Thursday, May 3, 2018

One step down, one step added

Hola.

So yesterday was my psych appointment. I was oddly nervous about it for some reason, like they would see I'm on medication and a seeing a therapist and just immediately tell me I was too crazy to do this again.

Thankfully, I think all that actually worked in my favor since I'm actively working on my mental health and my issues with food. We talked for about an hour and the only thing he wants me to do is try to attend a support group meeting (in person) and get a letter of support from my therapist. I actually called and asked her (my therapist) to do that like a month ago, but it hasn't been done yet. I called her office yesterday stating I needed that ASAP because they won't submit to insurance until I get that letter in.

Once they submit, I get to wait...and probably wait more since it will go through my primary, get denied, and then get sent to my secondary insurance before I hear anything. I hate this part of the process so much. You make a huge decision about your life, then you have to meet all these requirements, wait for approval, schedule a surgery. So frustrating. 

The idea of not knowing what's next or how long it will take to finalize everything is THE WORST.

Thursday, April 26, 2018

Emotional roller coaster

Do you ever feel like you just can't catch a break? My husband gets frustrated with me because I tend to be more pessimistic than optimistic but it's because something ALWAYS happens to my well laid plans.

I found out a few things yesterday.

The bariatric center through the hospital here (IU BMH) has started doing sleeves. Last year they were only doing lap bands. (You'll recall they wouldn't even see me because I had a Realize brand band and not a Lap Band brand band.) Now they have a NEW surgeon doing sleeve procedures as of January. So I called an asked if they did revisions. They are so new she had no idea so she said she would get back to me. Their insurance woman called me back 5 minutes later asking about my insurance because they saw I worked at BSU. She said BSU does cover bariatric surgery but ONLY the lap band or RNY (gastric bypass) and NOT the sleeve. She told me to double check my policy because she has been in talks with BSU insurance people to actually get the sleeve added to the policy next year when they do revisions.

Turns out, she was right. The gastric sleeve is not covered through my work insurance. That means getting the sleeve will default to my HIP. So I called HIP to ask about how that works since they are secondary. I was told I would have to meet all their requirements. When I asked about sleeve specifically and revision she said she couldn't give me details without procedure codes, but I would have to meet their regular requirements for bariatric surgery. I was also told by the insurance specialist at my surgeon's office that HIP is very strict with their requirements so my proof of 6 months of working out and dieting on my own may not be enough. Awesome.

I immediately called my doctor's office and scheduled a 'weight loss' appointment...for May 22. That's as soon as she could get me in. This means if I do have to go through 6 months of appointments, I won't be able to get the surgery until November or December at the earliest...which blows. My mom will be gone so she won't be able to help take care of the kids, it will be the middle of Fall semester at work (super busy AND Chris will be taking classes full time), and it will be winter. Let's just hope they take mercy on me and accept my attempt without my doctor's supervision. I'm not holding my breath though.

It's so frustrating that I even have to do all this again. I've literally been 'dieting' for the last 7 years off and on between kids. I KNOW what to do, I'm just struggling with it - the whole reason for the surgery. I can also feel my clothes getting tighter since I've started this revision process - which means I'm slowly gaining weight for some stupid reason. I'm sure part if it is stress. Another part of could be subconsciously eating whatever I want in anticipation of another surgery. Could be the end of semester parties at work. I'm so anxious and paranoid about all this.

I posted about my dilemma on a revision group on Facebook and someone asked why I didn't just go for RNY instead. I told her I wasn't really interested in going to that much of an extreme even though I probably meet all the criteria to need that one the most. A few people on there have told me they know people who are 10+ years out from RNY and have no vitamin deficiency issues and know what foods to avoid dumping and so rarely have problems with it. Now I'm wondering why I don't go that route? I never wanted to go that far. I'm only 33. I don't want to get this, have it go wrong, and have vitamin infusions for the rest of my life. But I really don't know what to do, if I'm being honest.

