wanted to treat it immediately with medication or diet. I've also had elevated liver enzymes (I saw a gastroenterologist about that, and he said that he thought weight loss would help with it) so she ordered a blood test on that, and while she was at it, she had my cholesterol tested as well.
I told her about Blue Cross's new requirements and she said she didn't think I should have any problems, but if I have to come back and do a 6-month supervised diet, she's there for me.
One of the smartest things I did - at my sister-in-law's suggestion - was to create a spreadsheet that detailed all the dieting attempts I've made in my life, and I showed that to Dr. M. She was very impressed by it, and looked it over and put it in my record. Thanks for the suggestion, Lee!
So now I just have to cool my heels until the 16th, when I see the coordinator at BWI. Having my PCP's approval and support has me very happy and excited, that's for sure!
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November 19, 2004. - I had my appointment on Tuesday (the 16th) to meet with Kristi at BWI. It went well - I had to be weighed and have my picture taken (ugh!) and go through my medical history and all that good stuff. Then Kristi went through every detail of what the surgery would entail (most of which I knew through my research). What surprised me was hearing that I'd have to give up gum, because if I accidentally swallowed it, they might have to open me up and remove the gum. ::Shudder:: I'm a big gum chewer, but I suppose I'd rather give it up than risk accidentally swallowing it!
Kristi told me that I need to attend at least one support meeting before surgery (it used to be three meetings, but they changed it). There's a pre-op meeting tomorrow at the Crestwood Women's Center at 10 am that I'm going to attend. There's also a meeting in Madison the first and third Thursdays of the month, so I'm probably going to attend at least one of those, if not both.
On December 1st I have a 9:15 appointment for the H. Pylori breath test (they do that at the doctor's office), and a 10:30 meeting with the nutritionist at BWI, where they'll do the metabolic test before the appointment. I think the metabolic test will be interesting, I'll be interested to see what the results are.
And then on December 7th I have my first appointment with Dr. Facundus!
I'm continuing to worry about the insurance, because it's my nature to worry. I've been a life-long worrywart. Hey, I've gotta give up the crappy food I've been eating my entire life, let me keep my worry habit! :)
I know that if BC turns me down at first since I don't have the 6-month doctor-supervised diet and I have to do the 6 months, my life will not end. But I'm so impatient - I want to have the surgery NOW, I want to get started NOW. Now, now, now!
I need to stop worrying, I suppose. There are people who have to pursue WLS for years before they're able to have it. Hopefully that won't be me, but if it is, I'll deal with it. I told my husband last night that I feel like I'm doing a lot of "hurry up and wait", but like I said, I'm going to just stop complaining and deal with it!
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November 27, 2004 ~ So, last week I went to the pre-op support meeting at the Crestwood Women's Center, and it was pretty interesting. There were four or five post-ops, all in various stages, and they looked amazing. They all had a lot to say, and I really enjoyed just sitting and listening to them. They got to talking about plastic surgery and one woman said "My boobs are like lemons in socks!", and I just laughed my butt off.
Hey, I've had big boobs for my entire life - I'd love to have small(er) ones!
I don't think I mentioned it, but a few weeks ago I was having a fluttering feeling in my chest and it got so bad I went to the emergency room. They did an EKG, among other tests, and didn't find a single thing wrong. I went to see my regular doctor the next day and she ordered an ECG (a sonogram of my heart) and a Holter Monitor (which is a monitor you wear around for 24 hours - it's like a 24-hour EKG, basically). The tests came back, and my doctor's office called to tell me that the ECG showed that I have something called mild tricuspid regurgitation. All this means is that I have to take antibiotics before I have any medical or dental procedures done. The Holter Monitor showed that I have periods of rapid heartbeat, and (the nurse said) they could either prescribe medication, or just monitor it for now.
Since I'm no fan of taking medication before talking face-to-face with my doctor about it (and especially because it didn't sound like I HAD to take the medication - it was just one of the options) I opted to just monitor it for now. The nurse told me I should make an appointment to see my doctor. I called first thing Monday morning (the nurse called at 5:30 on Friday evening - who knew there were any people in a doctor's office that late on a Friday?!) to make an appointment. Since this week was Thanksgiving week, I wasn't able to get in this week, so I have an appointment this coming Wednesday afternoon.
So on Tuesday I'll be doing the H. Pylori test at the doctor's office at 9:15, meeting with the nutritionist at 10:30 (and doing the metabolic test) and then meeting with my regular doctor at 2:45. That's more than I usually do in a single day, that's for sure!
I've been lurking over at the Alabama message board, and every now and then people post about the whole Blue Cross/ Blue Shield thing. I'll admit it - I'm still worried that I'll have to do the six-month doctor-supervised diet, and the thought just drives me crazy, because I want to have the surgery NOW.
The waiting is the hardest part, don'tchaknow.
At the support meeting last Saturday, Kristi said that something like 90% of the people who are initially turned down by their insurance company and appeal are approved upon appeal. I wonder if that's because a lot of people who are turned down just give up? You'd better believe that I'm going to appeal if I'm turned down.
I talked to my mother last weekend, and told her that if all went well and my insurance company approved me the first time, I might be able to have the surgery as soon as (this was just a guess on my part) February or March. But if insurance turns me down initially and then upon appeal, I might have to do the six month doctor-supervised diet, which means it could be more like late Spring, early Summer. From her reaction, I guess she was pretty stunned that it could be so soon - she said "February or March of 2005? Or the next one?" and when I told her 2005, she said "Wow, REALLY? So soon?" I guess she thought the whole insurance approval thing would take a whole lot longer.
Of course, BC/BS will probably be so backed up when they start taking preapproval applications (? I have no idea what they're called!) on November 29th, that there might be a delay.
Ah well - we shall see!
Thanksgiving was pretty good - we went to my husband's sister's house, and her boyfriend (who is french) made an apple tart that was to die for. As I was sitting at the table eating, I thought about what next Thanksgiving will be like, how I'll (hopefully!) be so much thinner and won't be able to eat nearly as much as I ate this Thanksgiving, and I got excited at the thought.
I can't wait!
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December 5, 2004 ~ So, I had the h. pylori test on Wednesday. I showed up about half an hour earlier than I was supposed to, because I had no idea how long it was going to take to get across Huntsville at that time of day - my appointment was at 9:15 - due to traffic. Traffic wasn't bad at all, though, so like i said, I got there about half an hour early. I had a hard time finding the building where Dr. Facundus' office is, because for some reason I thought the building I kept passing was the hospital instead of an office building. I drove back and forth three or four times before I finally figured out what was going on.
Duh!
I went into the office, filled out a short form (saying, basically, that if insurance didn't cover the test, I'd pay for it) and then sat in the waiting room for a while. This waiting room had the biggest, sturdiest chairs I've ever seen - I felt positively skinny!
After a while, the nurse called me back, had me sign something, then held out what looked like a small mylar balloon. I had to take a deep breath, hold it for four seconds, and then blow into the balloon. Then I had to drink something that tasted like too-sweet lemonade, and the nurse gave me a timer and told me to go back into the waiting room.
I'd brought a book with me, but I got caught up in watching the nice flat-screen television hanging in the waiting room, and before I knew it, 15 minutes was up and the timer was going off. The nurse took me back into the same room as before, had me breathe into a second mylar balloon-looking thing, and then told me it would be about 6 minutes for the results.
Long story short (too late!), the test came back negative - which is a good thing, as h. pylori can cause peptic ulcers, and that would NOT be a good thing.
Once I was done at the doctor's office, I stopped to fill up my gas tank, and then I went to the BWI office, where I had an appointment with the nutritionist and I also needed to take a metabolic test. By this time, I was getting hungry because I couldn't eat or drink anything for an hour before the h. pylori test, and once the test was over, I couldn't eat or drink anything because the metabolic test required that I not eat or drink anything an hour before that test.
So I did the metabolic test - it took about ten minutes. I sat in a recliner, had to put a nose clip on my nose, and breathed in and out through a tube. I felt a little uncomfortable - I guess I hadn't realized just how much I breathe through my nose - but it wasn't too bad. Once the metabolic test was done, I was allowed to drink, and I sat in the waiting room and guzzled down a ton of water waiting for it to be time for my appointment with Natalie. I didn't have to wait long before she was calling me back to her office.
