Weight Loss Surgery - WLS, no insurance, want it pretty bad.

Has anyone here had weight loss surgery without insurance...and also while being quite, err...broke? As in, you get the surgery and you just have to pay it for the rest of your life in bills?

I'm having such a derp of a time trying to just get below 300 pounds. I dont know if I am not working out enough or if cutting all of the bad crap out of my diet (clocking in at about 1400 cals a day) is not enough or what. I will admit I am only about 2-3 months into this shindig, but I find myself so envious (and amazingly proud and happy for at the same time. Weird?) of people who have managed to get WLS. Now, I am dirt poor! No insurance, no nothing. I've never had insurance of any kind my entire life for more than a few months, and I know at my weight and income level that getting it has a snowball's chance in ****. I'm an artist, so I dont make a whole lot, though I am trying to become a tattoo artist as well and actually live a life above the poverty line doing something I love.

Okay, back on track. Seriously though, has anyone managed this? Or would you mind suggesting a few things?

As some one who's been paying off unintended medical bills for the last year, I would really caution you against taking on too much debt if your income isn't secure! Not to mention that WLS is a surgery - what happens if you have complications? Will you be able to pay the bills if you wind up needing an extended hospital stay, medications, etc?

Especially when WLS isn't a guaranteed success - while many people who have it are successful, others are not. It seems like a lot to risk for something that isn't 100% guaranteed to work. (I should clarify that I haven't had WLS myself, but have had friends/relatives undergo the procedure with mixed results.)

One thing to consider - at your height and weight, 1,400 calories may not be nearly enough. If you eat too little, your body hangs on to fat in order to protect itself. I'd definitely recommend signing up for a website like Livestrong or SparkPeople - both have calculators that show how many calories you need to consume to lose weight each week (based on your basal metabolic rate).

There are ways to pay for WLS without insurance - I've seen people take out medical loans, use Care Credit, take out a second mortgage, etc. However, describing yourself as broke has me concerned for you not only because you might not be able to afford the actual surgery itself, but what about the vitamins and supplements and follow-up doctor care you will need for the rest of your life AFTER the surgery? I do have insurance, but I know that without it, I would be spending thousands of dollars a year on labs alone.

Maybe you could swing a part-time job that offers health insurance? I know places like Starbucks and Home Depot offer benefits even to part-time employees. That was my Plan B when my employer changed our insurance to plan with a 100% EXCLUSION for anything even remotely related to weight loss. I had my Starbucks application downloaded from their website and saved to my desktop! Now, I never go to Starbucks - I don't even drink coffee - but I was willing to do what I needed to do to make a better life for myself.

OH, I'm on Sparkpeople. I love it there, just figured I'd try to get some insight there as well. The nutrition calculator over yonder says 1480 for calories at best, so I try to stick around that. I start to panic if I go higher...I'm not sure whats wrong with me. But after being big so long I think my mind is snapping. XD

As for the surgery? I'm sure its some sort of desperation talking. Must calm it down...and knowing my luck it probably wouldn't work all that well...

I think you need to go to the doctor, but not necessarily for WLS. If you have been eating 1400 calories a day for 2-3 months, staying strictly on plan and have only lost 14 pounds at your starting weight, something is wrong... If people think you are getting too few calories now, with WLS you will be eating around 1/2 that for the first several months prior and after the surgery.

At my starting weight, with very little excercise to begin with and 1200 calories a day (no surgery) but with total dedication and NO CHEATING I lost an average of 4 pounds a week for that first 3 months, my loss was pretty typical for someone my height and super morbidly obese. Do you weigh and measure everything?

I'm pretty sure you will have even MORE rules with WLS, it certainly is no easy fix, and in my opinion much stricter than basic calorie counting. It's also terribly expensive, and if you have no insurance, and have to make payments for years, how will you ever afford all the awesome new clothes you will want?

I would suggest getting yourself checked out by a doctor... especially your thyroid it may not be functioning at a normal level making your metabolism slow. You could check out your local hospital and sign up with the clinic there.

Good Luck !!