Pros of RNY: Better percentage of weight loss maintained/better results, covered by primary insurance and so more likely to cost less, potentially not as strict hoops as HIP insurance, faster weight loss (not that I'm really concerned about this), no chance of GERD after surgery, unable to eat sweets/excessive sugar (less likely to 'cheat').

Cons of RNY: Completely changes the way you digest food - nutrient malabsorption, dumping syndrome, what if I lose too much/look sickly?, more chances for complications (small percent), more invasive surgery, more potential side effects, not as popular as sleeve currently

Basically I'm anxious, frustrated, pissed off, and torn all at once and I really just need someone to tell me what is the right choice.

Thursday, April 19, 2018

So much waiting

So my consultation appointment was last week. It took the entire 4 hours. I filled out some releases, met with a nurse to go over my health history that I filled out online previously, then we waited...and waited...and waited for at least another hour.

We went back to the group meeting room, got more handouts and things to fill out. A nutritionist came to speak first; giving a rough overview of what size your meal portions would be (golf ball-sized), what to focus on (protein), and what to avoid (carbs). Next, the insurance specialist came in to talk about the process, what your insurance could require, etc. I didn't listen too closely because a) I know all this and b) my insurance person and process will be different since I'm getting a revision.

Next up was the overview of the surgeries from Dr. Diaz. We waited probably a good 20-30 minutes for him to come back. He spent all of 10 minutes talking about the lap band. He said it was popular the time, but now its obsolete for the most part and isn't the most effective and they rarely do them. He also said 70% of people with lap bands get them removed or revised. How do you like that a number? (This is the time I really wish my TriCare from 7 years ago covered the sleeve because I would have gotten that first had it been an option.) He then moved on to the Sleeve for about 15 minutes, and finally RNY for a good 25 minutes. Thankfully, I wasn't as bored as I thought I would be with this since the information was updated. He also said a few things in the beginning that I really appreciated: Weight loss surgery is only a tool - not a magic wand. Weight loss surgery is NOT the easy way out. He said one other thing too but now I can't remember. All good points though.

Once he was finished, we (a group of about 7-8 people) waited to meet with him individually to go over our surgery options. I spoke with another woman getting revision surgery as well. She had her lap band for 15 years, had 5 kids (4 boys and 1 girl, bless her - that she home schools) and was coming from somewhere in northern Indiana. We waited probably another 30 minutes before being seen by Dr. Diaz. He came in and said "So you're ready to give up on the band?" and I replied, "I actually feel the band has given up on me." He smiled and agreed and reassured me that it wasn't me and that the band itself is becoming obsolete. He thought the sleeve was a fine choice since I don't have any issues with GERD. The hospital stay for sleeve will be 2 nights and he tries to do revision surgeries in one surgery (not 2 separate ones). (Given there are no issues once he gets inside and sees the band in person.)

One meeting down. One more to go before we can submit to insurance. My psych evaluation is scheduled May 2 (so 2 long weeks from now). The day after the consultation, I emailed and left a voicemail with the revision nurse that does that all the insurance approvals for revision patients. I wanted to ask about the 6 months of supervised weight loss attempts. You see, I did attempt 6 months of hard-core weight loss attempts roughly a year ago. I was working out 3-4 days a week, tracking calories/macros, and logging ALL OF IT. I have the proof. I even gave it all to my family doctor who wrote me a letter stating as such. I also gave them (bariatric office) a copy of my proof. I asked her if she thought this would be sufficient but I still haven't heard back from her (9 business days later, after a repeat email 2 days ago). The fact that she isn't getting back to me is making me anxious (and really annoyed). I don't like to be kept waiting on a simple question and I think it's really unprofessional to not call someone back even if you don't have answer for them. In the email, I told her when my psych eval is... I'm hoping she's not waiting until I have that to get back with me. Or if she is, a heads up would be nice.

So here I am, waiting again. For a response from the revision nurse. For my next appointment to happen. For insurance approval. For a surgery date.

So much waiting.