I think my appointment with Natalie (the nutritionist) took about half an hour. We went over a lot of stuff, she gave me several sheets of paper that detailed how I'll be eating after surgery. I asked her why it is that there isn't one standardized way of eating that all bariatric surgeons go by (I've been reading the ObesityHelp.com boards, and some people are allowed to eat normally as soon as two weeks after surgery). Natalie said she didn't know why, but that Dr. Facundus requires a week of clear liquids for the first week, a week of low fall full liquids for week 2, and then weeks 3 - 7 is pureed. This is because your stomach needs all that time to heal and throwing food that it's required to work to digest into it impedes the healing process.
Or somethin'.
Anyway, we talked for about half an hour and she answered the few questions I had, and then I was on my way home. I ran a few errands (Christmas is coming, you know!) and went home to have lunch. Then I had an appointment with my primary care physician to discuss the results of my ECG and Holter Monitor.
She told me that I had tricuspid regurgitation (which I knew), and then she told me that the Holter Monitor showed that I was having premature ventricular contractions (PVCs). The normal person has them every once in a while, but over the course of the 24 hours that I had the Holter Monitor, I had 996 of them. She told me that she wanted to prescribe beta blockers for me, a very low dose, to stop the PVCs.
I asked her the most important question - "Will either the tricuspid regurgitation or PVCs interfere with my ability to have weight loss surgery?", and she was completely surprised that I'd even ask - she immediately said "No, not at all!"
Whew! That's exactly what I wanted to hear!
So, that's what's going on right now. I have my first appointment with Dr. Facundus on Tuesday. Hopefully it will be interesting and informative. I think the doctor's office will submit the paperwork once the initial surgical consultation is out of the way - unless more tests are required - but I'll have to ask to be sure.
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December 7, 2004 ~ I had my appointment with the bariatric surgeon today. I've been looking forward to this ever since I made the appointment weeks ago, and I could hardly believe it was finally time. My appointment was at 11, so I left the house at 10:15 - I always figure it's best to get there early. I got there about fifteen minutes early and had to fill out some paperwork and pay the $225 out of pocket cost for the consultation.
Yes, $225. I was thrilled, as you can imagine, but at least I'd known about it beforehand. I can't imagine how mad I would have been if I hadn't!
I only sat in the waiting room for two minutes, tops, before the nurse called me back to the examining room. I sat on the examining table (the lowest examining table I've ever seen. It was nice not to sit with my legs dangling!) while the nurse double-checking information with me. She asked if Synthroid and Seasonale were the only medication I was on, and I told her that I'd just started taking a beta blocker. I could NOT for the life of me remember the name of the medication (Toprol XL), so she made a note in my records and told me to call when I got home and let them know the name of it.
(Which I didn't do, and it's too late now. I'm writing a note to myself to call them tomorrow...)
A few minutes later the surgeon came in and showed me the diagram of how the Roux en-Y is performed (none of which was a surprise to me) and he said "You probably know that, though, right?", and I said "I've researched this operation so much that you could just give me the scalpel and let me perform it myself!" and he jokingly said "Okay, then I'll see you later!" Then he went through the whole spiel of the details of the surgery, answering about half my questions before I'd even asked them. He asked if I had any questions, and I got out my notebook and started asking them. He answered them and did a cursory exam, then asked if I'd started the weight loss program.
I thought he was talking about meeting with the Nutritionist - which I did last week - and told him I had, but as the conversation went on, it became apparent that he was talking about something else entirely. Once they got the new guidelines from Blue Cross, they apparently sat down to see how they could deal with the six-month doctor-supervised requirement and came up with a program that's run by the coordination office. So I have to go back there on the 20th to meet with the Dietitian and hear about the weight loss "program". I guess they're still going to submit my paperwork for insurance approval at some point - I'll ask the Dietitian exactly what the timeline is, I guess - but if Blue Cross turns me down, which I expect them to do, I'll already be on my way with the program.
My only concern is that a Dietitian is not a doctor; I think it might behoove me to make an appointment with my primary care physician to get this on record with her and then continue to see her once a month, just in case Blue Cross decides to be a pain about this.
I have an appointment on Thursday to have an abdominal ultrasound of my liver (it's fatty) and my gallbladder. I have to be at the hospital outpatient care at 7:30 for an 8:00 appointment. I have a feeling that before everything is said and done I'm going to get to know this hospital really well!
So I'm glad the consultation with the surgeon is behind me. Onward!
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December 10, 2004 ~ The day after I had my appointment with the bariatric surgeon, I got a call from his office. Someone who ordinarily would have been there to talk to me about my insurance and about the new program wasn't there yesterday, thus the confusion. She basically told me that since Blue Cross had changed their requirements, it looked like I was definitely going to have to do the six-month program through their coordination office. But because there are so many different kind of BC/BS, they were going to send in all my paperwork as if they were trying to get a preapproval just so they'd get an itemized list back from Blue Cross to see what exactly I need to have completed before they submit the paperwork for real.
The woman I talked to - Susan, I think - was very nice. I asked her a question that Fred and I had been discussing in bed the night before - Say your BMI is above 40, thus putting you in the category where you're okay for surgery without any additional comorbidities. If you do the six month program and your BMI dips below 40, does Blue Cross then reject you because your BMI is too low?
She said she didn't know, because this whole thing is new to them, but the surgeon thinks that they'll have to go by what your BMI was before you went on the six-month program. Not that it's going to be a problem for me, because I doubt I'll lose enough in six months for my BMI to dip below 40, but I was just curious.
I realized yesterday the funniest thing - I've been weighed twice at the coordinator's office and once at the surgeon's office, but no one actually measures my height; they just believe me when I say I'm 5'5". What if I'm lying about my height so that they'll think my BMI is higher than it usually is? They'd never know, because no one thinks to measure how tall I am!
Maybe I should have said I was five feet tall. Heh. (Just kidding!)
When I was at the surgeon's office and the nurse had me step on the scale, I said "How high does this scale go?" just because I was curious, and she admitted that she didn't know. Higher than I weigh, anyway!
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February 12, 2005 ~ Boy, I haven't posted in here in a long time, huh? Well, right now I'm almost at the end of my second month of the six-month doctor-supervised diet. I lost 12 pounds last month and will probably lose another 5 or so this month. That's not bad, unless you take into account the fact that I've lost this exact same weight at least ten times in the past, only to put it back on, and more.
Ah well.
The time is going by so slowly. I feel like I'm in a state of stasis, waiting for this six months to be over, to be approved for surgery, to have the surgery done. Every time I get dressed in the morning, I think "This time next year, this shirt will be way too big on me and I'll have to get rid of it..." (Of course, it's already a size or two too big, because I've always worn clothes that are too big for me. Which wasn't easy back in the early 90s when the biggest size the Lane Bryant catalog had was a 26/28 and I was pretty close to approaching that size!)
I'm definitely in the "diet" mindset these days, because I dream about food at least three nights a week. And it's never happy dreams wherein I eat some gooey treat and am happy and go on to do something else, noooo. What it is, is a dream wherein I'm eating something I "shouldn't", and I wake up feeling panicked and guilty and thinking "Now I won't lose weight this week! What the hell did I DO?" I hate that feeling. Even during the day when I'm eating exactly as I should, if I should have some little tiny extra thing I'm absolutely wracked with guilt. For instance, I made lasagna for dinner earlier this week and I had a small spoonful of the (fat free) cottage cheese/ (fat free) mozzarella/ parmesan/ spinach mixture and I felt guilty for the rest of the day to the point that I skipped my snack that evening. A small spoonful of a cheese mixture! For god's sake, I hate feeling guilty about such a stupid thing.
Oh, but anyway. The main reason I'm posting today is because I got a call from my surgeon's office yesterday. Back in December the coordination office gave me a sheet of paper that explained exactly how the 6-month diet program - which I do through their office, with their nutritionist - works. It entailed a visit with the nutritionist (or I guess he's a dietitian, I'm sure there's a difference, but I don't know what the difference is!) each month for six months, and a visit with the surgeon at months three and six, which Blue Cross assured them would cover the "doctor-supervised" part. So because the documentation that Blue Cross was working on had - before they finalized it - required a monthly visit to a doctor, I thought it prudent to follow up each visit to the nutritionist with a visit to my primary care physician. I thought it might be overkill, but it's better to be safe than sorry, right?
