northman62
8/26/06 where have the time gone almost 4 months and no update. well here's the short and sweet . as of 8 16/06 i have 8.25 in my 11cc band and it feel good. have not been sick or had to PD yet(came close 1-2 times) eat good someday but still working my band. weight it starting 383 now down to 310 not bad for 5 months. Everyone is telling me how good i'm starting to look but i no i have about 110 to go for my doctor's goal my goal is under 200lbs. I'm giving myself until my 2007 b-day to get there. I gave myself until my 2006 b-day to get under 300lbs and i think i will be there next month(maybe by the end on this month. My b-day is 10/20 so i got time 13 months to lose 110 lbs . Pray for me that i can do this. My blood pressure is running low. Had my cpap machine turn down to 10 from 18cm. I got mad at my youngest son the other day and he took off running away from me and before i new it i way running after him. Also most got him but still alittle slow. I started walking 10000 steps or more each day and it really help my weightloss . ----------------------------------------------------------------------------- WEEKS POST-OP 4/14/O6 IT'S BEEN A FAST 3 WEEKS AND AS OF TODAY I'M DOWN 30LBS FROM MY STARTING WIEGHT. I WENT BACK TO WORK YESTERDAY AND FEEL GOOD TO BE BACK. I WORK AT THE HOSPITAL WHERE I HAD MY BAND PUT IN SO EVERYONE KNOW ABOUT IT BUT I DON'T CARE. MANY OF THE STAFF ASK ME HOW I GOT APPROVE FOR THE BAND SINCE NO ONE HAS BEEN APPROVE TO MORE THAN TWO YEARS AND I TELL THEM GOD FIRST AND THEN I APPEAL AND PRAYED. I GO FOR MY FIRST FILL ON MAY 6TH. I HOPE TO BE DOWN 10-15 MORE LBS BY THEN. WELL GOOD LUCK TO ALL THAT ARE LOOKING TO BE BANDED. I'LL KEEP US ALL IN MY PRAYS. 4/5/06 went for my 1st check-up and to have my staples remove(didn't hurt at all) i lose 27lbs in nine days. must be water weight and the full liqiuds but 27lbs is 27lbs and i will take it. move to puree foods today so life is getting better(very sick of soup) oat meal here i come. will have my 1st fill on may 3rd. hope everyone is doing good and i will keep all of us in my prays -- --------------------------------------------------------------3/27/06WELL I GOT HOME YESTERDAY IN A LITTLE PAIN . I HAD TO SIAY ANOTHER NIGHT BECAUSE OF MY HREAT DROPING BELOW 20 BEEP PER MIN. WELL WEEKS OF LIQUIDS AND MAYBE I CAN LIVE WITH IT. ----------------------------------------------------------------------------------------------------------------------3/23/06 well tomorrow i will be banded at the hospital were i work. It took a long time for this to happen but now i ready for it. Here's alittle about me: i'm a 43yo blackman from the kansas city area. i was born and live here most of my life. i'm married with 4 boys {18,16,14 and 10}. I belong to the best church in the world and that is the Church of Christ. i have a lovily wife and we have been married for 20 years. I'll been overwieght most of my life. but when i was in the Navy i was about 180-200lbs most of the time. i was put on the butterball exercise program because i had gain 20lbs when i was working lunch room. but after i got out i start back to my old ways and here i am now up to 360lbs. like most men i tried everything to keep the wieght out but it alway came back. i could lose 50-70pounds but get tried of dieting and go back to my old ways. but this time i will make it back to under 200lbs and if GOD is willing keep it off. so please keep me in your prays as i will be banded tomorrow. i have to be there @ 0700. i can tell you that this clear liquid is no fun but i can do it. 1/1/06 I hoping to be banded by march 1st. I still can't believe that I was approved today. I hope this letter can help you with your appeal this is the copy i use to write my appeal for the lap band. Where it said gatic bypass i change it to lap band This appeal letter was extracted from OSSG Insurance and is an excellent example of how to justify your case. This particular one was for an RNY.