Friday, March 16, 2018

Deja vu

I feel like I'm having major deja vu. The revision process is a literal repeat of all the processes I had to go through to get approval for surgery when I got my band.

I've scheduled and had to reschedule a revision consultation with my surgeon 4 times now due to scheduling (on my end) and insurance coverage rules (on their end). But I have it set now (for April 10) and hope to keep it that way. This consultation will be very similar to the first time - it's scheduled to be 4 hours long with a presentation in the beginning, what to expect, how it works, etc. Then a meeting with the surgeon to talk about what procedure I'm looking into and what he thinks would be best for me. And finally a meeting an insurance specialist for prior authorizations requirements. At the end of this appointment, I will also schedule my psych evaluation. I was hoping to get it done here but it seems it's going to be easier to just get it done at the office (albeit, $150 is required up front for this appointment and I would have to submit a claim to my insurance afterwards).

Once the psych eval is completed (and I pass), then they will submit the request to insurance to approval. I just realized it may take a little longer than usual as well because of my dual insurance. I'm not sure if once the first one is approved they can get the process started or if it has to be approved by both before we can continue. Which leads me to my next bit of information...

I just found out (literally, just now) that my primary work insurance now covers bariatric procedures including revision! I am shocked. I'm literally shaking. I had NO IDEA they changed the policy to cover anything bariatric. From the looks of it, it was changed effective Sept 2017. Which is AWESOME because that also means it's covered a few of my past appointments with my PA as well. This also means I now have dual coverage insurance and will likely not have to pay anything out of pocket for my surgery!!! O. M.G. I cannot even breathe right now.

I've been perusing gastric sleeve groups on Facebook lately. I want to be as prepared as possible for this change. I ask questions when I think of things I haven't seen concrete answers to. I know I can do it, but it's been a long time since I've been pre and post-op surgery and I didn't have 2 kids then. Hopefully I can get the surgery while my mom is still here for the summer (She usually leaves in October). I've also been watching a TON of YouTube videos of people who have had sleeve and even revision surgery. So far I haven't come across anything shocking or unexpected thankfully. I do know that I will have to seriously keep up with water intake if I want to avoid dehydration and a hospital visit (which I definitely do not have time for). Once I have this consultation, I intent to start making small changes here and there with my diet (cutting out chocolate at work, snacking less, less carbs + more protein), practice eating slower and taking smaller bites, and working on my water intake. I know all of these things need to improve if I want to succeed this time around.

I can't fail. I want to get back to a size where I'm happy with myself. I want to fit into my clothes again. I want to get to a size where I can get a panniculectomy and get rid of this stupid tire around my body. I do worry what it will do to my boobs, but in the long run I know it will be worth it...and if I hate it that much I will save up to have them fixed (probably in Mexico because it's WHOA cheaper there and they have special hospitals that cater to US bariatric patients).

I'm so torn right now about how soon I want to get this surgery. I shouldn't be in a hurry because that will just make speed bumps more frustrating. Ideally, summer would be awesome but winter is going to probably be more likely due to the 6 months of doctor supervised dieting requirements. (Unless the surgeon's office has a miracle worker and can prove I've been actively trying to lose weight all this time because I really have.) Right now, I hope to get that started next month which would put me out to September at the earliest, unless I can convince them the appointment I had in February with my family doctor was the start of it (it was the first time I mentioned revision surgery) but it also has to be consecutive and I didn't see her this month. See why I'm trying to NOT get in a rush? But on the inside I'm screaming and flailing around like a crazy person crossing my fingers for a miracle.

I'm also meeting with my therapist tomorrow to get a letter of recommendation from her. It's not required and I still have to do the psych eval with their psychologist but I don't think it will hurt anything and I want to be as prepared as possible. On top of the psych eval and the 6 months of doctor visits, I believe I've already met all the requirements for revision surgery (like being fat and whatnot).

At the risk of jinxing myself, things are looking up!