So Susan called from the surgeon's office yesterday to tell me that they got more detailed guidelines from Blue Cross, and guess what? Everyone's required to follow up with their PCP once a month!
You'd better believe I was patting myself on the back.
Susan also said that they'd be sending out a letter to my PCP detailing exactly what needs to be in my records. Hopefully it'll be what she's already been doing, because if I have to start the six months all over again, I will NOT be happy.
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April 20, 2005 - Just a quick post to say that nothing much is going on here. I'm still doing the doctor-supervised diet. I have an appointment with the nutritionist and my PCP on Friday. This will be the end of my 4th month; if my home scale is anything to go by, I'll have lost about 5 pounds this month.
The time is simultaneously crawling and rocketing by. The end of my six-month doctor-supervised diet will be around the 23rd of June, then I guess Dr. Facundus' office will submit everything again. In a perfect world, I'd be able to have surgery at the beginning of August; I'm keeping my fingers crossed that I can.
At this point, it's a matter of waiting for the next two months to go by!
Oh, and remember how a few months ago I said that no one had measured my height and I should say I was five feet tall? Well, at my last appointment with my PCP, the nurse actually measured my height. That's the first time that's happened, in five years of going there!
It turns out that I'm NOT 5'5 1/2". I'm 5'4 1/2"! I'm shriiiiiiiinking...
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6/6/05 - Right now, I'm just so ticked off, I can't see straight. I finished my 6-month doctor-supervised diet at the end of May, and the surgeon's office submitted my paperwork to Blue Cross. The DAY they submitted the paperwork, I found out that as of July 1st, our insurance plan will no longer cover weight loss surgery. Today I called to see what was going on with my pre-surgery approval, and the customer service rep told me that it was "in process" and "under review". When I asked her how long that would take, she said "30 to 45 days", even though I've heard of people being approved in a matter of a few days.
Now, let's think about it - if Blue Cross knows that to save themselves $30,000+, all they have to do is put off reviewing my pre-approval claim for 30 days, then why wouldn't they do it?
I'm pretty sure I'm screwed. I'm so emotional right now - I've burst into tears three different times today. This is so FRUSTRATING.
ARGH!
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July 9, 2005 ~ I got my denial from Blue Cross today. Of COURSE on a Saturday, when I can't do a thing. They said I only did 5 months of the 6-month doctor-supervised diet, and you know what? They're right. My first visit was on December 20th, my last on May 25th. That only adds up to five months.
In the month and a half since I last saw the nutritionist and my PCP, I've gained back about ten of the 25 pounds I lost over that five months. Ugh.
I've heard of a lawyer (I read about him on the Insurance Help message board). He specializes in appeals to insurance companies who turn down people for weight loss surgery, and has something like a 90% success rate. I've filled out the email form on his web page, and hope to hear back from his office this week.
I'm frustrated, but hopeful. I took so long to come to the decision that weight loss surgery was right for me, and now to have this whole process dragged out is crazy-making. I think of myself telling my mother back in November that I hoped to have the surgery in February or so, and I just shake my head. Was I naive, or what?
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January 27, 2006~ Okay, I'm back. Wow, the last time I wrote anything is back in July when I'd just hired a lawyer to handle my appeal, after I'd been denied by my insurance company.
I'll tell you what - hiring that lawyer was the biggest waste of money, ever. It took him forever to get the letter out to my insurance company, and even longer for him to send me a copy of the letter. The letter was just a boilerplate and it was full of typos and at one point in the letter there was someone else's name, not mine. Also, the letter didn't address the reason I was denied, at all. Once BC/ BS got the letter, I'd email the lawyer every few weeks or so to see if they'd heard anything from them, and he'd say that they hadn't. He led me to believe that someone in his office was calling BC/ BS at least once a week to see what the status of the appeal was, but never had any information for me.
I finally started calling BC/ BS myself, and to my surprise - this was in mid-October, I believe - I was told by a BC/ BS customer service rep that I was denied at the end of September.
Now why, I've gotta wonder, did the lawyer's office not know this, if they were supposedly calling every week to check on the status? Oh, I know! I know! Because they WEREN'T. What a half-assed way of doing things. When I emailed the lawyer to ask him why I wasn't informed of the denial, I got a non-answer and a lot of bull.
A complete waste of money. If you want to know who he is - so you can avoid him - email and ask.
Anyway, a copy of the denial letter went to my surgeon's office - the reason for the denial was, again, was because there was no proof of the 6-month doctor-supervised diet. When they got the denial, they got the paperwork together again and faxed it to BC/ BS, and then called me to let me know.
Another denial sometime in November, another faxing of information from my surgeon's office to BC/ BS.
At this point, I'd pretty much decided that there was no way on earth they were going to approve me, and that I'd have to go to Plan B.
Plan B was to go to Nashville to get Lap-Band surgery. I mean, we could have found the money to pay for RNY surgery ourselves, but if there were any complications at all with the surgery, BC/ BS wasn't going to pay for having those complications taken care of. Lap-Band surgery tends to have far fewer complications, but a lot of insurance companies - including mine - won't cover it, because it's considered "experimental". Even though it's the most-performed weight loss surgery done in the rest of the world, it's "experimental" here in the US. Oookay.
So I was running errands two days before Christmas, when my daughter called me on my cell phone. "Um, your surgeon's office called," she said.
"What did they say?" I asked. I assumed it was just a call to see what was going on, and if I'd heard anything from BC/ BS.
"I didn't answer it, I let the voicemail pick it up," she said.
So I called the voicemail for our home phone and there was a message from the surgeon's office, someone asking me to give them a call as soon as possible.
When I did, I found that they'd received a call from someone at BC/ BS who was doing the medical review on my appeal asking for a little more information. The woman I talked to - Stephanie - faxed the information to them, and a little while later got a call from the medical reviewer telling her that he'd approved me.
Approved! For weight loss surgery! FINALLY!
All we had to do now, Stephanie told me, was wait for the approval letter to arrive, and then things could be scheduled.
I got the letter one Saturday - of COURSE, because NOTHING can be done on the weekend, since no one's at the surgeon's office - and so on Monday I called Stephanie to let her know I'd gotten the letter. She asked if I could fax it to her, and so I ran it to my husband's office, and he faxed it for me, and then she said she was going to pass it on to someone else in the office, who would call me to set up my date for surgery, and the preop appointment.
I'd about given up hope for the day, when the phone rang. In short order, I had an appointment for the 18th for my preop appointment, and for the 23rd for surgery.
I was SO EXCITED.
So. I went to my preop appointment on the 18th, expecting to get pre-surgery instructions and pain relievers and a "See you on Monday!" (the 23rd, for which my surgery was scheduled).
It didn't actually happen like that. What happened is that I got pre-surgery instructions, and then the doctor came in, and he saw that I had gained ten pounds since my very first appointment at the surgeon's office (which was 14 months ago, so in the course of 14 months I lost 20-something pounds and gained them back, PLUS 10 pounds. Any questions why I seriously want this surgery?) and he told me that the policy is that if a patient has gained weight since their initial consultation, they have to lose back down to at least what they weighed that first time. This is because every pound you gain increases the size of your liver, and since I seem to have a fatty liver anyway (according to blood work), it's especially important that I reduce the size of my liver.
So I thought he might give me two weeks to drop ten pounds, only what he said was "Come back next Wednesday (which was a week from that day) and we'll see how you're doing."
I spent the next week working out on the elliptical (which kicked my butt in a serious way), eating very, very, very little, and whining about how hungry I was to anyone who would listen. I couldn't really weigh myself on our Tanita scale, because I was MAXING IT OUT, and I couldn't depend on our other scale, because I'd step on it and it would bounce back and forth by about five pounds, making it useless). But I did think that the trend was downward, though when I stepped on the Tanita scale Wednesday morning and saw that my weight was finally registering, I knew I'd lost SOME weight, just not how much.