Leenie :hug:

I agree with Leenie--I'd go to a doctor first to make sure you have no health issues that are preventing you from losing weight. You've only been doing this seriously for a couple months, maybe you need a bit more time.
Having WLS is a big decision..I paid out of pocket because it is not covered under our medical insurance here in BC. So, I had to use my line of credit.
However, I have a job and I'm secure financially--not sure what I would have done otherwise. My parents would have helped, but I felt that it was my own responsibility to do this myself.
I don't regret my decision for a moment. It has changed my life in so many ways.
Hope this helps a bit.
Cheers,
Carol

there's also a risk if you don't have insurance and have the surgery. when you DO get the surgery, care related to complications may be subject to at least a 6-month waiting period OR not be covered at all.

is there any way you could qualify for MEDICAID?

Lori --I used to joke with my friend that "Yeah, I'll pay for WLS forever and go butt naked if I have to". Heh. But yes, I do need to go to the doctor. My period likes to last 6 months at a time for no reason at all and I have a lot of random break outs (not herpes, but small boils) in a very ah...special place.

Which leads me to think the worst: That I might have PCOS. I'm already sure I'm insulin resistant. As for weighing and measuring? I have no measured as I cant find the bloody tape, but I fit into pants I haven't been able to wear in about a year so I know I've lost some circumference. If just a little...

Leenie -- We have a local free clinic but not only is it a ***** to get to, but they just dont offer some services, like the one you mentioned. But I have made appointments for other clinics. Louisville just isnt a great place for health without insurance like most other cities. Ironic, seeing as this place is a rather big medical hub. As for my metabolism? I'm half convinced I dont have one. XD Realistically, it's just so slow. Hypothyroidism has been suspected by medical professionals before.

Zombie -- That's about all I can do for the moment is wait it out, you know? So, more working out, etc. I'll just have to see where it takes me. I feel like with the amount of effort I've put in I should at least be out of the 300's. Or maybe I'm just not working hard enough. I hope it's the latter, pride notwithstanding!

jiffypop -- Nah. When my leg got messed up due to the old bone tumor my life was in pretty big shambles. I owe a lot to hospitals and the Medicaid thing never quite could go through. I don't know if I could get it now due to those old bills for the MRI, etc going to collectors, but I do need to find out. If it turns out I can get it, I'm going to look into WLS ASAP. Chances are it's negatory, though.

darlin - just gotta point out that in the last 2-3 months you've lost 14 pounds!!! you should be EXTREMELY proud of yourself for that - and NOT beating yourself up that you think you should have lost more. Most experts consider a loss of 1-2 pounds a week to be appropriate. and you're right on target with that! and it sounds like you're being consistent with that.

We ALL want the weight to come off the minute we decide it should go, but it doesn't work that way. unfortunately.

While you work on figuring out the surgical angle, the lessons you're learning, strategies you're developing, etc, will only help you if and when you have surgery. in the meantime, you're going in the right direction, and it sounds like you're doing it the right way.

BTW, how old are you? and when was the last time you had a physical? i think it's beyond time that you have one -

Very, very good advice here. I guess my mind has just had enough of being in this body and is glitching out due to it not happening fast enough!

And I am 27 years old. I haven't had a physical since high school. Kind of afraid to have one, you know? I'm a bit of a recluse, but I am trying to change that at least by working walks into my regime. As for the weight loss I have a crushing worry its mostly water. I got on the scale and its up to freaking 305.1. I hope its just a random fluctuation in weight.

just keep on track. BTW, did you know that you can use STRING to measure yourself? and you can mark your progress on it with markers or something.

and tracking your food and exercise is a good idea. you'll be able to see exactly what's happening - and what you might want to tweak.

breathe, honey!!!!

As some one who's been paying off unintended medical bills for the last year, I would really caution you against taking on too much debt if your income isn't secure! Not to mention that WLS is a surgery - what happens if you have complications? Will you be able to pay the bills if you wind up needing an extended hospital stay, medications, etc?

Especially when WLS isn't a guaranteed success - while many people who have it are successful, others are not. It seems like a lot to risk for something that isn't 100% guaranteed to work. (I should clarify that I haven't had WLS myself, but have had friends/relatives undergo the procedure with mixed results.)

One thing to consider - at your height and weight, 1,400 calories may not be nearly enough. If you eat too little, your body hangs on to fat in order to protect itself. I'd definitely recommend signing up for a website like Livestrong or SparkPeople - both have calculators that show how many calories you need to consume to lose weight each week (based on your basal metabolic rate).

just keep on track. BTW, did you know that you can use STRING to measure yourself? and you can mark your progress on it with markers or something.

and tracking your food and exercise is a good idea. you'll be able to see exactly what's happening - and what you might want to tweak.

breathe, honey!!!!

