Colleenj2

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I had surgery November 18th.  Everything went well surgery wise, but I do NOT tolerate narcotic pain meds at all.  I had a rough first day and a half until they finally took me off the pain meds at my request.  For the rest of my hospital stay I just took Tylenol (liquid).  So far so good.  I do miss being able to actually eat, though.  I am still on pureed foods, which are quite boring, for another week before I can move on to soft.  I will be back on regular food December 30th and I can hardly wait to actually be able to chew something.  I have lost a total of 25 pounds so far at just 3 weeks postop.  Getting my energy back...I was really wiped out for the first 2 weeks. 

I have been waiting and waiting, so finally I called to see what was up.  Good thing, cuz they scheduled me on the spot.  My re-birthday is scheduled for November 18.  I am excited and just sort of dumbstruck.  Its weird.  I thought I would be really over the top, but I am not.  I am happy to finally have a date, but I have no real emotion about it yet.  Maybe it is shock, or maybe it is because it doesn't feel real yet.  I have had to wait for so long (4 years now) that I don't think I am as excited any more, weird.

They have the letter.  It is signed.  Just need my psych evaluation, which is next Wednesday, and I should be good to go. 

Ok, so she revised the letter, but it was still wrong so Stacey sent her the "sample" letter so she could get the wording just right.  I followup with the PCPs office today and they tell me they don't see the letter and she is not in and don't know if she got the request to revise it again.  So they take a message.  An hour later, Stacey from Barix emails me to say PCPs office faxed the new revised letter to her, but her signature was not on it...so I am still waiting for my letter.

Lo and Behold, my PCP revised my letter to include the words six consecutive months.  Now I am waiting to hear back from Stacey that this letter is acceptable.  She didnt say it was within the last 4 years, so I don't know if she will need to also make this change.  However, the letter says I have been her patient for over 12 months, so maybe it will be okay.  Waiting to hear.  Meanwhile, I have scheduled my psych evaluation for 7/30.  Trying to get everything done so that I can hopefully get a date for September.  I hear Dr. Schram is booking about 6-8 weeks out, so we will see. 

Ok, so Stacey at Barix said I needed a letter from my PCP stating I had completed 6 months of medically supervised diet.  I asked bcbs if my diabetic diet would suffice and they said yes, as long as doctor said it was consecutive.  Ok, so I seen my pcp last week and she wrote a letter...first road block encountered...she did not say I had 6 months consecutive supervised diet.  She said I had been her patient for over 12 months and she medically supervised me for diet and weight management during that time.  You would think that would suffice, but nope.  Stacey said letter must say CONSECUTIVE.  So, Stacey called my pcp and asked her to revise the letter to include the word consecutive.  I called pcp today and MA said she has the info and when letter is ready they would call me.  Now, this is where it gets gray....I was diagnosed and put on diabetic diet and meds back in November.  I had another followup appt in December, but did not have another followup appt until last week.  Technically, I have been on the diet for 8 months, and technically medically supervised, I just did not see my pcp every month during that time frame. I mean really, who does this?  I don't know of any doctor that makes you come back monthly once they put you on this diet.  So, I am not sure whether doctor will add consecutive to the letter or not.  Seems kind of trivial to me, though I know this is serious business.  Now I am patiently waiting to see if she will revise the letter so I can move forward rather than have to go back 5 more times over the next 5 months so she can say "consecutive" with a clear conscience. 

Ok, here I go again.  It has been 2 years since I was initially approved by HAP and then lost my insurance before I could get my case rolling due to job outsourcing.  I now have a new job with BCBS Comm Blue as my insurance.  I had an initial consultation at Barix in Ypsilanti, MI yesterday.  Unfortunately, I had some concerns about the surgeon I met and I have opted for a repeat consult with another surgeon at Barix who did my cousin's surgery. I really wanted a surgeon with a lot of lap RNY experience.  So, here I sit waiting to here back from Barix on what all I need to meet my insurance company's requirements.  Yesterday, I was told I would definitely need a psych eval and 6 months medically supervised weight loss, and also an EKG.  They said my PCP would write the letter for the supervised weight loss and could do my EKG, but I am not sure why I need 2 EKGs?  They want me to have my doctor do one, but yet they also do one during PATs, so not sure why the need for 2, unless it is just for comparison.  So anyway, that is about where I am at.  Hopefully everything will go through this time and I won't have any more insurance denials. 

September 2005: Im a 41-year-old, single mother of two girls, ages 17 and 2-1/2. Like most of you, I have struggled with my weight for a very long time, basically since puberty. What is it about puberty that seems to be a trigger point for so many that end up as "fat" adults?