I had a hair appointment at 9, and I sat through that, seriously considering having her cut all my hair off to increase the amount of weight I'd lost. (I didn't, though. I suspect bald would not be a particularly good look for me.)
Finally, I got to the doctor's office, waited for the nurse to call me back, kicked off my shoes and put my purse and jacket on the floor, and stepped on the scale.
I'd lost nine pounds in one week. NINE POUNDS.
I thought for sure since I'd lost so much that they would let the one pound slide, but was very disappointed to find that they wouldn't. The nurse explained to me that the doctors are sticklers about the numbers, and I know that my surgeon has an excellent reputation (did I mention that his mortality rate is half the national mortality rate when it comes to weight loss surgery?), and there's a reason for that.
So I was disappointed, but understood it - since, after all, it was my own fault in the first place that I had to lose the 10 pounds! I turned to the nurse and said "One more week?"
She said "Stick to your diet and come back on Friday, and we'll see if you've lost that one last pound."
I went back Friday - today - and found that though I hadn't lost that last pound, the doctor okayed my having surgery on Monday - January 30th - so I am ALL SET.
I'm so excited and nervous and scared and did I mention excited? Monday can't possibly come soon enough!!!
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February 3, 2006 ~ Four days after surgery, and I'm feeling pretty good! I'm being very careful about sipping, and I'm sticking to unsweetened juices (apple), jello, broth (though I stopped the broth after 2 days, because it was having the NASTIEST aftertaste on me!), popsicles. This morning I got dressed and went for a walk that was just over half a mile. Took me fifteen minutes to do it... can I blame it on my short legs?? :)
My hardest day by far was Wednesday - two days after surgery - when I was in pain and had to take hydrocodone to stop the pain, which was then making me dopey, and I couldn't stay awake for longer than 20 minutes at a time. But luckily I was able to sleep on my side that night - I'd been mostly sleeping in the recliner - with very little pain, and I got a decent night's rest and stopped taking the hydrocodone, and I improved about a million times!
I'm struggling a little with head hunger and cravings, but I try to point out to myself that it's just head hunger and the junky food was really never THAT good, when I slowed down enough to taste what I was eating, and it passes sooner or later.
I have an appointment with my surgeon in a week and a half; I'm anxious to see what the scale will say!
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February 17, 2006 ~ I saw the surgeon yesterday for my two week post-op visit. I've lost 20 pounds in two weeks - with the weight I lost the week before I had surgery, that's a total of 25 pounds!
Not bad for two weeks, I'd say. I see the nutrionist on March 2nd, and I'm going to weigh again that day. I'd like to see the number drop from 288 into the 270s. A girl can hope! :)
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March 17, 2006 ~ I've weighed in a few more times, just forgot to update my profile! I'm currently down to 273.5 pounds, which means I've lost 40 pounds since my preop appointment - or 34.5 pounds since the day of surgery.
I still wish it was more, but you know what? I'm not going to complain!
I started solid food this week and except for my pouch rejecting deli meat (which it then turned around and accepted just fine a little while later - I think I may have been eating too fast), everything's gone pretty well. I had sushi for lunch today and it went down okay (though I ate a little too much), but was disappointed to find that there are only 10 grams of protein in the amount I had. I guess I need to only have the sushi on special occasions, because that's not enough protein! I've been getting my protein (60 - 70 grams a day, usually) through food; I'd like to avoid protein shakes and bars as much as possible.
So anyway, everything's going well! 40 pounds gone, yay! :)
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March 30, 2006 ~ Today was weigh-in day (I weigh every two weeks, did I mention that?) and I weighed in at 267.5. That's another 6 pounds gone, for a total of 46 since my preop appointment (or 40.5 since the day I had the operation). I'd really like to hit 60 pounds gone at 3 months, but I'm not sure that'll happen. We'll see.
Everything's going fine, eating-wise. I'm getting all my protein in via foods and haven't had to have a protein shake in a long time. I'm eating a lot of shrimp lately - I love seafood - and was eating turkey pepperoni for a while, but got tired of it, and never want to see another turkey pepperoni again in my life.
One day last week I got a piece of pork chop stuck in my pouch, and spent two hours trying to get it to come back up. It eventually did - THANK GOD - and I've been extremely careful to chewchewchew every single bite, since then.
Water's going fine, exercise is going fine (though I slacked off a bit - a LOT, really - last week), and starting next week I'm going to do a FIRM exercise tape (with weight-lifting) two days a week and walk the other three.
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April 16, 2006 ~ Another weigh-in day has come! I weighed in at 259 pounds this week (Thursday), which makes for a total of 54.5 pounds since my preop appointment. I actually had to go out and buy new bras earlier this week, since the ones I had were getting ridiculously (and uncomfortably) big on me. I've gone down three band sizes - this is the smallest band size I've worn as an adult, and it's only going to get smaller!
Unfortunately, my cup size didn't get any smaller, but I'm sure that'll change in the months to come.
All's going well - I ate a little too junky on Friday and paid for it with extremely painful gas and having to run to the bathroom a LOT through the evening. Hopefully I've learned my lesson on that! :)
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May 11, 2006 ~ Apparently I forgot to update the last time I weighed in. I weighed in this morning and have lost 11.5 pounds in the past two weeks, which brings me to a total of 74 pounds lost since my preop appointment! I have 80-something pounds to go to reach my goal weight of 150.
I've "discovered" Tropical Punch Kool-Aid (sugar-free, of course), and have been drinking it like crazy. It's SO good; earlier this week I drank an entire 2 quarts in about 24 hours. I don't want to think about what that dark red dye is doing to my insides, though!
So far, I'm feeling good. I've vomited an average of once a week in the past few weeks - I absolutely cannot eat any kind of chicken at this point - but other than that, everything's okay. I'm walking a little more than 4 miles a day 4 - 5 mornings a week, and on the weekends I usually go kayaking with my husband at least once for a couple of hours.
I finally took pictures to show my progress, and I'll post them at the bottom of the page. I'm taking the next set at my six-month point at the end of July. I really hope I make it to 100 pounds lost since then. I might be hoping for too much, but I'm going to hope for it anyways! :)
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July 30, 2006 ~ Wow, I haven't updated this page in ages, have I? Today marks 6 months since my surgery, and I have lost a total of 123 pounds since my preop appointment.
I'm THRILLED with that number. I'm feeling good, although I just found out last week that I have hepatitis (my husband and I went to Florida last month, and I had some raw oysters) and I've been quite tired in the last few days.
I just wish I'd stop losing so much hair. I don't want to end up bald!
January 29, 2006 (313 lbs) ~~~~~ July 30, 2006 (190.5 lbs)
Current weight (7/30/06): 190.5
RNY: 1/30/06
October 25, 2004 - I called Dr. Facundus' office to make my initial appointment this morning after I got home from the pet store. My heart was pounding because I had no idea what I was going to say "Hi, I'm fat and I need surgery. Help!"? I'm just not very good on the phone. I have a phone phobia, if I haven't mentioned it. When the call was answered and a woman said "Alabama Surgical Associates", I said "Um, hi. I need to make an appointment?"
Without batting an eyelash (or at least I didn't hear any batting), the woman asked for my insurance type, contract number, group number, height, weight, home phone number, cell phone number, and address.
I guess she's done this before, huh?
Then she gave me an appointment for November 15th at 8:00 and told me they'd send me paperwork to fill out, and that the first appointment would be $100 up front.
I hung up the phone and called my husband to tell him, which is when I realized that the 15th was a Monday. Monday mornings I volunteer at the pet store, and I usually don't get done there until 9:30 or so. I dithered about whether or not to reschedule the appointment and then decided I would. I called Dr. Facundus' office back and they transferred me to the scheduler. Since it had only been five minutes since I made the appointment I wasn't in the system yet so she had to go up to the front desk to talk to someone, and then she came back on and asked if Tuesday at 8:00 was okay. It was, so she signed me up for that, and no doubt put a "Warning: This patient is already a pain in the ass" note by my name. Heh.
Three weeks! I am just excited beyond belief. To be honest I thought that I might start having doubts once I made the appointment, but if anything, I'm even more certain that this is what I want to do.