String?!

....Brilliant! I may try this!

My surgery was free as part of a study about people with Type 2 and a BMI between 35-40. My blood sugar has been perfect since the surgery, but that's neither here nor there. Anyway, you may want to find out if there are any studies that you qualify for.

That said, however, I have health insurance that would cover any complications or anything. I would be wary of having such a major surgery without any coverage.

Gah, that would be freakin' awesome. I've never seen these studies in Kentucky though.

Start with the physical and figure out whats going on. Its cheaper and you can ask questions about whats going in with your body, what you need to do to get WLS (most people I know seem to need to lose little before they get it), and it will a first step toward WLS if you decide to get it.

Very, very good advice here. I guess my mind has just had enough of being in this body and is glitching out due to it not happening fast enough!

And I am 27 years old. I haven't had a physical since high school. Kind of afraid to have one, you know? I'm a bit of a recluse, but I am trying to change that at least by working walks into my regime. As for the weight loss I have a crushing worry its mostly water. I got on the scale and its up to freaking 305.1. I hope its just a random fluctuation in weight.

Neb - there are clinical trials in two major topics: what happens to diabetics who aren't quite heavy enough for WLS under the current rules, and what happens to teenagers with lapband or gastric bypass.

so, i'm not sure you'd qualify for either. unfortunately.

Oogh, yeah...probably not! Oh well, I did randomly receive a reply from an organization I contact months ago (in a fit of desperation, lol) and they wanted me to stay in contact with them for their 2011 cycle since 2010 is completed. I guess that's a good thing as it both gives me time to see if my body can change and all. That's of course assuming in the rare chance it -does- happen.

Hi.:)

I can really empathize because for some darn reason, I could not get my body to drop weight calorie-counting.....after trying and trying. SO:

I went on Atkins...very low carb....and complete reversal....losing weight was no problem. AND I was not hungry due to the generous amounts of fats allowed.

Now prior to that, I did have BW done to make sure my thyroid was functioning....which it was. But the Dr. did think my metabolism was "sluggish".

Now you MUST follow the plan diligently...exactly...as in the 2002 Atkins book....which I would recommend reading before starting. I stayed on the induction phase the entire time because it was working so well for me....but...I NEVER went off plan and never put even a taste of a non-allowed carb in my mouth.

Also, low-carb is already recommended for blood-sugar alterations...be it diabetes, pre-diabetes, insulin-resistance (and PCOS would be on this list also).....so it would be good for your diagnosis, to boot.

I can explain the whole process if you'd like (how and why low-carb is good and works) but you can also learn all about this in not only the 2002 Atkins book, but also in a great book called "Good calories, Bad calories" by Gary Taubes.....very eye-opening.

Look, I have no problem with calorie counting plans. They have worked and are working amazingly well for many folks here and can help folks be successful in a diet plan/eating plan. What's also good is that it prepares you for maintenance...in terms of knowing how many calories you can eat and how to stick with that.
BUT...I could NOT get it to work for me...and it was so frustrating. I could not figure out how strict calorie-counting was not causing weight loss for me.
Every time I got on the scale, I was cursing the skies (or crying)....because I was trying so hard...and nothing was happening for me. I wanted to believe it was a thyroid problem...so medication might fix it...but no, the labs showed it was functioning normally.

This is just my own theory...but I believe that I possibly have an alteration in my carb metabolism. And when I eat simple carbs, no matter how many calories, my body clings to that weight and won't let go. There are certain people who are "carb addicts"....and this also points to there being a possible alteration in carb metabolism...in certain individuals.

I mean...you could try it. No harm in just trying it, right? If you don't like it or it doesn't work for you, just drop it. It could at least give you some indication of whether or not you might have a carb metabolism problem.

deena :hug:

Thats true, I could try it. But I already eat so few carbs as it is...Sparkpeople keeps whinging at me about it like HOW DARE YOU EAT SO MUCH PROTEIN AND SO LITTLE FAT YOU ARE GOING TO DIIIIIIEE.