Wednesday, March 7, 2018

The road to revision

So. Here I am again. 8 months have passed. Nothing has changed. My last fill did nothing but made me get stuck more often and PB or throw up at least every other night. I kept it that way for about 6 months, constantly telling myself it was just me and I needed to try harder.

But then I got tired of it all. Tired of counting calories, logging my food, thinking of everything I put in my mouth, thinking of what I can't put in my mouth for fear of getting stuck (again), constantly being frustrated with no changes, always feeling hungry, still not losing weight (but not gaining either). Just so tired. Over it.

About 6 weeks ago, I went to my PA and told her this. I was over it. Always getting stuck, always getting the questions from the kids and the looks from my husband when I got stuck. Nothing changed. No matter if I ate well or like shit. My portions were NOT as small as they should be but getting more of a fill would just make things worse. So I got a 1 cc unfill instead.

Sweet relief, I can eat normally again. Good, but potentially bad right? My portions are 'normal' sized. I can eat bread and pasta for the most part (less taking giant bites of course). No weight loss obviously, but no real gain either.

She ordered a ton of labs to check everything. Vitamins, hormones, thyroid, insulin. They came back all normal. I got an upper GI. Normal. Everything is 'fine'. Yesterday, she offered to put another 1/2 cc back in. I made a face. I told her I was over it. I loved my band before kids, but now it's just not working for me or with me. The stress of 2 little boys makes my band close up every night when I'm in the green. Then I can't eat at all and that's not how I want to lose weight. I'm already working on my mental health to deal with it that way but I know it won't be enough. I told her I wanted to look into revision to sleeve. I was ready for the more permanent solution. I was worried she would laugh at me and tell me I couldn't because this was all my fault.

But she didn't. She understood. I got a call from the Bariatric Center that afternoon for a revision consultation appointment. Basically another 4 (ish)-hour informational presentation and pre-surgery appointment to talk about the pros and cons, how it works, risks, etc. I will also find out if they do it in one or 2 procedures. Some surgeons take out the band and then wait a few months for the stomach to heal - others do it all in one go.

So now I'm starting all over again. Consultation, another psych evaluation (with a letter of recommendation from my current therapist) paid for out of pocket for $120, then they will submit to insurance.

My primary insurance will not cover any type of bariatric anything. This is all going through my secondary. Once initially approved, I will likely be doing another 6-9 months of 'doctor supervised' weight loss appointments before surgery will be approved.

Ideally, I wanted to be able to have this surgery in the summer when we weren't busy in my office. I got a promotion and I am the lead now so I don't feel comfortable taking time off work during the school year (especially in the fall semester when we are most busy). Ideally, I would only take off one week for surgery since I have a desk job but I may have to prepare for more than that just to be safe. I've talked with my manager already about my plans. If I can't do it right before the semester starts (so the beginning of August), I will probably put it off until December (to allow the semester to wind down). I'm not in a rush this time around, I just know I need to do something else. I'm also trying to psych myself up to start obsessing over my food again for a while. I won't lie, I'm not looking forward do it, but I'm hoping my mindset will change as the process continues. (I won't have a choice really.)

I'm frustrated it has come to this. I'm mad that I even needed WLS in the first place. Balancing the concept of body positivity and loving yourself no matter what with completely altering your insides and eating barely anything just to lose weight is a hard line to walk. I hate the way some WLS people talk about their bodies (past and present) and I hate the way some body activists shame people who try to diet or get WLS. If I ever find out how to achieve that perfect balance, I'm going to write a book about it.

Tuesday, August 8, 2017

Self-doubt is a real bitch

Well, after a day of research, watching videos, reading blogs, talking to insurance providers, I've realized I need to re-think my priorities and be honest with myself regarding my efforts with my band.

Yesterday I spoke to my new secondary insurance provider. They will cover my fills and if I pay for the premium coverage for $25 a month they will cover any type of bariatric surgery that I may want or need in the future (whether it be a revision or a repair). So I'm definitely going to upgrade my insurance no matter what. It would be silly not to as it will save me so much money in the long-run. 