Dear Sir/Madam:
My name is , I weigh 312 lbs. and I am morbidly obese, in this
letter I want to talk to you about my health not my weight. I would like to
tell you more about myself, my morbid obesity and the ROUX-EN-Y Gastric
Bypass (RNY). I am writing this letter with the hope that Humana Healthcare
will BE FIRMLY CONVINCED that there is a medical necessity IN PROVIDING ME
WITH THIS LIFE SAVING RNY SURGERY and that I HAVE very serious underlying
medical conditions that will be mitigated or eliminated by said surgery.
Patients who have bypass operations generally lose two-thirds of their
excess weight within 2 years. I hope to lose over 150 in the first 2 years.
Imagine going from nearly 3251bs pounds to 175 pounds, weight loss of this
kind is not only possible but is considered typical of this kind of surgical
procedure, that weight loss will be only a by-product of this surgery. The
primary benefits from this surgery are limitless they will cure/mitigate:
pain and fatigue, sleep apnea, hypertension, and associated cardiac risks.
It is possible that this surgery will prevent me from needing bilateral knee
replacements. Gastric bypass surgery will certainly decrease my severe back
pain, there by allowing me to become physically active again and regain my
physical mobility, the preceding changes will surely improve or cure my
depression. Finally, my Gastro Esophageal Reflux Disease will be cured or
significantly decreased as will the stress incontinence, and my recurrent
pelvic rashes. Without this surgery and improvement of my co-morbid
conditions, I will be doomed to living what time I have left in pain and
decreasing mobility. Ultimately I will die without living a normal life span
due to my disease of morbid obesity, and the complications of my medical
conditions. All of which could have been mitigated and/or eliminated by
approval of the RNY gastric bypass surgery for me.
I am currently experiencing several severe co-morbid conditions that affect
my health and lifestyle in a negative manner. These conditions are listed as
follows:
chronic low back, hip, ankle pain, and bilateral knee pain. I have been told
that I will need to have bilateral knee replacements if I do not lose
weight. Severe arthritis, leg pain from varicose veins, severe anxiety and
depression, sleep apnea, restless sleep patterns, shortness of breath on
exertion, racing heartbeat with activity, chronic fatigue, hypertension,
recurrent pelvic rashes, stress incontinence.
All of these problems can be directly attributed to the disease of Morbid
Obesity.
* Chronic back pain
The entire weight of the upper body falls on the base of the spine, and
overweight causes it to wear out, or to fail. The consequence is accelerated
arthritis of the spine, or "slipped disk", when the cartilage between the
vertebrae squeezes out Either of these conditions can cause irritation or
compression of the nerve roots, and lead to sciatica - a dull, intense pain
down the outside of the leg.
* Chronic fatigue
Having to carry around so much excess weight each day leaves an obese person
with very little energy for much else. Routine tasks such as cleaning and
maintaining a household. Shopping, and laundry are often put off or
neglected. Severely overweight people are unable to participate in
recreational activities with family and friends, and can only watch from the
sidelines due to their physical limitations. Imagine trying to perform your
daily activities with a 1OOlb. weight tied to your back. These are the
challenges morbidly obese people face each and every day AND I AM LOSING
THIS BATTLE.
* Respiratory insufficiency
Obese persons find that exercise causes them to be out of breath very
quickly. The lungs are decreased in size, and the chest wall is very heavy
and difficult to lift. At the same time, the demand for oxygen is greater,
with any physical activity. This condition prevents normal physical
activities and exercise, often interferes with usual daily activities, such
as shopping, yard-work or stair climbing, and can be completely disabling. I
am short of breath, unable to breathe and feel like my weight is suffocating
me.
* Persistent joint pain
The body parts that bear most of the weight are: hips, knees, ankles and
feet. These joints tend to wear out more quickly, or to develop degenerative
arthritis much earlier and more frequently, than in the normal-weighted
person. Eventually, joint replacement surgery may be needed, to relieve the
severe pain. Unfortunately, the obese person faces a disadvantage there too.