Anyway, I didn't get to be obese or morbidly obese until after I had my first child when I was 23. I gained a lot of weight quickly postpartum(I went from 210 prenatally, 233 at delivery, 178 at 6 weeks postpartum, up to 265 at 6 months postpartum--almost 100 pounds in less than 6 months). I went to a half dozen different doctors trying to find out why I gained so much and so quickly and they all basically said the same thing...quit eating. Thing is, I really didn't eat anymore or any differently then anyone else in the house and my eating really didn't seem to be the source of the problem. However, I spent the next dozen+ years trying to get it off with various diets, potions, pills, equipment and never lost more than 36 pounds. I kept it off for no more than a year and it slowly started to creep back on again. Somewhere during that time, I think I did develop an eating disorder....I ate out of frustration. Next thing I know, I became an emotional eater.

By the time I got pregnant with my second child in 2003 at the age of 38, I was 272 pounds. I did, however, find out that I had PCOS in the year before I finally got pregnant with my second child. Pregnancy #2 carried the hefty price tag of gestational diabetes for a second time around, plus the added bonus of mild hypertension that kicked in at 38.5 weeks. I was delieved by c-section after a failed induction at 39.4 weeks. By 12 weeks postpartum, my blood pressure had decided it was never going to be normal again and I was started on antihypertensives.

So, here I am now...41 years old, the mother of a very energetic, almost 3-year-old, and I can't keep up. If it weren't for my 17-year-old, Id be dead already Im sure. When my youngest turned one, I started researching WLS options. I found out my insurance did not cover WLS (and I work for a healthcare institution to boot). I had two options basically...1) Stay fat and keep trying to lose the weight or 2) Change my insurance option through work at open enrollment. I just about had my mind made up last year (2004), but I still had 3 months to open enrollment to change my mind and change my mind I did. I chickened out. I got a horrible email from someone telling me how selfish I was being and how horrible a death her sister died as a result of WLS complications. That was all I needed to hear. I put it off. I wasn't ready. One year later, I started considering it again. I know five people personally from work and community that have had the surgery. So I started interviewing everyone and researching every aspect of the surgery and complications and decided that Im ready to make the change. This time I followed through with changing my insurance (effective Jan 1, 2006) and I hope to start the approval process shortly after the new year. I don't know how long it will take. It seems some people get through the process quicker than others and I think a lot lies with how supportive and committed your PCP is to helping you get the approval, but Im hoping that with a little luck and a few dozen prayers that I will be able to be on the losing side by this time next year.

If you read this and you are a praying person, please pray for my approval and my safe journey to the losing side. Im ready, but every now and then I still get nervous. I guess I wouldn't be normal if I didn't get nervous about such a life changing event.

 

November 8, 2005: I called Henry Ford Internal Medicine and made my appointment with my new PCP (eff Jan 1) for Jan 9. This is the day I will hopefully begin my journey. I have chosen Dr. Vlahakis as my PCP and Ive heard all good things about her and apparently she is also one of the medical clearance doctors for the Bariatric Program, so Im hoping to get well on my way once I see her. Im so excited. I had my first case of major butterflies today.

 

November 26, 2005: Ive been working hard at giving up my Diet Coke habit, which I thought would be more difficult than it is prooving to be, but Im down to maybe one 12 oz can a day and up to 64 oz of water. I weighed myself today and the scale says Ive lost 6 pounds. However, I never truly believe it because I can be down 6 pounds today, and up 6 pounds tomorrow. I have some real water retention issues I think, though I really don't have swelling in my hands and feet very often. But then again, maybe giving up the Diet Coke has helped. They say drinking a lot of Diet Soda increases your appetite. Now if I could just kick the sugar habit, I might see some real progress.