I also spoke with my husband last night. Told him my fears of my band 'failing' and the pros of a revision. He didn't say no immediately, so that's a plus. He did ask if I had some type of time frame in mind (which I didn't). He feels I need to give my band more time and make more of an effort as well (he suggested at least 2 years)...after thinking about it and facing some hard truths... He's right about my (lack of) efforts. 

When I jump into things, I generally want them RIGHT THEN. Once I make up my mind, I do anything I can to get what I want. But I need to take a step back. I'm obviously frustrated with myself and my lack of progress. I haven't really even been trying very hard to control my portions or what I'm eating because I'm NOT in the green and my home life is stressful. Knowing I won't have time to work out on a regular basis next semester also has me feeling some kind of way. I was working out 3-5 days a week last semester and even though I didn't lose a single damn pound, I felt GREAT. I was getting stronger. It was my place to work out my frustration and just overall feel good about myself for making progress with SOMETHING. Now I'm losing that and I'm very sad about it. It also means I will have to be more strict with my diet if I'm going to shed any pounds whatsoever. 

This is all assuming this fill I have scheduled for Thursday will put me in the green. God I hope it does. I am going to be super busy at work when the school semester starts and I will not feel comfortable taking time off work any time soon. Which means the soonest I could get another fill without missing work would be Fall break...which is October 9-10. Oof. 

No, I'm not taking revision to sleeve completely off the table at this point. I still want to talk to my surgeon and get her take on it. See when she considers the band a 'failure' and what the revision process would look like and maybe a rough time frame. I'm going to be completely honest with her about my efforts, stressors, etc. My husband is going with me so he can ask any questions he has...or put in his 2 cents about my choices (which I know he will). 

I have to be honest with myself if I want to see any results. If I can't follow through honestly with my band, why would I be able to do so with a sleeve? I'm just going to remind myself to think long-term instead of short-term. It's all I can do at this point.



Friday, August 4, 2017

Hair-brained ideas

So I scheduled a fill for next Thursday. I'm hoping to get into the green finally but my hopes are not high. Every day I get more and more worried that I'm becoming one of those statistics of failed lap-banders. Unable to find that sweet spot again. Always too loose or too tight. Stuck in purgatory.

Who's fault is that? Mine? The band? Both? Could I try harder? Always. Is that feasible? Maybe only partially. Is my band even feasible for me anymore as a busy mom of 2? This is what I'm struggling now. What do I do? Chris doesn't like me getting fills because I'm getting stuck a few times a week at dinner from eating when stressed or too fast. It upsets him to see me in pain. It hurts him to have to dodge questions from our 4-year-old on what is wrong with mommy...and it hurts me too. But I got my band for a reason and I WANT to use it. It's worked before and I hate thinking it may not work for me again like has happened to so many other people.

I've also been shamefully researching revision surgery from lap band to the gastric sleeve. I have a friend who recently went to Mexico to have the sleeve done and she is doing great. We talked about it throughout her process. Now I'm getting the itch. I always told myself I wouldn't get anything more than lap band... but now I'm reconsidering and I don't know if I'm thinking clearly or if I'm thinking out of frustration.

I need a list of pros and cons. I need to know if my (new) secondary insurance will even cover a revision. As you may recall, my primary insurance does not and will never cover anything bariatric. I need to see if my husband would just flat out say no due to the severity of the procedure itself.

Pros: Faster weight loss, no more stuck episodes, more likely to be able to get panniculectomy down the road (and sooner rather than later), no more fills, less feelings of hunger

Cons: Any potential issues or scar tissue caused from lap band, increased risks after surgery (leaks, perforation), more invasive surgery, chance of regain (lower than lap band), longer recovery time (2-3 weeks), risk of permanent GERD, slight risk for vitamin deficiency (B12, iron)

While the cons are scarier, the pros are big. I just don't know what to do how to feel now that I've admitted to myself this is something I would consider if my insurance covered it. I feel like a hypocrite and failure and cheater... I guess we'll see how my surgeon feels about it next week.