Expensive joint replacement has much poorer results in the obese and can
often be prevented by simply helping the patient lose weight, which this
surgery does accomplish. Many orthopedic surgeons refuse to perform the
surgery in severely overweight patients, because these patients are at a
greater risk for immobility complications because of the weight stress to
the new joint. The decreased mobility of joint pain leads to a sedentary
life style, which leads to further weight gain.
* Stress incontinence
A large heavy abdomen, and relaxation of the pelvic muscles, may cause the
valve on the urinary bladder to be weakened, leading to leakage of urine
with
coughing, sneezing, or laughing. This condition is strongly associated with
being
overweight, and is usually relieved by weight loss. This is an embarrassing
condition
that is also one contributory cause to my feeling of depression. This can
be eliminated by reduction in weight, which this surgery will accomplish.
*Sleep Apnea
The Greek word "apnea" literally means "without breath." People with
untreated sleep apnea stop breathing repeatedly during their sleep,
sometimes hundreds of times during the night and often for a minute or
longer. Obstructive sleep apnea is caused by a blockage of the airway,
usually when the soft tissue in the rear of the throat collapses and closes
during sleep. With each apnea event, the brain briefly arouses sleep apnea
victims from sleep in order for them to resume breathing, but consequently
sleep is extremely fragmented and of poor quality. Risk factors
include being overweight, and over the age of forty. Sleep Apnea is a
serious
disorder can have significant consequences. Untreated, sleep apnea can cause
high blood pressure and other disease, memory problems, weight gain,
impotency, and headaches. Moreover, untreated sleep apnea may be responsible
for job
impairment and motor vehicle crashes. I have sleep apnea and this is serious
enough to cause my death. Sleep Apnea almost always disappears when the
morbidly obese individual loses weight, which again this surgery will
accomplish. Source: American Sleep Apnea Association
*Depression
Depression is characterized by feeling persistently sad, anxious, or "empty"
mood. Feeling helpless, guilty, or worthless, hopeless or pessimistic
feelings. Loss of pleasure in activities decreased energy loss of memory or
concentration restlessness, irritability or sleep disturbances, loss of or
increase in appetite, thoughts of death. Depression is one of the most
common - and potentially dangerous -- complications of every chronic
illness. For centuries, physicians have noticed that chronic disease and
depression frequently go hand in hand. In addition, the depression caused by
chronic illnesses often aggravates the illness, especially if the condition
causes pain, fatigue, or disruption of social life. Depression makes pain
hurt more, causes fatigue and lethargy to be more severe. The loss of energy
can exacerbate many chronic conditions. Depression's aggravation of chronic
illness can be fatal. Duke University researchers tested 730 men and women
for depression several times over a period of 27 years. Compared with
participants who were not depressed, those who experienced major depressive
episodes were 59% more likely to die of all causes, and 71% more likely to
succumb to heart attack
I have listed below a number of prescription medications I am currently
taking.
1. Effexor 225 mg qd Depression and Anxiety
2. Buspar 10 mg bid Anxiety
3. Celexa 10 mg qd Depression
4. Daypro 1200 mg qd Osteoarthritis
5. Prinivil 20 mg qd Hypertension
6. Ultram 50mg q 4 h prn pain I take approximately 200 mg qd
The only pain medication that helps is Oxycontin, which is a heavy duty
sustained release narcotic. I don't want to become dependent on this type of
medication. Since the side effects of this medication are addiction,
lethargy, and depression. I have been
taking Ultram for approximately 1 year. It does not totally relieve the
pain but makes it bearable.
I have mobility issues and constraints that are due to my weight. At night,
my arms, legs and other body parts experience numbness and I am told that
this is due to the pressure on my nerves. I do know that these conditions
cause me pain, a pain that can be alleviated through reduction in body mass,
which can be achieved through gastric bypass surgery.