I have a real issue with carb/sugar sensitivity, its called Impaired Glucose Tolerance. This means that my fasting blood sugar is generally quite normal, but when my system is challenged with sugar, my blood sugar rises to a level that is no longer normal, but is not yet diabetic. Im one of those fat people not because I eat too much at my meals or hoard food, Im fat because I eat sugar and carbs far too often for my metabolism. This causes a rise in my insulin levels (hyperinsulinemia) because my cells have become resistent to the effects of insulin over time, and this elevated insulin level in turn causes my body to store excess fat. Truly, I don't think I would be overweight if I could just give up the sugar and carbs completely, but as of yet, I haven't been able to do so. Or maybe this is some form of denial? But truly, I never eat seconds and I never pile food onto my dinner plate. Aside from my sugar habit, I eat pretty much the same as most normal-sized people. I fear the sugar habit is going to be my biggest obstacle both pre and postop. I LOVE chocolate. I have a bag of Hershy's Kisses on my kitchen bench, and while they won't disappear overnight, I can't just eat one or two. I'll eat two, then a few hours later I have to have another two, and over the course of the day I could quite easily eat half the bag. Now, I don't do this every day, but even the 2 or 3 days the candy is in the house is enough to keep me where Im at. Its not like Im constantly gaining weight either. It happens in spurts. The first spurt was 17 years ago when my oldest daughter was born. I went from being about 25 pounds overweight to morbidly obese in six months time. No one could tell me why. I had some yo-yo dieting subsequent, but I could just never shake the weight I had gained after having my first child. But I did stay within 10 pounds + or - until I got pregnant again with baby #2 14 years later. Same scenario. Lost quite a bit postpartum, gained it all back within 6 months and have just hovered there 10 pounds + or - for the last 3 years. I hope this surgery gives me the tool I need to correct my sugar/carb habit. Im praying that I will be the sort that dumps if I even smell the stuff. Im an all or nothing sort of girl. If I can even tolerate a hint of the stuff, it will make my struggle all the more difficult. I quit smoking once. Just once. Once was all it took. I quit cold turkey. It was the only way I could quit. That was 18 years ago at a 1-1/2 pack per day habit. I think the sugar/carb addiction is going to have to play out the same way, but I don't see myself being able to go completely cold turkey until I know there is no turning back. However, I have started making a conscious effort to avoid the chocolate. Ive also started making a conscious effort to recognize the "head hunger" angle (which I really think plays into the sugar/carb addiction) and drinking water or eating some protein (slice of cheese, ounce of peanuts) whenever I have that overwhelming urge to indulge. It doesn't win out every time yet, but I feel that I have made progress and I really think surgery will be the turning point for the long haul.

 

December 3, 2005: I started using Fitday.com today. I figured it couldn't hurt to have a hard copy food diary for when I see the PCP next month. I also wrote a letter to my current PCP yesterday requesting my medical records and specifically asked them to be sure to include weight, b/p, diet recommendations, as well as all lab and radiology reports. Im also thinking I will request the records from my ob-gyn because I was on a "supervised" diet during my pregnancy. I was on an 1800 cal ADA diet from August 2002 through October 2003 (two pregnancies, one miscarriage) and Im hoping that will count for something. Plus, they have a record of my weight gain and loss pre and postpartum as well as my blood sugars. I figure every little bit may help with the insurance company to get approval.

 

December 29, 2005: My appointment to discuss having WLS is less than two weeks away. Last Thursday, I got my confirmation of benefits statement from work (post open enrollment when I switched my insurance so I could get WLS covered), and some how they signed me up under the wrong insurance. I get on the phone and get tossed into someone's voice mail, so I left a message. After an hour, I called back. They were all gone for the day (it was 3:30 at this point) and are out of the office until Jan 2. My appointment is Jan 9. I left a message on the emergency line. I did get a call back on Tuesday (12/27) and was told the woman that updates the system would be in on Thursday (12/29) to handle this problem and get it corrected in the system. But, now I may not have my insurance card before my appointment and I cannot select my new PCP without my insurance card (Im sure there has to be some way around this glitch and hopefully I won't have to cancel my appointment). So, I guess this is the first of hopefully not too many roadblocks that I will encounter on my journey. It is very frustrating. Oh, and I found out I have shrunk an inch in height since the last time I was measured (10 years ago) I am now 66.75 inches when I used to be 67.75 inches. But whatever, keeps my BMI in the surgery range, since I seem to be losing weight all of a sudden. I have dropped another pound, even with the holidays and all the food. Go figure...cuz if I wanted to lose the weight on my own or if I were actually trying, I wouldn't budge an ounce on the scale. I have now lost a total of 7 pounds in the last month and I still attribute this to drinking more water and less soda.

 

JANUARY 2006

Im doing my journaling a little different now. Im going to keep everything to monthly headings.

January 3: I spoke with the intake specialist today. I was waiting for my HAP ID to show up so that I could call back with this information. She said all I need now is to see my PCP on Monday, January 9, and get my referral and the nurse coordinator from the Bariatric Surgery Center will be calling me to schedule my nurse/nutrition consultation. Im getting excited and a bit nervous. But Ive been working really hard at the mental aspect of surgery. Dealing with my food triggers, giving up diet soda, and am beginning to limit my sugar intake as well. Ive lost a total of 9 pounds since the end of November. Who knew all I had to do was quit drinking so much diet soda???? Of course, there is a man lingering around too, so Ive been a little more preoccupied with lustful thoughts and that always seems to make me drop a few pounds. LMAO We'll see if it develops into anything. He knows about my desire for surgery and is very supportive. He's really like no other man Ive ever met, so who knows....I'll be back with an update after my PCP appointment next Monday.

