Monday, June 18, 2018

5 stages of grief

I've gone through at least 3 or 4 stages of grief in the last 2 hours.

Anthem finally denied my surgery but because of the lack of 6 months of doctor supervised dieting, instead of the fact that they don't cover sleeve. I told my insurance person this because she at first told me she can't submit to my secondary until it's approved by Anthem. I told her it wouldn't be because they don't cover the sleeve at all. She said she was going to look into it for me and if that was the case she would go ahead submit to my secondary. She is also adamant that they won't accept my proof of 6 months of attempted weight loss on my own and will not do a peer-to-peer evaluation unless there was something physically wrong with my band. So.... there's that.

I'm trying to stay positive but it's looking more and more like I won't be getting this surgery until winter time. Meanwhile, my weight is slowly creeping up because I've been more stressed than ever and apparently I use food to cope. Awesome. Still need to figure out how and when to start the Dr. V diet going forward. I need to talk to my husband about it this week.

I've started with a new therapist recently, so I'm hoping to work on my ways of coping with stress. I'll also be changing my meds this week for a plethora of reasons. Fingers crossed I find something that works and can calm these demons.

I'm trying to weigh out the pros of potentially having surgery in the winter. My 6 months of dieting would be complete in November. That means the earliest I would be getting surgery would be December but only if they aren't already all booked by then since surgery dates are probably going to be limited that month due to the holidays. Then, there is the fact that it's the holidays. Do I want to have a major surgery around Christmas? Christmas break for campus starts Dec 17. A week before Christmas. Do I want to be healing while trying to do Christmas with my families? I suppose we could just have them all come to us. It would be the best time in terms of getting days off that I don't have to use my PTO for and therefore potentially being able to take off more than a week.

I would still prefer to do it this summer, but the window is narrowing quickly. August is a HUGELY busy month for me. Xander starts KINDERGARTEN on Aug 6. Chris's birthday is Aug 3. August 6 is also when we are going to start scheduling new students for intakes which means we could potentially be busy well before the semester starts on August 20. I really don't want to be still healing when the semester starts because it's going to be insanely busy at work and I will need my mind in the right place.

On the other, other hand, if I have to wait until January, there is potential that my primary will finally accept and cover my sleeve and it would again be double-y covered. (It's a small chance, but a chance nonetheless.) Sooner is always better in my book when it comes to this. Once you make up your mind about something, you really don't want to have to wait a year for it to come to fruition.

This. Is. All. So. Frustrating.

Tuesday, June 5, 2018

Studying

Turns out the revision nurse is on vacation until NEXT Monday (June 11). I cannot tell you how frustrating it is that they only have one insurance approval specialist for revisions. So. Frustrating.

To kill time, I've been doing some research/prep in order to be as prepared as possible. I came across a doctor named Dr. Duc Vuong aka Dr. V. I've seen some of his videos before but I never really watched them. I figured it was all just the same crap I've heard a million times. But he has like 12 books, so I thought I would give him another shot.

I found his YouTube page and started watching videos. He has a HUGE selection of videos. From how you should eat, what you should eat, overcoming mental hunger, tips for success... just so many videos. He also some controversial thoughts on protein amounts and macros (that you don't need extra protein as a WLS patient) and exercise (that it is punishment and you should only do activities that make you happy and not all the time because you can't get in enough calories to sustain heavy exercise) as well as counting calories (you shouldn't because it's basically punishing yourself). Super interesting. Some of his stuff I don't necessarily feel is right for me, but I can see how his practices would bring about success.

I watched over 50 videos and took 2 pages of typed notes (because I'm a big research nerd - I'm pretty sure that's been established already). I shared this fact on some of my WLS Facebook groups and asked if anyone wanted a copy... 1 day later I have over 100 people asking for copies of my notes. 