Overweight persons are 10 times as likely to develop Type II, Adult-Onset
Diabetes. Elevation of the blood sugar leads to damage to tissues throughout
the body. Diabetes is the leading cause of adult-onset blindness, a major
cause of kidney failure, and the cause of over one half of all amputations.
It is the #3 cause of death in the United States. As a result of my morbid
obesity, I am a prime candidate for Type H, Adult-Onset Diabetes.
It has been documented that all of these diseases can be significantly
reduced or eradicated by weight loss. While I suffer from many co-morbid
conditions caused by obesity, I do not wish to wait until I become
completely bedridden before taking action to improve my health and prolong
my life.
Regarding my quality of life, aside from all of the medical information I
have provided weight has taken a toll on my mental health as well. I have
suffered from depression and have even attempted suicide, which is directly
attributable to my severe pain and ultimately my weight. My personal
relationships suffer because of my low self-esteem. Day to day activities,
smaller individuals (take for granted), are becoming increasingly difficult
for me to accomplish. It has become more difficult almost impossible for me
to exercise. I am unable too even support myself. If my husband chose to
leave me I would be destitute without the ability to provide for my
children. Long periods of sitting or standing causes back and hip pain. I am
no longer able to even go to the grocery store alone. I cannot fit in the
rides at amusement parks, and I avoid situations in which my weight will be
a hindrance thus having a poor quality of life. Bending over and tying my
shoes is very difficult task since I can't reach and can't breathe if I bend
over. Imagine if you can what it is like for me to go to the shoe store to
buy shoes. I would not wish my quality of life on my worst enemy. Obese
individuals suffer from a type of prejudice that has become acceptable in
this country. From theater seats to airplane seats, to cars, to turnstiles,
this world was meant for normal sized people, and obese individuals are
basically left to suffer alone and without government protection against
discrimination. I would like the chance to be respected for the qualities
that I have to offer as a well-rounded and educated woman, rather than being
stereotyped as unmotivated and lazy fat slob.
I am not seeking a cosmetic fix-all for my weight problem. I am asking for
help in controlling a disease that will only cause further health problems
and eventually death... Let me assure you I do not see gastric bypass
surgery as a panacea that will fix all my problems or even all my health
issues, but rather as a tool to use successfully to improve my quality of
life and health, and eliminate or mitigate my co-morbid conditions.
As per Dr. Samuel Klein, an official of the North American Association for
the Study of Obesity (NAASO) and Professor of Medicine at Washington
University School of Medicine in St. Louis. "When performed by experienced
surgeons on appropriately selected patients, surgery is an effective method
for weight loss and treating the medical complications of obesity. Moreover,
recent data demonstrate that surgery can even prevent the onset of diabetes,
high blood pressure and other life-threatening disorders in these patients."
As of November 1999 1 weighed 312 pounds (175 lbs. overweight) and had a BMI
of 53 .6. I am considered by the medical community to be morbidly obese.
Morbid obesity is defined by a patient having a BMII of at least 40 and/or
weighing at least 100 pounds over the ideal body weight or more than twice
the normal weight for height. I am currently almost 2 times that. No one at
this size can be living a healthy life myself included. Improvements in the
surgical correction of morbid obesity have allowed increasing numbers of
morbidly obese patients to undergo successful and sustained weight loss,
drastically improving their health, which lowers the cost of health care for
life.
In the past, I have tried many, doctor supervised, diets, exercise programs,
and weight loss medications, and (see attached DIET HISTORY). Although some
of them caused some weight loss, I always regained that weight, along with
significant additional weight. Of those who initially succeed with dieting,
most regain the weight they have lost and more! Commonly the "cure" rate for
morbid obesity is less than 5% with non-surgical methods. These statistics
are quoted from the National Institute of Health Guidelines and have proven
to be true in my case. I have tried commercial diets as well, such as Weight
Watchers, Overeaters Anonymous and pre-packaged food plans.