January 7, 2006: Ok, so the information I got was a little out of sequence. What I am waiting for is a letter from the BSC (bariatric surgery center) that basically outlines what it is my doctor and I need to do. I take this letter to my doctor, who will then request a referral from HAP. A HAP nurse will then contact me with an authorization number. Once I have that, I can schedule my nurse/nutrition appointment. I do think, however, that before my doctor can request the referral that I may have to have some other testing done (i.e., psych eval, sleep study). I'll know more on Monday, I hope. Be back with another update on Monday.

January 9, 2006: Saw my new PCP today. She was very thorough. She didn't think it sounded like I had sleep apnea, so Im not sure if I will have to have a sleep study or not...She also said I was a good candidate and was glad I kept a log of all my diet history for the last 20 years. She said she thought I had a good chance of getting approved, but she did say that since I have not been in WW or WOW or Jenny Craig that HAP may deny me on the first attempt, even though Ive been on some sort of diet and seeing my PCP for the last 3 years. She said she would write a very good letter and hopes that we won't have to appeal, but she did say if they deny based on the 12 month supervised diet, she wants me to enroll in WW or WOW and she will write an appeal letter. I will also write my own appeal letter. I mean c'mon, how many times do I have to waste money on diets that just don't produce long-term results. Its ridiculous and Ive been on a "diet" of some kind or another pretty much every year since I was 15 and Im now 41. Anyway, she said she should have her letter written requesting authorization by the end of the week and I should have an answer from HAP 1-2 weeks after that. So, basically, she said I should know something in about 2-3 weeks. If you are a praying person, please pray that I get approved and we don't have to fight the insurance company. I told my PCP I will do what I have to do, jump through all the required hoops, but ultimately at this point in time, I just want an approval. I don't want to put off surgery another 6-12 months and I have certain personal reasons for this that I don't want to get into other than to say Im not getting any younger and I don't want to close certain doors just yet and delaying surgery another year could ultimately close that door. So please pray for my approval. Oh, she also told me she thinks I would do very well because Ive got the right attitude and Ive done my homework. I'll update when I hear from HAP.

January 21, 2006: I was DENIED! I guess I knew I would be. Now I have to start the appeal process. Im not sure as of yet the basis for my denial, but I suspect it will be the 12 month supervised diet requirement, despite the fact that Ive been on a 1500 cal ADA for the last 2.5 years (likely PCP never charted this info). Damn insurance companies.

 

February 5, 2006: Im a new auntie again today. My step brother and his wife had their second baby girl today, a whopping 8 pounds 14 ounces. Geez, I had GDM when I was pregnant and my second was only 8lbs 12oz. How that skinny little girl had that big of a baby is beyond me.

Anyway, Ive decided to appeal on my own behalf. Ive requested my records all the way back for the last ten years and once I have all of them, I will submit my appeal letter to the insurance company. In the meantime, I just have to hurry up and wait. I hate this part.

In other news, my mortgage endeavor is looking up. Ive got two different mortgage specialists looking at my stuff and whichever one presents the better pre-qual/pre-approved offer will be the winner. Otherwise, there is not much going on with me right now. My love life fizzled back out and maybe its just as well for right now. Im not sure I am where I need to be to attract the right sort of man. I'll update again when my records arrive and I send in my appeal letter. Im just looking for a new PCP in the meantime. Need someone more supportive.

February 28,2006: Nothing much to report. Still waiting for one final set of records. I had given every place a 30 day window and my most recent PCP is the one who has yet to respond to my request. I need her records and I hope she has something worthwhile written in them.

Unfortunately, after attending an info session at the hospital I work for (where they are now offering this surgery, but still not covering it under our employee health plan) I was told that at this point I have no choice but do the 12 month program that HAP requires. So, I have two choices. I can either join the WOW program at HFH, or I can see my PCP no less than every three months. My PCP would have to be responsible for covering all topics related to the requirements. Meaning we would have to discuss diet efforts, behavior modification, and exercise endeavors. Oh joy!

On the other hand, I did find out at the info session that my employer is considering adding the WLS benefit to our employee health plan offered, but even if they do approve it, it will not be effective until Jan 2007 and they will likely have some pretty stringent guidelines, not unlike what HAP is requiring. So, now my dilema is do I stay in the HFH network and start working on the 12 month documentation requirement and continue my appeal process and see what happens, or do I switch back to my employers network under HAP, start the 12 month documentation requirement, continue my appeal and wait and see if they add the benefit to our employee group plan and switch my insurance option back at open enrollment in the Fall.

The first option would mean that if I appeal and get approved I would have surgery at HFH, but if Im denied I will have to appeal again and ultimately to the state. With the second option, if they add the benefit to our employee plan, I could switch back at open enrollment if HAP and/or the state has ultimately denied me, but that would mean having to change hospitals and surgeons, which is really not my first choice, but if Im denied at the state level, it won't really matter because it will be a done deal on the HAP/HFH front.

