Hello to everyone!! This is my first time to post on this forum. First I would like to say hello to debkay and jiffypop. I have been reading a lot of your entries and you both sound very informed about this procedure. debkay what were your complications? Are you the one that almost died? What happened if you don't mind my asking?
O.K. sorry for the length of this but I need to explain myself as best as I can.
After months and months of searching the internet and my heart and praying endless prayers about this I have come to the decision that I want to have this surgery. I am talking about gastric bypass using the laproscopic procedure, not open procedure. I live in the northeastern section of Mississippi and there are facilities in the adjoining state of Alabama who perform this procedure. I want to hear from anyone and everyone but would especially like to hear from someone in my area of the world who has had the surgery done in the Birmingham, Alabama or Huntsville, Alabama area. I have Blue Cross and Blue Shield insurance. I am very limited on funds so I really need this approved by insurance if possible.
Some about me. I am a 37 year old woman. I am 5'2" and weigh approximately 256 lbs. Now while this may not sound like much to the ones of you who have 200-300 to lose, for my small frame I am grossly, morbidly obese, my BMI is 44 and my stomach rests on my legs. I can only wear stretch clothes, haven't worn jeans of any kind for years. I stay at home most of the time secluded because I am so ashamed of myself and appearance. I have children and I want to do things with them and enjoy life. My only 2 hang ups about this procedure have been, (1) the fear of dying and leaving my children and (2) not being able to afford to do this because of insurance denial.
I don't even know where to start. Please help me. How do I start the initial work up and see if I can get this approved by my insurance? What are the steps that I need to take. I am totally ignorant about this. I know it takes months to get everything approved and have the surgery set up but I am a very patient person and I am ready to start living my life and stop living hiding under a rock.
ANY HELP WOULD BE GREATLY APPRECIATED. THANK YOU
"Don't sweat the small stuff...and ya know what?....
its all small stuff".
Hi Teresa, I would be glad to help you in anyway that I can.
First, if your more than 100 pounds overweight and have a bmi of over 40 you are a candiate for this surgery. Does that mean this is a fit for everyone, of course not. There are other things that would qualify, but you covered both of those.
I'll be glad to share my journey with you.
In the past I have thought about wls, but never, ever thought my insurance would cover it. I put it to the back of my mind and just didn't think about it.
On August 31, 2001, while attending a high school football game, my daughter is in the band (fair warning, I'm full of band stories ) Anyway, one of the Mom's of another band student mentioned to me that Vicky, another band Mom had had gastric by-pass. I was floored, I had never met anyone who had ever had this surgery.
When the game was over, I grabbed Vicky, who is by the way a RN who did work as a operating room RN. She and I stood and talked for quite sometime, she was a self-pay, I didn't want to do that. She told me how she at 3 months post-op was down 60 pounds, I was amazed.
Long story short, that started me thinking and looking into wls. The next day was Saturday, I found our insurance booklet and found that, if medically necessary my insurance company would pay for the surgery. AT over 300 pounds, with high blood pressure, diabetes and a family history of heart disease, I felt I was the poster child for "medically necessary."
At the time my insurance company was Cigna-HMO. I needed to see my PCP for a referral to a surgeon.
I searched my insurance companies web site for the name's of surgeons that my friend Vicky gave me, remember she was an OR room nurse who knew surgeons that did this surgery.
I found a few. Called them to see when I could get an appt with them, and to see who did the lap surgery. Vicky really advised me to seek out lap as the recovery time is much less. I must tell you, I would have done open if that was all that was available.
Went to my PCP and requested a referral. She had never referred anyone for a gastric-bypass before. She was a little leary, I cried, she relented. She knew that I had tried many, many times in the past to diet, with success, only to gain it all back and more. She was and continues to be one of my biggest supporters.
Sweated out getting the referral, finally got that and made an appt to see the surgeon I selected.
From my research, I found that when I went to see the surgeon I wanted to have letters of support from every doctor I use. My PCP wrote a wonderful letter talking about my previous weight loss attempts (important for approval) my health issues and how a large weight loss could help my medical conditions. My GYN just basically said she supported my decision to have wls. My orthopedic doc wrote a letter noting that a large weight loss could help my knee pain.
I took these three letters and a letter I wrote myself telling the insurance company why I wanted this surgery, why I thought I was a good candiate, and I explained how much I understood that this was a life long change. All of the items were given to the insurance lady in my surgeons office to be included in the packet they submit to my insurance company for approval.
I also included a pic of me, I wanted them to see me, not a number. The pic was of me and my daughter.