As for atkins? Hrm, well...I'm certainly thinking on it, but restricting certain food groups from my diet temporarily has never worked for me. My brain just wont do it, you know? And I am exactly the sort of person who would fail if told to not eat meat or carbs or dairy or vegetables. What worries me about Atkins is the ketosis itself and how it supposedly mauls energy levels which I have so little of and makes one cranky!

But in the end if nothing gives after say, a month? I might have to try your suggestion regardless. Just to try and find -something-. I feel like I should have lost more than 10 pounds in two months, though. Or am I an ingrate..I dunno! But I'm certainly not above doing what I can!

As for the past week or so I have knocked my calorie intake down to a comfortable 1200-1400 calories. I havent been ravenous at all so far, which is good. I dont miss bread now that I have the flat bread and pitas for far less puffyness and calories and drinking a lot more water has helped me. I'm also trying to work out a whole lot more.

I guess I'm gonna give it 3 weeks or so and see if I cant get down 4-6 pounds like I should at the correct rate. But thanks for the in-depth input! I'm glad something finally worked for you. ^^

Thats true, I could try it. But I already eat so few carbs as it is...Sparkpeople keeps whinging at me about it like HOW DARE YOU EAT SO MUCH PROTEIN AND SO LITTLE FAT YOU ARE GOING TO DIIIIIIEE.
Why are you eating so little fat? My tracking thingy always told me I was eating too much protein, too, but if you're eating very little fat, I'd bet your carb intake is higher than you think. I know it doesn't sound easy, but pre-op and even now that I'm no longer easily losing weight after my surgery, low carbing was the absolute BEST plan for me, and that includes NOT restricting fat intake. Recent studies show that fat is actually only bad for you if eaten WITH carbs - a diet high in fat and low in carbs does NOT cause the things people tend to associate with high fat such as high cholesterol, weight gain, or other cardiovascular health risks.

When I stopped counting calories and started focusing on the types of foods I was eating (re: protein first, fat second, carbs dead last), I was much more successful.

I am hearing a lot of excuses and not a lot of action!

And Atkins isn't about restricting certain food groups for a short amount of time it's about restructuring the way you eat. It works ;).

I understand that you want the procedure badly. But you have to understand that it's not a quick fix. If you don't readjust your attitudes toward food you can and WILL gain the weight back. Why not make some real changes now and stop waiting around for a fix ;). It may be harsh but it's reality. Nobody ever lost weight waiting around for it to happen.

Val, what you're seeing as 'excuses' I'm seeing as exploration and questioning.

Neb - just about all of us who've had ANY of the surgeries seem to end up on some sort of carb-controlled plan. whether it's more atkins-induction or south beach is entirely individual. and i think that's the bottom line message.

What Jilly outlined is pretty much the way we're all supposed to eat. and, with the altered absorption some of us have, eating protein first - and a bit more of it than 'normally recommended' is truly important. veggies are next. then fruit. then other carbs - and it's on a 'space available' basis - with the emphasis on high quality carbs.

right after surgery i was told to eat not more than a total of 30 grams of carbs per day - not more than 15 grams per eating episode [i hesitate to call them MEALS!]. that limit was gradually relaxed, but there's no way i should be eating 100+ grams per day [and now you can see how i gained some of the weight back!!!!]

surgery or not, you'll still have to make changes that work FOR YOU. it's not usually a good idea to stay on atkins induction forever - people need veggies and fruit. so eating to ketosis shouldn't be a forever thing. like you said, ya gotta function. and what's the point of making all these changes if you don't feel better and have more energy???

keep up the exploration - and the good work!!!!

Jill: Well, I had thought that getting more almonds and other nut-fats in would increase the intake, but it still may not be enough. I also think its because the tracker would like me to eat 1800 calories a day when I am doing the 1200 recomended by a friend who is a nutritionist. Because my metabolic rate is crap. As for carbs? Sparknutrition yells at me for that, too. Apparently I just dont get enough. Possibly due to the flat bread or things I make with almond meal. I'm murderous with the protein though. I keep going -over- since I eat a lot of fowl and fish. My biggest carb day was 88 net carbs (I only eat complex carbs, no refined) and it suggests like 90-130 more!!) So yeah, its a bit confusing.