But what really irks me, is that if I had known about this info session before my PCP requested a referral for bariatric surgery, the doctor at my employing facility and his coordinator could likely have gotten me approved for surgery, but now their hands are tied because Ive already been denied on my initial request. Really pisses me off.


On the upside, I got my mortgage preapproval, and I found a house, made an offer and it was accepted. Timing works out well for my current lease and I will be an official home owner June 1. I'll be back with further updates as time permits and developments occur.

 

MARCH

March 17, 2006 : Im still waiting on a final set of medical records from my former PCP. I requested them January 27 and asked them to send them within 30 days because I needed them to appeal an insurance decision. Here it is almost 2 months later and I still don't have them. I sent a second request March 7. Im starting to think she just doesn't want to comply since I left her practice. I know they are my records and she can't keep me from having them, but at the same time, she sure can drag her ass on getting them to me. I just don't have enough supporting documentation, I don't feel to send my appeal without her records. I had been seeing her regularly for the last 3 years and we discussed my weight, diet and exercise shit at damn near every visit. Of course, she may not have recorded it as so many other doctors have not, but I still need whatever she did document or it will look like I have not done what I say I have done. Its just so frustrating. Of course, even if I get approved, Im not sure where Im going to get the $1000 copay, I may have to try to get a loan for that. Lord knows with buying the house, Im not going to have any money left. In fact, with expenses so far (app fees, inspections, earnest money), my bank account is falling fast and I still will owe 1900 at closing. Arrggghhhhhhh. To make matters worse, the stress is eating at me, or Im eating because of it. I have gained back 4 pounds, I feel horribly bloated and just down right sick of myself. But I digress.....I'll update again when I get those darn records.

March 24, 2006 Still no records. I will have to call and find out what the hold up is. Everything with the house is moving along for our June 1 closing. Today, I have to go see my PCP. I have had a pain in my side for 4 days. I can't yawn, cough, take a deep breath, laugh, or move a certain way that it doesn't give me a horrible stabbing/tearing stitch like pain just below my rib cage on the right. It has me worried. I always assume the worst. Of course I did a symptoms search and it comes up with things like liver disease, abdominal aortic aneurysm, gallbladder disease, and atypical appendicitis. Im sure its none of those things. My friend thinks its a cracked rib because if I hold that spot when I yawn, cough, breath etc..it doesn't hurt. But I don't know how I would have cracked a rib, so I tend to think its something else. I thought maybe gas, but gas doesn't usually last this long in one spot, but I suppose its still possible. No urinary symptoms, so I doubt its kidney related, but who knows. On the upside, Im back down a few pounds. I gained all but 2 of the pounds I had lost between thanksgiving and new year, I still need to lose 2-4 to get back to where I was.

 

APRIL

April 3, 2006: I sent my appeal package in today. I say package because it looks like a presentation. In addition to my appeal letter, which is 4 pages long, I sent photos of myself and my skin condition resulting from my hyperinsulinemic state. I also included a graph of my weight fluctuations for the last 20 years and a BMI graph, plus my medical records for the last 5 years. I sure hope this does the trick. I sent my package certified mail to be sure it gets to where its going. It cost me $6.60, but if I get approved, that will be a small price to pay.

April 21, 2006 I thought I would post my appeal letter. I don't know if it worked yet, but I'll let you know in the next day or two as that is when Im expecting an answer.

Dear Sir or Madam,
I would like to ask that your previous denial on January 19, 2006 of my preauthorization request for bariatric surgery (Diagnosis Code 278.01 Procedure Code 43846 and/or 43644) be reconsidered. I am including a photo of myself to remind you that I am a real person and not just another case file. Please give careful consideration to the following information as you decide the appeal for my case.
First I would like to introduce myself to you so that you will have a sense of who I am and why this surgery is so important to me. My name is Colleen and I am a 41-year-old, single mother of two, morbidly obese female at 5�7� tall and weighing 282 pounds, giving me a body mass index of approximately 44.1. (See BMI attachment). I have been struggling with obesity from the age of 10 with the onset of puberty. Many of my family members also struggle with morbid obesity and the complications arising from this disease. This letter will touch on that and many other issues that I feel should be sufficient to overturn your previous denial.

After multiple failed attempts with dieting and exercise over the last 25 years, I began exploring my options. I have spent the previous two years considering and researching bariatric surgery, specifically Roux-en-y, as a possible solution to my ongoing weight struggle. I did not come to this decision lightly, but only through education and understanding of the risks and benefits regarding weight loss surgery. My extreme morbid obesity is causing significant adverse health conditions and has a negative affect on my activities of daily living. The demands on my life combined with my morbidly obese state are taking a toll on my physical and mental well being, and I can no longer function effectively living in this body. Weight loss surgery would provide the tool I desperately need to regain control over my health.