My insurance company requires a psych-eval and a meeting with a nutritionist before approval. I had both done before the initial meeting with the surgeon.
My meeting with the surgeon was on Oct. 25, 2001. I was approved by my insurance company 2 weeks later.
My surgery was on January 14 (the initial surgery anyway)
Yep, I'm the one who almost died after surgery. I'm going to end this post and continue that story after I get lunch.
Okay I'm back, I will now try to relate my complication story. My hubby would be better to do this, but for some reason I don't think I would get him to post.
Like I said, my initial surgery was on 01-14-02. Everything seemed to go as planned. The next day, I had a leak test. Well to my complete and utter dismay I had a leak.
One of the questions while talking to the doc before surgery was how many leaks have you had. One.........so I was his second. How many blood clots 2, thank goodness I didn't have any of those. The biggie, how many deaths, none........I tried very, very hard to be his first.
The second evening they went back in to repair the leak. Hubby and I were told it would be a 20 minute procedure. I was taken in around 7PM, at midnight my hubby said the panic was really setting in for him.
Finally a little after that time they came out and told my hubby everytime they stitched up the leak I would spring another. At this point all leaks were repaired.
Next day, back for my second leak test. Thank goodness, this one I passed.
Surgery Monday, Friday I went home.
I came home, followed all instructions. Everything was going well, or so we thought.
On January 29th, Jiff had her surgery. Her sister peachie called me to tell me that Jiff was doing well. peachie and I had neglected to tell Jiff, by design, that I had the leak. We didn't want her to worry.
Around 5PM on the 29th I went to get up from the couch. I had a severe stabbing pain in my left back area, it was so bad it took my breath away. Instead of going away it was constant. Finally within a few minutes we had called the doctor and he said to come to the hospital. We debated about calling or not calling an ambulance, that's how horrible it was. Finally we just piled into my van and drove to the hospital, it was a horrific trip.
Finally after getting into the emergency room and they saw how horrible I was they took me ahead of other's, thank goodness.
I can remember them getting a doctor to me right away. Finally after what seemed like hours they gave me pain meds, which did nothing! They did x-rays, more pain meds...........changed pain meds and still nothing was killing the pain or even touching it.
The next thing I know, its the next day. I'm on a morphin pump, the only thing that is even touching the pain. I'm in a room, my husband gets worried about me, I was so out of it. Finally I come to and all these people are in the room, watching me, it seems somehow I had to much morphine......they gave me a shot of something that immediatly counteracts the morphine (Jiff can explain this I'm sure) I was feeling no pain, they lower the morphine which puts me back in pain.
The next thing I remember it's Valantines Day and my hubby is telling me happy Valentine's Day. I'm sure I had some moments where I was awake but I can't remember.
My hubby has told me, they did a third surgery, found no leaks. I guess what was causing all the pain was, the initial leak had caused an infection pocket to form on or around my lung.
They finally inserted two chest tubes to drain the fluid. After the third surgery I was having trouble breathing, I was put on a ventilator. I was in ICU for 6 1/2 weeks and all but 11 of those days I was on the vent.
I had pnemonia, fevers of 105, heart problems (never had any before) blood tranfusions and other things.
After 6 1/2 weeks I was transfered to a rehab hospital where I had to regain my strength and learn to walk again, my legs had gone to mush while in ICU.
I also had a trach, which was used to wean me off the ventilator. The first words out of peachie's mouth when we met for the first time was, "look what they did to you." She was talking about the trach scar.
Oh, and to top it all off...........on March 15th when they moved me to the rehab hospital I had gained 20 pounds!!! they had me on high calorie tube feedings. I was so upset, I couldn't believe I had gone through all that only to gain weight. But, all is well, I have lost 111 pounds since March.
I know there is more, but I can't remember all of it. My husband tells me bits and pieces at a time. He did tell me he thought more than once he was going to lose me.
In lots of ways this was much harder on my family than on me. I don't remember it, my family remembers it all.
If you have any questions I will be glad to answer them.
I hope this all makes sense, at times I just type what is in my head and it makes no sense to anyone but me.
You must be the worst case scenerio of this procedure. Bless your heart. It just wasn't your time to go. Thank you so much. You have given me loads of information.
There is 1 person that I know personally who has had this surgery and she is about 8 months out and she has already lost close to 100 lbs and she looks terrific. She is one of the best case scenerios. She has only thrown up about 4 times and has had no complications. She said she would go back tomorrow and have the surgery all over again. She highly recommends it but at the same time says it is a major surgery with risks and complications and that I should make an informed decision.