None have proved to be an effective weight loss method. I am within the 95%
where
dieting has not produced or maintained a significant and beneficial weight
loss making me a prime candidate for surgery. Based on my history of
uncontrollable and persistent weight gain, I will continue to gain weight
and in time, become sicker. I am frustrated and depressed over my past
efforts to keep the weight off
My doctor's, and I feel as though I have exhausted every other weight loss
method without success and that surgery is the next and final step in
permanent weight loss for me. Gastric Bypass Surgery is currently the most
effective method of PERMANENT weight loss. Operative procedures are designed
for severely obese patients who have attempted medical management of their
obesity but have been unsuccessful in achieving permanent weight loss.
Gastric Bypass, along with other methods of
surgical treatment of obesity, is broadly recognized as a safe, effective,
and cost effective method of weight loss for morbidly obese patients.
The National Institute of Health released a consensus statement supporting
Weight loss Surgery as an approved procedure that states, "A gastric
restrictive or bypass procedure should be considered only for well-informed
and motivated patients with acceptable operative risks. The patient should
be able to participate in treatment and long-term follow-up. Patients whose
BML exceeds 40 are potential candidates for surgery if they strongly desire
substantial weight loss, because obesity severely impairs the quality of
their lives". I have thoroughly researched my intended surgery, and I am
keenly aware of the risks involved. I am also aware that the long-term
benefits far outweigh those risks, and I wish to proceed. I am very
fortunate to have a large network of family and friends, as well as my
physician, who support my decision for surgery, and are committed to
assisting me with after-care. I have already joined a support group and
regularly participate in discussions with other morbidly obese people who
have had, or will have weight loss surgery. This group has been and will
continue to be tremendously beneficial in providing me with first-hand
information on all aspects of surgery pre and post op. There is not one
person who is post op, which has not reported an improvement in the quality
of their lives. Surgical means to begin the weight reduction process is my
only option. It is a tool that I will use and as the weight starts coming
off, I will be able to begin the exercise I need in order to make this
procedure successful. I can once again have and live a healthy life. I know
this is how it works and what I will have to do.
I want to do the only thing that has any measurable amount of success and as
you know the success rate for bariatric surgery is very high. I know it is
not a catch all thing and I will have to work to lose the amount of weight I
need to be healthy.
I have experienced some form of obesity most of my adult life. I live in
fear of my health deteriorating further to the point I will be bedridden and
require nursing care including physical therapy and knee and hip replacement
surgeries. These surgeries
would probably be UNNECESSARY if I have a RNY procedure. It has been shown
that the gastric bypass surgery will be a more cost effective way of
treating all these conditions than to have to have them treated by drugs and
other surgical techniques and interventions. It has been indicated that
diabetes, heart disease, an increased risk of cancer and death are in my
near future. It is only a matter of time before these affect my health more
severely than they do already. In my opinion, having surgery is protecting
my life.
The National Institute of Health supports obesity surgery, along with
following individuals and organizations:
Milliman and Robertson Healthcare Management Guidelines
Former U.S. Surgeon General C. Everett Koop, M.D.
American Association of Clinical Endocrinologists
Mayo Clinic
Johns Hopkins Medical Center
American Diabetic Association
American Society for Bariatric Surgery
The New England Journal of Medicine
The following is a list of enclosures included with this letter
1. Letter from my former primary care physician,
2. Supporting letter from my Orthopedic physician,
3. Supporting information regarding Roux-en-Y Gastric Bypass Surgery
4. My diet history
I know that if your were in my position you would write exactly the letter I
have before you, if I were in your position I would approve the surgery
based on the medical need of the patient. You would want to save your life
as much as I want to save mine. I am a mother, a wife, a friend, and a human
being. My life is valuable not only to me but also to those around me. I
have mattered to a great many people during my time on earth. Many of them
strangers that I have cared for during my professional career as a RN.
Please contact me should you have any further questions or requests for
information. I look forward to a prompt response to my request for Gastric
Bypass surgery, as I am eager to make this life saving change!
Sincerely,
it a great letter just change it to fit your needs