As for my medical conditions, I would like to start with my most significant problem. I have hypertension, low HDL cholesterol with high LDL cholesterol and elevated triglycerides, as well as hyperinsulinemia, better known as Metabolic Syndrome. Having this syndrome puts me at a much greater risk for heart attack and/or stroke. My family history of heart disease and stroke further add to my risk level. My high blood pressure was diagnosed in 2003 when I was only 38-years-old. My hypertension is controlled with medication only minimally, with my blood pressure running approximately 130-150/80. I am currently taking enalapril 5 mg once a day for treatment. I have taken Glucophage 500 mg three times a day in the past for my hyperinsulinemia, but had to discontinue it due to gastrointestinal side effects. My most recent Hgb A1c was reported at 6.3, up from approximately 5.2 in 2003, which indicates that my blood sugar levels have been increasing over the last 3 years.

I also suffer with joint pain on a daily basis, including cervical spine, shoulders, lower lumbar spine and hip joints, as well as degenerative joint disease of the spine as diagnosed by my former chiropractor in 1993-94. I also have a heel spur on my right foot as evidenced by an x-ray in the last 5 years and I have frequent flare ups of pain associated with this spur. I take over-the-counter ibuprofen to help lessen the pain. This pain contributes to a decrease in my mobility and ability to exercise due to the added weight. The pain also makes my work as a medical transcriptionist, which requires me to sit for 8 hours a day at a computer, more difficult and contributes to frequent muscle strain, pain and headaches. Significant weight loss would greatly relieve the stress on my joints, spine and feet allowing me to become more active. I look forward to the day when I can actually get outside and play with my toddler, Rachel, and enjoy trips to the park with her. Currently, I am not able to run and play with her because of the pain in my joints and back that I suffer from daily. Due to my morbid obesity, I become short of breath and have difficulty keeping up with Rachel. I am too large to play on the playground equipment with her. I�ve never been able to take my daughter down the slide, or swing on the swing set with her. Not only is this emotionally distressing to me, it also infringes upon my daughter�s right to a happy, healthy childhood. I would like to become a healthier mom while there is still time for me to enjoy her youthfulness as I missed out on these same activities with my older daughter, Nicole, due to my weight restrictions. I want very much for my children to be proud of their mother and not feel embarrassed by my size.

I suffer with episodes of stress incontinence, which can cause an embarrassing odor. I need to wear panty liners and wash frequently. Also, because my panniculus is so large, I have a tendency to develop an odor in this area due to profuse sweating, I also get frequent yeast infections under my breasts, which has left a permanent skin discoloration scar beneath my breasts. Additionally, whenever I shave underneath my arms, I develop recurring folliculitis, an infection affecting the hair follicle in the form of a cyst-like sac that enlarges until it eventually starts to drain. This is very painful.

I also suffer from reflux and difficulty sleeping. Often at night I am woken from a sound sleep with heartburn. In addition, carpal tunnel syndrome symptoms also cause me to wake often in the night and reposition myself to alleviate numbness, pain and tingling in my arms, hands, and fingers. I wake to change positions no less than once an hour all night long. Between reflux, joint pain, and carpal tunnel symptoms, I rarely get a �good nights� sleep and find that I am often very tired during the course of the day making it difficult to concentrate while working and I feel this is compromising my ability to perform the duties of my job.

I have suffered with worsening acanthosis nigricans skin disorder since puberty and I was sent to a dermatologist at the age of 15. I subsequently underwent testing to rule out Cushing�s Syndrome, but have since been told the skin disorder is directly related to my hyperinsulinemic state. This skin disorder has been and continues to be very embarrassing as people always assume I do not bathe on a regular basis and that I am �dirty� when in fact my elevated insulin levels are the contributing cause. I have these very large patches of dark skin on my elbows, inner elbow creases, around my neck, between my breasts, inside of my thighs and upper arms, underarms, down the crease in my back, on my knees and ankles, wrist and finger joints. I have suffered great humiliations as a result of having this skin disorder and it dictates the types of clothing I will wear, even in the hot summer months, in an effort to hide the embarrassing skin discolorations. (See pictures included)

Furthermore, my obesity and Metabolic Syndrome has affected my menstrual cycles and ovulation, which ultimately led me to seek treatment with a fertility specialist when I was unable to conceive a second child after trying for many years. The fertility specialist diagnosed me with polycystic ovarian syndrome (PCOS), which is a direct result of insulin resistance, which ties back into having Metabolic Syndrome. My PCOS is also clearly recognized and reported in my cesarean section report found in my medical records file. (See enclosed records) I now suffer with heavy menstrual cycles, a common complaint in women with PCOS, which prevent me from leaving my house for at least two days during my menstrual cycle because my flow is so heavy and I often need to use the restroom at least once an hour, and I require both a super plus tampon and an overnight pad during these two days.