Valrock: "Harsh"? I can do harsh, but you just assumed a whole helluva lot about me. My eating has been completely revamped thanks to Spark Nutrition and obsessive reading about food. And before restricting my calories? I hadn't had processed food in 6 months. Tell me I am making "excuses" or being "lazy" in lieu of the waiting around bit? It reeks of the "Stupid lazy fatty!" tone I hear outside of this website, especially when working out like a slave for two hours a day and putting my all into this. The reason I want the surgery is because I fear there is something wrong with me health wise, and I'm looking into it. Not really cool with hearing it that kinda rhetoric here...but thanks for your input, anyway.

Jiffypop: Sparkfolks wants me to have like...150. And I don't want that. I eat half that at best and it scolds me. XD

Neb - you don't sound like a person who would EVER let a computer program run your life!

My suggestion, though, is to find a dietician/some other professional clinician who can be more impartial than your friend. Not that she's necessarily steering you wrong, but a second opinion may be in order, especially since you don't know right now if you're diabetic, hypoglycemic, hypothyroid, or WHAT.

seriously. honest. above everything else, ya gotta be healthy, and lose weight in a way that works FOR YOU, and that'll take a bit more exploration to figure out.

I'm sorry if I was 'harsh'. You just sound an awful lot like me six years ago and it didn't get me anywhere then. I never ended up getting the WLS and I'm glad I didn't.

First and foremost... you need to have a consult with a doctor and go from there. Like jiffypop said... you never know what issues you may have going on that are making weight loss hard for you. It's a struggle for everyone... If it was easy we'd all be skinny.

I wish you the best of luck in your journey.

Valrock: Yes, I do need to hightail it to the doctor's office. It's going to be quite a toughy though, so many of the clinics in this city give me a lot of "We don't do that sort of testing" when it comes to say...thyroid, insulin resistance, etc. But I'm still going to look.

I hear you on not getting the surgery, though. A lot of the people here who have lost weight without it give me some inspiration; at least enough to get checked out and give myself a six month buffer before I try for it again.

I mean, you did it and I bet it was hard...but you still got it done. Which is inspiring. <3

Jiffypop: Very wise words. Still hard without insurance, but I suppose if there is a will, there is a way. I -fear- that I have PCOS. I do bleed for 3-5 months at a time with 3 day breaks every now and then. And I was hoping that was just another pound of flesh I pay for being overweight. But, the more I read? The more I seem to have some of the symptoms.

Worriesome, but eh.

darlin - bleeding for months at a time with only occasional breaks IS NOT NORMAL at any age - but you're not even 30!!!

please remember - every single person is entitled to good medical care. DO NOT let docs/nurses/other healthcare professionals get away with the 'you're overweight and this will go away when you lose weight' line.

that is NOT providing medical care - it is verging on malpractice, because they are jumping to a conclusion that they haven't justified with appropriate testing. While weight may be a factor here, there are very likely OTHER things going on.

Heh, I've actually become very callous with the few doctors I've had the privilege of seeing while overweight and without insurance (which makes you the person they care least about saving, even statistically and with anonymous polls in the health community.) and I swear if I came in with a broken leg, they would tell me to lose some weight to heal it and then boot me out.

Problem is, most hospitals seems to give me this impression that they wont treat you without Insurance unless its the ER, so I suppose I am a little ignorant about working around this. Well, ignorant may not be the word...I did extensive research, actually. Free clinics don't do the testing, regular clinics you need insurance for. So I wonder if I have to wait until my reproductive organs fall out in order to get treated....

I suppose its back to researching it. :/ -hopeful-

Has anyone here had weight loss surgery without insurance...and also while being quite, err...broke?

Yes I have. I went to India for mine. The cost here in California was $33,000 and that only included one nights stay in the hospital. The cost in India was $7,800 and that included seven days in the hospital, all medications and pre-surgery tests e.g. Blood work, EKG and upper endoscopy. The only thing I had to pay for on top was a return air ticket which cost me $1,200 from San Francisco. The care was exceptional and could not be faulted at all. The staff were wonderful. They even picked me up at the airport and took me back when it was time to go home.

My husband took the money out of his 401k retirement plan. I did have surgery for another problem some years earlier and did it using two credit cards......big mistake. That took us YEARS to pay off as we were broke then.

I plan on going back to India in about 12 months for plastic surgery. This time my husband will be going with me.

GReat information, Klassy - did you have followup care lined up before you went to india? or did you find it afterwards? that's the one thing that scares me about out-of-country surgery, even though i know that the results can be great

I did talk with my primary care physician before going to India and he was very supportive. I also do not have healthcare insurance.