November 2, 2004 - I'm so peeved. No sooner had I made the appointment with Dr. Facundus' office than I find out Blue Cross and Blue Shield is changing their requirements so that if you want to have the surgery, you have to have documentation that you've been morbidly obese for at least five years (not a big deal for me - I know at one point in my past I maxed out the 350-pound scale at my doctor's office) and you have to have been on a weight loss program under your doctor's supervision for a period of at least six months in the past two years. This is a problem for me because I've never ever been under a doctor's supervision during the many times I've lost weight.
I'm so mad! I mean, I kind of understand why they're doing it, but still! Grrr!
I have an appointment tomorrow with my primary care physician to talk to her, to basically let her know that I want to have the surgery and get her blessing. That way if I find out that I do have to do the six-month supervised dieting thing, she won't be all surprised that I want to have the surgery. And in two weeks, I'll be seeing the coordinator at BWI (good thing I wrote it on my calendar - I thought my appointment was next week, not the week after. Darn!). Hopefully she'll have good things to tell me...
November 3, 2004. - I saw my PCP today to let her know that I'm pursuing the surgery. I'm such a dork - I got all worked up before I went for my appointment, worrying that she would say "Oh, you don't want to have WLS!" and then suggest one of the ten thousand diets I've been on in the past. But I told her and she was so sweet and supportive and understanding. She went back through my records and pointed out things that might help with the insurance company. Basically, she said she'd help out any way she could, and she was behind me 100%. Then she ordered blood tests - I've had elevated blood sugar in the past; my previous PCP (at the same practice - she moved a few months ago and I switched to my current PCP) considered it pre-diabetic, but Dr. M told me that she's a little more aggressive about that stuff and would have wanted to treat it immediately with medication or diet. I've also had elevated liver enzymes (I saw a gastroenterologist about that, and he said that he thought weight loss would help with it) so she ordered a blood test on that, and while she was at it, she had my cholesterol tested as well.
I told her about Blue Cross's new requirements and she said she didn't think I should have any problems, but if I have to come back and do a 6-month supervised diet, she's there for me.
One of the smartest things I did - at my sister-in-law's suggestion - was to create a spreadsheet that detailed all the dieting attempts I've made in my life, and I showed that to Dr. M. She was very impressed by it, and looked it over and put it in my record. Thanks for the suggestion, Lee!
So now I just have to cool my heels until the 16th, when I see the coordinator at BWI. Having my PCP's approval and support has me very happy and excited, that's for sure!
November 19, 2004. - I had my appointment on Tuesday (the 16th) to meet with Kristi at BWI. It went well - I had to be weighed and have my picture taken (ugh!) and go through my medical history and all that good stuff. Then Kristi went through every detail of what the surgery would entail (most of which I knew through my research). What surprised me was hearing that I'd have to give up gum, because if I accidentally swallowed it, they might have to open me up and remove the gum. ::Shudder:: I'm a big gum chewer, but I suppose I'd rather give it up than risk accidentally swallowing it!
Kristi told me that I need to attend at least one support meeting before surgery (it used to be three meetings, but they changed it). There's a pre-op meeting tomorrow at the Crestwood Women's Center at 10 am that I'm going to attend. There's also a meeting in Madison the first and third Thursdays of the month, so I'm probably going to attend at least one of those, if not both.
On December 1st I have a 9:15 appointment for the H. Pylori breath test (they do that at the doctor's office), and a 10:30 meeting with the nutritionist at BWI, where they'll do the metabolic test before the appointment. I think the metabolic test will be interesting, I'll be interested to see what the results are.
And then on December 7th I have my first appointment with Dr. Facundus!
I'm continuing to worry about the insurance, because it's my nature to worry. I've been a life-long worrywart. Hey, I've gotta give up the crappy food I've been eating my entire life, let me keep my worry habit! :)
I know that if BC turns me down at first since I don't have the 6-month doctor-supervised diet and I have to do the 6 months, my life will not end. But I'm so impatient - I want to have the surgery NOW, I want to get started NOW. Now, now, now!
I need to stop worrying, I suppose. There are people who have to pursue WLS for years before they're able to have it. Hopefully that won't be me, but if it is, I'll deal with it. I told my husband last night that I feel like I'm doing a lot of "hurry up and wait", but like I said, I'm going to just stop complaining and deal with it!
November 27, 2004 ~ So, last week I went to the pre-op support meeting at the Crestwood Women's Center, and it was pretty interesting. There were four or five post-ops, all in various stages, and they looked amazing. They all had a lot to say, and I really enjoyed just sitting and listening to them. They got to talking about plastic surgery and one woman said "My boobs are like lemons in socks!", and I just laughed my butt off.
Hey, I've had big boobs for my entire life - I'd love to have small(er) ones!
I don't think I mentioned it, but a few weeks ago I was having a fluttering feeling in my chest and it got so bad I went to the emergency room. They did an EKG, among other tests, and didn't find a single thing wrong. I went to see my regular doctor the next day and she ordered an ECG (a sonogram of my heart) and a Holter Monitor (which is a monitor you wear around for 24 hours - it's like a 24-hour EKG, basically). The tests came back, and my doctor's office called to tell me that the ECG showed that I have something called mild tricuspid regurgitation. All this means is that I have to take antibiotics before I have any medical or dental procedures done. The Holter Monitor showed that I have periods of rapid heartbeat, and (the nurse said) they could either prescribe medication, or just monitor it for now.
Since I'm no fan of taking medication before talking face-to-face with my doctor about it (and especially because it didn't sound like I HAD to take the medication - it was just one of the options) I opted to just monitor it for now. The nurse told me I should make an appointment to see my doctor. I called first thing Monday morning (the nurse called at 5:30 on Friday evening - who knew there were any people in a doctor's office that late on a Friday?!) to make an appointment. Since this week was Thanksgiving week, I wasn't able to get in this week, so I have an appointment this coming Wednesday afternoon.
So on Tuesday I'll be doing the H. Pylori test at the doctor's office at 9:15, meeting with the nutritionist at 10:30 (and doing the metabolic test) and then meeting with my regular doctor at 2:45. That's more than I usually do in a single day, that's for sure!
I've been lurking over at the Alabama message board, and every now and then people post about the whole Blue Cross/ Blue Shield thing. I'll admit it - I'm still worried that I'll have to do the six-month doctor-supervised diet, and the thought just drives me crazy, because I want to have the surgery NOW.
The waiting is the hardest part, don'tchaknow.
At the support meeting last Saturday, Kristi said that something like 90% of the people who are initially turned down by their insurance company and appeal are approved upon appeal. I wonder if that's because a lot of people who are turned down just give up? You'd better believe that I'm going to appeal if I'm turned down.
I talked to my mother last weekend, and told her that if all went well and my insurance company approved me the first time, I might be able to have the surgery as soon as (this was just a guess on my part) February or March. But if insurance turns me down initially and then upon appeal, I might have to do the six month doctor-supervised diet, which means it could be more like late Spring, early Summer. From her reaction, I guess she was pretty stunned that it could be so soon - she said "February or March of 2005? Or the next one?" and when I told her 2005, she said "Wow, REALLY? So soon?" I guess she thought the whole insurance approval thing would take a whole lot longer.
Of course, BC/BS will probably be so backed up when they start taking preapproval applications (? I have no idea what they're called!) on November 29th, that there might be a delay.
Ah well - we shall see!
Thanksgiving was pretty good - we went to my husband's sister's house, and her boyfriend (who is french) made an apple tart that was to die for. As I was sitting at the table eating, I thought about what next Thanksgiving will be like, how I'll (hopefully!) be so much thinner and won't be able to eat nearly as much as I ate this Thanksgiving, and I got excited at the thought.
I can't wait!
December 5, 2004 ~ So, I had the h. pylori test on Wednesday. I showed up about half an hour earlier than I was supposed to, because I had no idea how long it was going to take to get across Huntsville at that time of day - my appointment was at 9:15 - due to traffic. Traffic wasn't bad at all, though, so like i said, I got there about half an hour early. I had a hard time finding the building where Dr. Facundus' office is, because for some reason I thought the building I kept passing was the hospital instead of an office building. I drove back and forth three or four times before I finally figured out what was going on.
Duh!