Additionally, during my pregnancies, I developed gestational diabetes and had to follow a strict 1800 cal ADA diet for the duration. Most recently, I was on this diet for the better part of two years due to back-to-back pregnancies, or roughly a total of 17 months when I came off the diet after miscarrying my third pregnancy. Immediately postpartum of my two term pregnancies, I lost a significant amount of weight only to gain it all back plus within 3-8 months of delivery, likely the effects of elevated insulin levels postpartum from having Metabolic Syndrome and PCOS. After my last pregnancy, which resulted in miscarriage, I was given a 1500 calorie ADA diet from my primary care physician at my request because I was struggling to lose weight following my pregnancies in 2002 and 2003, and I have been following this diet since 2004. I feel that the combined gestational diabetic diet and subsequent 1500 calorie ADA diet together more than fulfill the 12-month medically supervised weight loss attempt, as they were prescribed by the treating physician(s) and I was seen on a regular basis by my physician(s) over the last 4 years. The nurse dietician working with my maternal/fetal medicine physician also counseled me during my pregnancies on at least three separate occasions. Therefore, asking me to do another 12 months in a supervised program would not be of any benefit to me at this point. It is the equivalent of asking me to put my life and my children�s lives on hold for another 12 months and this is unacceptable. A lot of things can change in 12 months. I could walk outside tomorrow, next week, or six months from now and have a heart attack, stroke, or become so short of breath that I could collapse and die all because I had to �wait� for a surgery that is life saving. If that happened, I would have died in vain and my children would never have the opportunity to have a quality life with their mother. Please remember that I am a real person and I deserve to have a healthy productive life to share with my family and society.

Socially, I am frequently embarrassed by my size. If I go out for dinner with family or friends, I am too large to fit in most restaurant style booth table settings comfortably. The stares and remarks from normal-sized people are quite disturbing to me. I rarely go to the movies anymore and when I do go, I only go to newer theaters where they have moveable arm rests and I do not sit next to anyone because both the person next to me and myself will have no room to sit comfortably. Even something as simple as getting a haircut is embarrassing because the stylist cannot fasten the cape around my neck. This is very humiliating and embarrassing and causes a great deal of emotional pain because I do not feel normal and I do not look normal. I no longer date because I do not feel comfortable in my own body. What man wants a woman that weighs nearly 300 pounds and cannot go out and enjoy life? My weight significantly impacts my social life and I cannot enjoy my life. This is not living. This is just surviving. It is like being a prisoner inside your own body.

Finally, I have a strong family history of breast cancer with two premenopausal aunts, one who died from breast cancer at the age of 45 and she herself also suffered with extreme morbid obesity, a premenopausal cousin diagnosed at age 36, and a postmenopausal grandmother. My paternal grandmother passed away from bone cancer. She was also obese and also had a previous history of transient ischemic attacks and severe degenerative disease of the spine. Of her eight children, four of them are obese to morbidly obese. My grandfather was obese as well. He suffered with coronary artery disease, myocardial infarction and died after a bypass procedure in 1994. He also had type 2 diabetes and suffered with vascular disease. My uncle has recently undergone stenting in his abdominal aorta for aneurysm and he also has peripheral vascular disease. I have two other uncles who have had a heart attack, one of whom is also morbidly obese and suffers from type 2 diabetes. I have a paternal aunt with severe rheumatoid arthritis. She has been on multiple medications, including injections, and has had to use braces on her hands and wrists. I also had a first cousin who died from complications related to diabetes. My maternal grandmother also has type 2 diabetes, angina, hypertension, and hypercholesterolemia, as well as the postmenopausal breast cancer mentioned above. I had a maternal uncle who died from lung cancer, and an uncle that died from a massive stroke who was also obese. My mother suffers with chronic obesity and also has hypertension and elevated triglycerides. She also has arthritis in her neck, back, hips, knees, ankles and feet, and had her thyroid removed for precancerous type cells in 1999. My brother suffers from chronic asthma and osteoarthritis in his knees. My maternal grandfather has cancer of his lower leg, which is requiring amputation. I don�t want to become another statistic within my own family tree, but clearly my health is headed down the same path as my other family members. Bariatric surgery would greatly improve my overall health and lower my risks for many of the disorders that run in my family.