I have kept in touch with my surgeon should a problem arise, though so far there has been none that I didn't create myself........a little dumping.

At the time I went the choice was surgery in India or get heavier and heavier with a slew of health problems, of which now I have none.

I did talk with my primary care physician before going to India and he was very supportive. I also do not have healthcare insurance.

I have kept in touch with my surgeon should a problem arise, though so far there has been none that I didn't create myself........a little dumping.

At the time I went the choice was surgery in India or get heavier and heavier with a slew of health problems, of which now I have none.

So you paid a cool $8700 at best? Augh, that's amazing. I wish there was a way for me to come up with that kind of money! But my credit is shot and I am poor.

Still, thats a great price...

Heh, I've actually become very callous with the few doctors I've had the privilege of seeing while overweight and without insurance (which makes you the person they care least about saving, even statistically and with anonymous polls in the health community.) and I swear if I came in with a broken leg, they would tell me to lose some weight to heal it and then boot me out.

Problem is, most hospitals seems to give me this impression that they wont treat you without Insurance unless its the ER, so I suppose I am a little ignorant about working around this. Well, ignorant may not be the word...I did extensive research, actually. Free clinics don't do the testing, regular clinics you need insurance for. So I wonder if I have to wait until my reproductive organs fall out in order to get treated....

I suppose its back to researching it. :/ -hopeful-

I can relate to the doctor's blaming every issue on weight, it is frustrating and sad :(

I am not a barrel of info or anything but I can tell you that I moved from Tennessee to New York 2.5 years ago. I have never had medical insurance. When I was in Tennessee I was being seen at the county health department. A few months ago, I signed up for Medicaid in New York and was approved. I have no copay or anything. It was easy to do and the process didn't take long at all. Now I can go to the doctor and get any necessary medicines. Have you checked into Medicaid? I didn't read through the entire thread (forgive me, it is going on 7am here and I haven't had sleep yet :o) so if it has already been discussed, ignore me :D

Good luck :hug::hug:

I can relate to the doctor's blaming every issue on weight, it is frustrating and sad :(

I am not a barrel of info or anything but I can tell you that I moved from Tennessee to New York 2.5 years ago. I have never had medical insurance. When I was in Tennessee I was being seen at the county health department. A few months ago, I signed up for Medicaid in New York and was approved. I have no copay or anything. It was easy to do and the process didn't take long at all. Now I can go to the doctor and get any necessary medicines. Have you checked into Medicaid? I didn't read through the entire thread (forgive me, it is going on 7am here and I haven't had sleep yet :o) so if it has already been discussed, ignore me :D

Good luck :hug::hug:

Well, coincidentally I am going on the fifth to see if I can't be signed up for Medicaid, actually. I don't have an appointment, but my cousin does and we're both hoping they will see me as a walk-in. What did you have to bring with you to sign up for it? I have my social security card, but that's about it. And I don't know if they would consider me unemployed as a freelance illustrator....but it's worth a try!

I know someone who had gastric bypass with low income insurance (I can't tell you if it was medicaid but I'm guessing it was). Although she had lots of food issues she didn't work out prior or after her surgery so in the end, so she initially lost some weight but then she gained most of the weight back. But it seems like whether or not you get the surgery, you should look into getting the health insurance. If you decide to go for the surgery, then they might be able to help you with that as well.

Well, coincidentally I am going on the fifth to see if I can't be signed up for Medicaid, actually. I don't have an appointment, but my cousin does and we're both hoping they will see me as a walk-in. What did you have to bring with you to sign up for it? I have my social security card, but that's about it. And I don't know if they would consider me unemployed as a freelance illustrator....but it's worth a try!

I had to have social security card, picture id and birth certificate. I also had to have a certified letter from my boyfriend stating that he provides shelter and food for me and that I am not currently employed. I wish you the best of luck :hug:

I had to have social security card, picture id and birth certificate. I also had to have a certified letter from my boyfriend stating that he provides shelter and food for me and that I am not currently employed. I wish you the best of luck :hug:

Thank you! And drat, I seem to be missing one element of that...the birth certificate. DX Gotta get on that, it seems. And have my roommate-and-sometimes-pretend-spouse write the letter. heh