I went into the office, filled out a short form (saying, basically, that if insurance didn't cover the test, I'd pay for it) and then sat in the waiting room for a while. This waiting room had the biggest, sturdiest chairs I've ever seen - I felt positively skinny!
After a while, the nurse called me back, had me sign something, then held out what looked like a small mylar balloon. I had to take a deep breath, hold it for four seconds, and then blow into the balloon. Then I had to drink something that tasted like too-sweet lemonade, and the nurse gave me a timer and told me to go back into the waiting room.
I'd brought a book with me, but I got caught up in watching the nice flat-screen television hanging in the waiting room, and before I knew it, 15 minutes was up and the timer was going off. The nurse took me back into the same room as before, had me breathe into a second mylar balloon-looking thing, and then told me it would be about 6 minutes for the results.
Long story short (too late!), the test came back negative - which is a good thing, as h. pylori can cause peptic ulcers, and that would NOT be a good thing.
Once I was done at the doctor's office, I stopped to fill up my gas tank, and then I went to the BWI office, where I had an appointment with the nutritionist and I also needed to take a metabolic test. By this time, I was getting hungry because I couldn't eat or drink anything for an hour before the h. pylori test, and once the test was over, I couldn't eat or drink anything because the metabolic test required that I not eat or drink anything an hour before that test.
So I did the metabolic test - it took about ten minutes. I sat in a recliner, had to put a nose clip on my nose, and breathed in and out through a tube. I felt a little uncomfortable - I guess I hadn't realized just how much I breathe through my nose - but it wasn't too bad. Once the metabolic test was done, I was allowed to drink, and I sat in the waiting room and guzzled down a ton of water waiting for it to be time for my appointment with Natalie. I didn't have to wait long before she was calling me back to her office.
I think my appointment with Natalie (the nutritionist) took about half an hour. We went over a lot of stuff, she gave me several sheets of paper that detailed how I'll be eating after surgery. I asked her why it is that there isn't one standardized way of eating that all bariatric surgeons go by (I've been reading the ObesityHelp.com boards, and some people are allowed to eat normally as soon as two weeks after surgery). Natalie said she didn't know why, but that Dr. Facundus requires a week of clear liquids for the first week, a week of low fall full liquids for week 2, and then weeks 3 - 7 is pureed. This is because your stomach needs all that time to heal and throwing food that it's required to work to digest into it impedes the healing process.
Or somethin'.
Anyway, we talked for about half an hour and she answered the few questions I had, and then I was on my way home. I ran a few errands (Christmas is coming, you know!) and went home to have lunch. Then I had an appointment with my primary care physician to discuss the results of my ECG and Holter Monitor.
She told me that I had tricuspid regurgitation (which I knew), and then she told me that the Holter Monitor showed that I was having premature ventricular contractions (PVCs). The normal person has them every once in a while, but over the course of the 24 hours that I had the Holter Monitor, I had 996 of them. She told me that she wanted to prescribe beta blockers for me, a very low dose, to stop the PVCs.
I asked her the most important question - "Will either the tricuspid regurgitation or PVCs interfere with my ability to have weight loss surgery?", and she was completely surprised that I'd even ask - she immediately said "No, not at all!"
Whew! That's exactly what I wanted to hear!
So, that's what's going on right now. I have my first appointment with Dr. Facundus on Tuesday. Hopefully it will be interesting and informative. I think the doctor's office will submit the paperwork once the initial surgical consultation is out of the way - unless more tests are required - but I'll have to ask to be sure.
December 7, 2004 ~ I had my appointment with the bariatric surgeon today. I've been looking forward to this ever since I made the appointment weeks ago, and I could hardly believe it was finally time. My appointment was at 11, so I left the house at 10:15 - I always figure it's best to get there early. I got there about fifteen minutes early and had to fill out some paperwork and pay the $225 out of pocket cost for the consultation.
Yes, $225. I was thrilled, as you can imagine, but at least I'd known about it beforehand. I can't imagine how mad I would have been if I hadn't!
I only sat in the waiting room for two minutes, tops, before the nurse called me back to the examining room. I sat on the examining table (the lowest examining table I've ever seen. It was nice not to sit with my legs dangling!) while the nurse double-checking information with me. She asked if Synthroid and Seasonale were the only medication I was on, and I told her that I'd just started taking a beta blocker. I could NOT for the life of me remember the name of the medication (Toprol XL), so she made a note in my records and told me to call when I got home and let them know the name of it.
(Which I didn't do, and it's too late now. I'm writing a note to myself to call them tomorrow...)
A few minutes later the surgeon came in and showed me the diagram of how the Roux en-Y is performed (none of which was a surprise to me) and he said "You probably know that, though, right?", and I said "I've researched this operation so much that you could just give me the scalpel and let me perform it myself!" and he jokingly said "Okay, then I'll see you later!" Then he went through the whole spiel of the details of the surgery, answering about half my questions before I'd even asked them. He asked if I had any questions, and I got out my notebook and started asking them. He answered them and did a cursory exam, then asked if I'd started the weight loss program.
I thought he was talking about meeting with the Nutritionist - which I did last week - and told him I had, but as the conversation went on, it became apparent that he was talking about something else entirely. Once they got the new guidelines from Blue Cross, they apparently sat down to see how they could deal with the six-month doctor-supervised requirement and came up with a program that's run by the coordination office. So I have to go back there on the 20th to meet with the Dietitian and hear about the weight loss "program". I guess they're still going to submit my paperwork for insurance approval at some point - I'll ask the Dietitian exactly what the timeline is, I guess - but if Blue Cross turns me down, which I expect them to do, I'll already be on my way with the program.
My only concern is that a Dietitian is not a doctor; I think it might behoove me to make an appointment with my primary care physician to get this on record with her and then continue to see her once a month, just in case Blue Cross decides to be a pain about this.
I have an appointment on Thursday to have an abdominal ultrasound of my liver (it's fatty) and my gallbladder. I have to be at the hospital outpatient care at 7:30 for an 8:00 appointment. I have a feeling that before everything is said and done I'm going to get to know this hospital really well!
So I'm glad the consultation with the surgeon is behind me. Onward!
December 10, 2004 ~ The day after I had my appointment with the bariatric surgeon, I got a call from his office. Someone who ordinarily would have been there to talk to me about my insurance and about the new program wasn't there yesterday, thus the confusion. She basically told me that since Blue Cross had changed their requirements, it looked like I was definitely going to have to do the six-month program through their coordination office. But because there are so many different kind of BC/BS, they were going to send in all my paperwork as if they were trying to get a preapproval just so they'd get an itemized list back from Blue Cross to see what exactly I need to have completed before they submit the paperwork for real.
The woman I talked to - Susan, I think - was very nice. I asked her a question that Fred and I had been discussing in bed the night before - Say your BMI is above 40, thus putting you in the category where you're okay for surgery without any additional comorbidities. If you do the six month program and your BMI dips below 40, does Blue Cross then reject you because your BMI is too low?
She said she didn't know, because this whole thing is new to them, but the surgeon thinks that they'll have to go by what your BMI was before you went on the six-month program. Not that it's going to be a problem for me, because I doubt I'll lose enough in six months for my BMI to dip below 40, but I was just curious.
I realized yesterday the funniest thing - I've been weighed twice at the coordinator's office and once at the surgeon's office, but no one actually measures my height; they just believe me when I say I'm 5'5". What if I'm lying about my height so that they'll think my BMI is higher than it usually is? They'd never know, because no one thinks to measure how tall I am!
Maybe I should have said I was five feet tall. Heh. (Just kidding!)
When I was at the surgeon's office and the nurse had me step on the scale, I said "How high does this scale go?" just because I was curious, and she admitted that she didn't know. Higher than I weigh, anyway!
February 12, 2005 ~ Boy, I haven't posted in here in a long time, huh? Well, right now I'm almost at the end of my second month of the six-month doctor-supervised diet. I lost 12 pounds last month and will probably lose another 5 or so this month. That's not bad, unless you take into account the fact that I've lost this exact same weight at least ten times in the past, only to put it back on, and more.
Ah well.