I have made many, many attempts to lose weight and this has gone on all my life. I would lose some weight then gain it all back, and more. I have tried for the last 20+ years to lose weight with various methods and minimal success, including Optifast, Weight Watchers, Atkins Diet, ADA diets from doctors, over-the-counter diet aids, gym memberships and many more too numerous to list with no lasting success. (See attached chart). I have also tried many exercise routines, including weight training, skier, walking, bicycling, and various aerobic formats. I have spent all my adult life trying to lose weight. I am now at the point where physically everything is an effort. The obese individual has functional impairment in the activities of daily living. This dysfunction impacts sleep, recreation and work, as well as personal and social interactions. I truly feel requiring me to join another weight loss program is wasted effort. It is a medically proven statistic that diets are only effective in 5% of cases and do not have long-lasting results. Weight loss is not substantial in 90-95% of patients with clinically severe obesity using medication, diet and exercise, and behavior modification. Weight is usually regained in five years. As I stated earlier in my letter, I did not just �decide� to have surgery, but at this point in time, I need more than a diet, I need the tool that bariatric surgery provides to have any hope of losing and keeping my weight off for the rest of my life.

As you can see, I have exhausted the traditional ways to lose weight. The gastric bypass is an approved and proven means to permanently lose weight. Bariatric surgery has also been shown to alleviate and/or reverse all of the problems I am currently living with. This surgery is a covered benefit under my insurance contract and I respectfully request that you approve this surgery. I am very committed to the lifestyle changes involved with having this surgery. I have already begun taking steps to make the transition from my current lifestyle to that of a bariatric patient easier by eliminating carbonated beverages, caffeine, and switching to sugar-free products, in addition to the dietary changes I have made over the last several years, which include lowering fat intake, using only whole grains, eliminating pasta and rice, and drinking 64 ounces of water daily. These changes are behavior modifications and these changes have resulted in very minimal weight loss. I am very committed to having this surgery, as I believe this surgery will give me a second chance to live a full healthy life.

I am asking you to put yourself into my shoes for one moment and imagine what it is like to live with the restrictions of obesity, to be limited physically, emotionally, socially, and in all other aspects of normal living that so many people take for granted. I meet all of the requirements for Roux-en-y gastric bypass surgery. Please reconsider and approve my request for bariatric surgery referral.
Sincerely,
Colleen Jackson

 

April 29, 2006 This is a copy of my final appeal letter to HAP. Their denial letter stated that I send a detailed letter requesting a grievance hearing should I disagree with their decision, so here it is. I chose to do it in outline form to make it more readable and so that they could really see just how significant my personal and family history are.


I have removed my letter temporarily. I may need to use it again in the future and I don't want 100 copies of my letter being used before I can benefit from it.

My second appeal letter did ultimately get approval pending a psych evaluation, so I know Im on the right track and if anyone needs any help with their letters, please just email me and I will help you to the best of my ability. I will repost my 2nd appeal letter once I have reaped the benefits of it for myself.

 

May 1, 2006 Today I found out my job is being outsourced. As such, my insurance is expiring on May 31. I got my notice for my in person appeal hearing for May 17. I won't be going because I cannot complete my journey in 14 days. I will have to start over with the new insurance company through my new employer. I can't catch a break. Im going from one HMO to another. From HAP to BCN. Both require the 12 months medically supervised diet and my doctor did not document shit, so I guess I need to start working on the 12 months so that I can eventually get approved. Don't know what else to do at this point. I guess I never imagined that my doctor didn't keep notes on our discussions, nor did I realize how important that information would be to me now. I feel like Im really getting cheated on this, but Im not about to give up. Prepare for assault BCN. Now, I just need to find a PCP that will refer me to Dr. Weber because I think I want to switch to him for my surgery.

May 14, 2006 As luck would have it, I got another letter from HAP stating I have been approved pending psych evaluation and therefore they have cancelled my in person appeal hearing scheduled for later this week. Unfortunately for me, this comes a little too late. My insurance runs out in 2 weeks and I will have to start over with the new insurance company. But, I am hopeful that this surgery is still meant to be, its just requiring a few detours to get there. sigh.

 

July 2, 2006: I haven't updated in a while, mainly because I have nothing to update. My insurance with the new company was supposed to be effective June 1, but I still have no cards. They assure me I will get them, but so far nothing. As for the job itself, Im not too sure I will be staying with this company for long, so I may just put the idea of surgery on hold until I figure out what Im doing job wise. I would hate to start the process of approval over fighting every step of the way only to have a sudden shift in employment and benefits again. As it stands right now, I just do not plan on sticking it out with this new company.

 

September 13, 2006 I haven't updated in a while. So much has been going on. The company that we were outsourced to did not work out for me and I chose to quit and move on to another company and good thing too, because the new company has BC/BS PPO...no more HMOs. What a relief. I have scheduled my initial consult appointment at Barix for November 3, 2006. My insurance is supposed to kick in the first of the month after my hire date, which technically should be Oct 1, but since Im still waiting on the paperwork, it will likely be Nov 1. I don't care, Im just excited to see what happens. I may have to hold off on Surgery until February because technically Im not allowed any PTO until I have been employed 6 months and then I get one week. However, I think if I asked, they would let me take unpaid time off prior to that date. We'll see how it goes.