You said you got approved through your insurance company. Did you have to pay any costs? She also had BC/BS and was approved for the surgery but she still had to pay about 400.00 in different kinds of costs. This had to be paid upfront. I know different insurance companies have different benefits.
Please keep posting I am soaking this up like a sponge. I have to get this process started. I have just celebrated my 37th birthday and I don't want to live this way anymore than I have too.
Gotta go for now, I'll check back later.
"Don't sweat the small stuff...and ya know what?....
its all small stuff".
Hey Teresa, thought of something else. Before surgery my surgeon required I have a chest x-ray, pulmonary function test and of course bloodwork. Depending on your health, some surgeons might require more. I have heard of many requiring a sleep apnea test, I had no symptoms of sleep apnea so that was not required of me.
Whatever they require it is usually for your own good and just a couple more hoops to jump through.
Yea, I think I am one of the worst complication cases, at least that I have ever heard of.
Most people have the surgery with little or no problems. It's major surgery and carries risks, the risks must be weighed against the benefits and a decision made from there.
I just want to add, even with the problems I had, I would do it all over again. I feel terrific. Now my husband on the other hand, has told me he never ever wants to go through anything like that again.
Here are a couple other web sites www.spotlighthealth.com this is a very busy web site, lots of pre and post ops post on this site. Every so often it flares up in flame wars, but always passes.
Another is www.obesityhelp.com you may be able to find a doctor in your area on this site. This site is packed full of information. I learned LOTS from this site. Also has a great before and after photo gallery.
i started to answer yesterday afternoon, and got distracted and never came back!!! actually, i checked out the american association of bariatric surgery website [www.asbs.org] to see if there were any members in mississippi or alabama. and there are!!
but back to deb's points. teresa, first check out your policy and call the insurance company if you have any questions. with a BMI over 40 and some comorbidities, you are definitely a candidate. the best thing for you to do is to find a surgeon who's a member of the asbs, AND in your health care plan. if you can find only out-of-network docs, and your plan has an out-of-network benefit, you will be out of pocket a bit more money.
no matter what, the only way for this process to go smoothly is to do exactly what the insurance company says to do. if they say that you need a referral from the PCP to the surgeon, GET IT. even if you have to change PCPs to do it. if you have to get letters from 5 different docs, get them.
no insurance company approves the surgery without a diet history. so, make a list of every blessed diet you've been on, every exercise program you've tried, every diet doc you've seen, every diet medication you've taken, every gym you've joined. my list ran for two pages. and i've heard that some insurance companies require a year of physician-supervised dieting. but they'll count all those visits to the doc that you put in your history as part of the year.
while i understand that money is an issue [and you're not alone on that one!!! i had my surgery after my company went bankrupt and i had to buy my own health insurance!!!], PLEASE keep in mind that this is your life we're talking about, and it's not a good idea to be penny-wise and pound foolish [not like i wanted to make this pun!!! sorry!!!}.
reputable surgeons want you to come through this in one piece. the good ones will insist that you get a whole list of clearances: cardiology, pulmonology, psychology, and sleep apnea [in some cases]. and most want you to lose some weight beforehand to take some of the strain off your heart. but remember, you just have to lose a few pounds, you don't have to worry about keeping it off... so it's ok.
don't go to a surgeon who's not in the asbs. this organization accepts only those who are trained in the procedure and who put the long-term care of their patient as a high priority.
oh, and when choosing a surgeon, make sure that there's a requirement for life-long support groups. we need them. it's not an easy thing to get through the surgery, but it's even harder to keep it going throughout our lives so that we can be healthy.
the risks of vitamin and protein deficiencies are very very real, and it's possible to out-eat the surgery. so we always have to stay on our toes, and we need help for that.
has this helped? there will be more later. promise.
now, monday morning, read your policy and call your insurance company.
and let us know. keep us posted every step of the way.
and PS. we all thought that debk would go through the surgery with flying colors, because she was so healthy beforehand. everyone thought i would have trouble because i had been so very ill. but i sailed through it with no problems whatsoever [other than throwing up for 6 weeks!] and look what happened to deb!!!!
Start your day with a smile, and get it over with.
Keeping it off is a hundred decisions a day that help you maintain what you achieved. And that's the hard part. - L Sanders
start: 506 [Sept 2001]
weight at gastric bypass [Jan 29, 2002]: 409
current weight: 225
weight for plastic surgery: 200
final goal: 180
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