The time is going by so slowly. I feel like I'm in a state of stasis, waiting for this six months to be over, to be approved for surgery, to have the surgery done. Every time I get dressed in the morning, I think "This time next year, this shirt will be way too big on me and I'll have to get rid of it..." (Of course, it's already a size or two too big, because I've always worn clothes that are too big for me. Which wasn't easy back in the early 90s when the biggest size the Lane Bryant catalog had was a 26/28 and I was pretty close to approaching that size!)
I'm definitely in the "diet" mindset these days, because I dream about food at least three nights a week. And it's never happy dreams wherein I eat some gooey treat and am happy and go on to do something else, noooo. What it is, is a dream wherein I'm eating something I "shouldn't", and I wake up feeling panicked and guilty and thinking "Now I won't lose weight this week! What the hell did I DO?" I hate that feeling. Even during the day when I'm eating exactly as I should, if I should have some little tiny extra thing I'm absolutely wracked with guilt. For instance, I made lasagna for dinner earlier this week and I had a small spoonful of the (fat free) cottage cheese/ (fat free) mozzarella/ parmesan/ spinach mixture and I felt guilty for the rest of the day to the point that I skipped my snack that evening. A small spoonful of a cheese mixture! For god's sake, I hate feeling guilty about such a stupid thing.
Oh, but anyway. The main reason I'm posting today is because I got a call from my surgeon's office yesterday. Back in December the coordination office gave me a sheet of paper that explained exactly how the 6-month diet program - which I do through their office, with their nutritionist - works. It entailed a visit with the nutritionist (or I guess he's a dietitian, I'm sure there's a difference, but I don't know what the difference is!) each month for six months, and a visit with the surgeon at months three and six, which Blue Cross assured them would cover the "doctor-supervised" part. So because the documentation that Blue Cross was working on had - before they finalized it - required a monthly visit to a doctor, I thought it prudent to follow up each visit to the nutritionist with a visit to my primary care physician. I thought it might be overkill, but it's better to be safe than sorry, right?
So Susan called from the surgeon's office yesterday to tell me that they got more detailed guidelines from Blue Cross, and guess what? Everyone's required to follow up with their PCP once a month!
You'd better believe I was patting myself on the back.
Susan also said that they'd be sending out a letter to my PCP detailing exactly what needs to be in my records. Hopefully it'll be what she's already been doing, because if I have to start the six months all over again, I will NOT be happy.
April 20, 2005 - Just a quick post to say that nothing much is going on here. I'm still doing the doctor-supervised diet. I have an appointment with the nutritionist and my PCP on Friday. This will be the end of my 4th month; if my home scale is anything to go by, I'll have lost about 5 pounds this month.
The time is simultaneously crawling and rocketing by. The end of my six-month doctor-supervised diet will be around the 23rd of June, then I guess Dr. Facundus' office will submit everything again. In a perfect world, I'd be able to have surgery at the beginning of August; I'm keeping my fingers crossed that I can.
At this point, it's a matter of waiting for the next two months to go by!
Oh, and remember how a few months ago I said that no one had measured my height and I should say I was five feet tall? Well, at my last appointment with my PCP, the nurse actually measured my height. That's the first time that's happened, in five years of going there!
It turns out that I'm NOT 5'5 1/2". I'm 5'4 1/2"! I'm shriiiiiiiinking...
6/6/05 - Right now, I'm just so ticked off, I can't see straight. I finished my 6-month doctor-supervised diet at the end of May, and the surgeon's office submitted my paperwork to Blue Cross. The DAY they submitted the paperwork, I found out that as of July 1st, our insurance plan will no longer cover weight loss surgery. Today I called to see what was going on with my pre-surgery approval, and the customer service rep told me that it was "in process" and "under review". When I asked her how long that would take, she said "30 to 45 days", even though I've heard of people being approved in a matter of a few days.
Now, let's think about it - if Blue Cross knows that to save themselves $30,000+, all they have to do is put off reviewing my pre-approval claim for 30 days, then why wouldn't they do it?
I'm pretty sure I'm screwed. I'm so emotional right now - I've burst into tears three different times today. This is so FRUSTRATING.
ARGH!
July 9, 2005 ~ I got my denial from Blue Cross today. Of COURSE on a Saturday, when I can't do a thing. They said I only did 5 months of the 6-month doctor-supervised diet, and you know what? They're right. My first visit was on December 20th, my last on May 25th. That only adds up to five months.
In the month and a half since I last saw the nutritionist and my PCP, I've gained back about ten of the 25 pounds I lost over that five months. Ugh.
I've heard of a lawyer (I read about him on the Insurance Help message board). He specializes in appeals to insurance companies who turn down people for weight loss surgery, and has something like a 90% success rate. I've filled out the email form on his web page, and hope to hear back from his office this week.
I'm frustrated, but hopeful. I took so long to come to the decision that weight loss surgery was right for me, and now to have this whole process dragged out is crazy-making. I think of myself telling my mother back in November that I hoped to have the surgery in February or so, and I just shake my head. Was I naive, or what?
January 27, 2006~ Okay, I'm back. Wow, the last time I wrote anything is back in July when I'd just hired a lawyer to handle my appeal, after I'd been denied by my insurance company.
I'll tell you what - hiring that lawyer was the biggest waste of money, ever. It took him forever to get the letter out to my insurance company, and even longer for him to send me a copy of the letter. The letter was just a boilerplate and it was full of typos and at one point in the letter there was someone else's name, not mine. Also, the letter didn't address the reason I was denied, at all. Once BC/ BS got the letter, I'd email the lawyer every few weeks or so to see if they'd heard anything from them, and he'd say that they hadn't. He led me to believe that someone in his office was calling BC/ BS at least once a week to see what the status of the appeal was, but never had any information for me.
I finally started calling BC/ BS myself, and to my surprise - this was in mid-October, I believe - I was told by a BC/ BS customer service rep that I was denied at the end of September.
Now why, I've gotta wonder, did the lawyer's office not know this, if they were supposedly calling every week to check on the status? Oh, I know! I know! Because they WEREN'T. What a half-assed way of doing things. When I emailed the lawyer to ask him why I wasn't informed of the denial, I got a non-answer and a lot of bull.
A complete waste of money. If you want to know who he is - so you can avoid him - email and ask.
Anyway, a copy of the denial letter went to my surgeon's office - the reason for the denial was, again, was because there was no proof of the 6-month doctor-supervised diet. When they got the denial, they got the paperwork together again and faxed it to BC/ BS, and then called me to let me know.
Another denial sometime in November, another faxing of information from my surgeon's office to BC/ BS.
At this point, I'd pretty much decided that there was no way on earth they were going to approve me, and that I'd have to go to Plan B.
Plan B was to go to Nashville to get Lap-Band surgery. I mean, we could have found the money to pay for RNY surgery ourselves, but if there were any complications at all with the surgery, BC/ BS wasn't going to pay for having those complications taken care of. Lap-Band surgery tends to have far fewer complications, but a lot of insurance companies - including mine - won't cover it, because it's considered "experimental". Even though it's the most-performed weight loss surgery done in the rest of the world, it's "experimental" here in the US. Oookay.
So I was running errands two days before Christmas, when my daughter called me on my cell phone. "Um, your surgeon's office called," she said.
"What did they say?" I asked. I assumed it was just a call to see what was going on, and if I'd heard anything from BC/ BS.
"I didn't answer it, I let the voicemail pick it up," she said.
So I called the voicemail for our home phone and there was a message from the surgeon's office, someone asking me to give them a call as soon as possible.
When I did, I found that they'd received a call from someone at BC/ BS who was doing the medical review on my appeal asking for a little more information. The woman I talked to - Stephanie - faxed the information to them, and a little while later got a call from the medical reviewer telling her that he'd approved me.
Approved! For weight loss surgery! FINALLY!
All we had to do now, Stephanie told me, was wait for the approval letter to arrive, and then things could be scheduled.
I got the letter one Saturday - of COURSE, because NOTHING can be done on the weekend, since no one's at the surgeon's office - and so on Monday I called Stephanie to let her know I'd gotten the letter. She asked if I could fax it to her, and so I ran it to my husband's office, and he faxed it for me, and then she said she was going to pass it on to someone else in the office, who would call me to set up my date for surgery, and the preop appointment.
I'd about given up hope for the day, when the phone rang. In short order, I had an appointment for the 18th for my preop appointment, and for the 23rd for surgery.
I was SO EXCITED.
So. I went to my preop appointment on the 18th, expecting to get pre-surgery instructions and pain relievers and a "See you on Monday!" (the 23rd, for which my surgery was scheduled).
It didn't actually happen like that. What happened is that I got pre-surgery instructions, and then the doctor came in, and he saw that I had gained ten pounds since my very first appointment at the surgeon's office (which was 14 months ago, so in the course of 14 months I lost 20-something pounds and gained them back, PLUS 10 pounds. Any questions why I seriously want this surgery?) and he told me that the policy is that if a patient has gained weight since their initial consultation, they have to lose back down to at least what they weighed that first time. This is because every pound you gain increases the size of your liver, and since I seem to have a fatty liver anyway (according to blood work), it's especially important that I reduce the size of my liver.
So I thought he might give me two weeks to drop ten pounds, only what he said was "Come back next Wednesday (which was a week from that day) and we'll see how you're doing."
I spent the next week working out on the elliptical (which kicked my butt in a serious way), eating very, very, very little, and whining about how hungry I was to anyone who would listen. I couldn't really weigh myself on our Tanita scale, because I was MAXING IT OUT, and I couldn't depend on our other scale, because I'd step on it and it would bounce back and forth by about five pounds, making it useless). But I did think that the trend was downward, though when I stepped on the Tanita scale Wednesday morning and saw that my weight was finally registering, I knew I'd lost SOME weight, just not how much.
I had a hair appointment at 9, and I sat through that, seriously considering having her cut all my hair off to increase the amount of weight I'd lost. (I didn't, though. I suspect bald would not be a particularly good look for me.)
Finally, I got to the doctor's office, waited for the nurse to call me back, kicked off my shoes and put my purse and jacket on the floor, and stepped on the scale.
I'd lost nine pounds in one week. NINE POUNDS.
I thought for sure since I'd lost so much that they would let the one pound slide, but was very disappointed to find that they wouldn't. The nurse explained to me that the doctors are sticklers about the numbers, and I know that my surgeon has an excellent reputation (did I mention that his mortality rate is half the national mortality rate when it comes to weight loss surgery?), and there's a reason for that.
So I was disappointed, but understood it - since, after all, it was my own fault in the first place that I had to lose the 10 pounds! I turned to the nurse and said "One more week?"
She said "Stick to your diet and come back on Friday, and we'll see if you've lost that one last pound."
I went back Friday - today - and found that though I hadn't lost that last pound, the doctor okayed my having surgery on Monday - January 30th - so I am ALL SET.
I'm so excited and nervous and scared and did I mention excited? Monday can't possibly come soon enough!!!
February 3, 2006 ~ Four days after surgery, and I'm feeling pretty good! I'm being very careful about sipping, and I'm sticking to unsweetened juices (apple), jello, broth (though I stopped the broth after 2 days, because it was having the NASTIEST aftertaste on me!), popsicles. This morning I got dressed and went for a walk that was just over half a mile. Took me fifteen minutes to do it... can I blame it on my short legs?? :)
My hardest day by far was Wednesday - two days after surgery - when I was in pain and had to take hydrocodone to stop the pain, which was then making me dopey, and I couldn't stay awake for longer than 20 minutes at a time. But luckily I was able to sleep on my side that night - I'd been mostly sleeping in the recliner - with very little pain, and I got a decent night's rest and stopped taking the hydrocodone, and I improved about a million times!
I'm struggling a little with head hunger and cravings, but I try to point out to myself that it's just head hunger and the junky food was really never THAT good, when I slowed down enough to taste what I was eating, and it passes sooner or later.
I have an appointment with my surgeon in a week and a half; I'm anxious to see what the scale will say!
February 17, 2006 ~ I saw the surgeon yesterday for my two week post-op visit. I've lost 20 pounds in two weeks - with the weight I lost the week before I had surgery, that's a total of 25 pounds!
Not bad for two weeks, I'd say. I see the nutrionist on March 2nd, and I'm going to weigh again that day. I'd like to see the number drop from 288 into the 270s. A girl can hope! :)
March 17, 2006 ~ I've weighed in a few more times, just forgot to update my profile! I'm currently down to 273.5 pounds, which means I've lost 40 pounds since my preop appointment - or 34.5 pounds since the day of surgery.
I still wish it was more, but you know what? I'm not going to complain!
I started solid food this week and except for my pouch rejecting deli meat (which it then turned around and accepted just fine a little while later - I think I may have been eating too fast), everything's gone pretty well. I had sushi for lunch today and it went down okay (though I ate a little too much), but was disappointed to find that there are only 10 grams of protein in the amount I had. I guess I need to only have the sushi on special occasions, because that's not enough protein! I've been getting my protein (60 - 70 grams a day, usually) through food; I'd like to avoid protein shakes and bars as much as possible.
So anyway, everything's going well! 40 pounds gone, yay! :)
March 30, 2006 ~ Today was weigh-in day (I weigh every two weeks, did I mention that?) and I weighed in at 267.5. That's another 6 pounds gone, for a total of 46 since my preop appointment (or 40.5 since the day I had the operation). I'd really like to hit 60 pounds gone at 3 months, but I'm not sure that'll happen. We'll see.
Everything's going fine, eating-wise. I'm getting all my protein in via foods and haven't had to have a protein shake in a long time. I'm eating a lot of shrimp lately - I love seafood - and was eating turkey pepperoni for a while, but got tired of it, and never want to see another turkey pepperoni again in my life.
One day last week I got a piece of pork chop stuck in my pouch, and spent two hours trying to get it to come back up. It eventually did - THANK GOD - and I've been extremely careful to chewchewchew every single bite, since then.
Water's going fine, exercise is going fine (though I slacked off a bit - a LOT, really - last week), and starting next week I'm going to do a FIRM exercise tape (with weight-lifting) two days a week and walk the other three.
April 16, 2006 ~ Another weigh-in day has come! I weighed in at 259 pounds this week (Thursday), which makes for a total of 54.5 pounds since my preop appointment. I actually had to go out and buy new bras earlier this week, since the ones I had were getting ridiculously (and uncomfortably) big on me. I've gone down three band sizes - this is the smallest band size I've worn as an adult, and it's only going to get smaller!
Unfortunately, my cup size didn't get any smaller, but I'm sure that'll change in the months to come.
All's going well - I ate a little too junky on Friday and paid for it with extremely painful gas and having to run to the bathroom a LOT through the evening. Hopefully I've learned my lesson on that! :)
May 11, 2006 ~ Apparently I forgot to update the last time I weighed in. I weighed in this morning and have lost 11.5 pounds in the past two weeks, which brings me to a total of 74 pounds lost since my preop appointment! I have 80-something pounds to go to reach my goal weight of 150.
I've "discovered" Tropical Punch Kool-Aid (sugar-free, of course), and have been drinking it like crazy. It's SO good; earlier this week I drank an entire 2 quarts in about 24 hours. I don't want to think about what that dark red dye is doing to my insides, though!
So far, I'm feeling good. I've vomited an average of once a week in the past few weeks - I absolutely cannot eat any kind of chicken at this point - but other than that, everything's okay. I'm walking a little more than 4 miles a day 4 - 5 mornings a week, and on the weekends I usually go kayaking with my husband at least once for a couple of hours.
I finally took pictures to show my progress, and I'll post them at the bottom of the page. I'm taking the next set at my six-month point at the end of July. I really hope I make it to 100 pounds lost since then. I might be hoping for too much, but I'm going to hope for it anyways! :)
July 30, 2006 ~ Wow, I haven't updated this page in ages, have I? Today marks 6 months since my surgery, and I have lost a total of 123 pounds since my preop appointment.
I'm THRILLED with that number. I'm feeling good, although I just found out last week that I have hepatitis (my husband and I went to Florida last month, and I had some raw oysters) and I've been quite tired in the last few days.
I just wish I'd stop losing so much hair. I don't want to end up bald!
January 29, 2006 (313 lbs) ~~~~~ July 30, 2006 (190.5 lbs)