Here are some of the things I agree with:

He has a great visual for the size of your new stomach - 2 fingers wide, 2 fingers long, and 1 finger length thick. He calls it your baby stomach. He stresses that the first 6 weeks are strictly about healing and cheating is the dumbest thing you could do. He also says to avoid artificial sweeteners, don't count calories, and don't exercise. (Crazy right?) 

He's also come up with his own "Texture Scale". It's basically a more comprehensive way of determining texture as opposed to the usual clear liquids, full liquids, mushies, solids categories. His consists of a scale of 1-6 and you are to determine where things lie. He also says the best place on the scale for weight loss and just being healthy in general is #3-4 on the scale. The scale is as follows:

1. Liquids
2. Smoothies
3. Soft Fish/Veg
4. Other seafood
5. Chicken (dark, then light)
6. Steak

I think he has really explained this well. All the healthy foods you NEED are included in #3-4 in the scale. You don't NEED chicken and steak. Technically, you don't even need fish. Especially with his thinking - you don't need as much extra protein as they always tell you AND plenty of WLS people are vegetarian and vegan.

Meal sizes are also put into a simple way to visualize. Meals should be the size of the palm of your hand (NOT including fingers). Protein should be the size of your thumb muscle the rest should be veg. Salads can the size of your entire hand because the lettuce breaks down to nothing. He encourages the chew 20 times, wait 30 seconds, take nickel-sized bites that most people do. He also stresses that if you feel weird or like you are going to regret that last bite to not be afraid to spit it out and spare yourself the pain of being overfull.

His meal plan is simple and strict. Green smoothie for breakfast (not a protein shake), salad with protein for lunch, healthy dinner. 8-10 servings of water. That's it. No snacking unless you are doing something strenuous and need the extra fuel. It's simple and to the point. Do I think I could NOT snack throughout the day? Maybe. I suppose that depends on how the surgery makes me feel. Snacking is generally my downfall at work so not being able to snack would be ideal. The size of the meals don't intimidate me at all since I'm used to those with the band. I look forward to being able to eat that much and feel satisfied again.

I haven't watched a few types of videos he has yet, like how to lose after regain and some of the mental stuff. He's a very good motivational speaker. Thinks logically, which I like. Explain the science behind it.

His thoughts on the feeling of fullness are interesting too. He says feeling hunger is natural but feeling fullness is not. We were not meant to always be stuffed after every meal. Our bodies were not made to sustain that type of lifestyle. I think that's a pretty solid way of thinking and helps to justify NOT stuffing yourself at every meal in order to feel satisfied. He says, "Fill it, don't feel it."

Naturally, he has a ton of books on beginning, succeeding, salad ideas, smoothie recipes, and "nuggets" of advice to help you succeed.

Overall, I think his way of thinking and ideas would be a good fit for me and I may consider starting his meal plan soon (just with larger portions).

So yeah, that's what I've been up to while trying to forget the fact that I have wait another week to submit to insurance and then wait even more to find out if I'll be approved or have to do the 6 months of supervised dieting. Still crossing my fingers, but not holding my breath.







Tuesday, May 29, 2018

Chirping crickets

Here I am. Still waiting to hear something....anything.

In the past 3 weeks I've just been impatiently waiting for any word from my surgeon's office. I saw my personal therapist and she wrote me a letter of support for my revision. I emailed it to the revision nurse and to the psychologist at the surgeon's office.

Last week I had my first official nutrition appointment with my family doctor even though I haven't heard back from the insurance person yet. I figured the sooner I could get it rolling the better just to be safe. I told her I was eating 1400 cals a day (or trying to), working out 3-4 days a week (goal) for 30-40 mins, seeing my therapist on a regular basis. She wrote all that down and basically said to just try to keep doing that but work out 4-5 days a week instead. Awesome. Can do...well I'm going to try. My life has been more stressful emotionally and mentally than ever before so finding motivation right now to work out has been especially hard.

The revision nurse emailed me back last week finally and said she was waiting for the psychologist to clear me in order to submit to insurance. So that's literally all I'm waiting for. She said she would talk to him and see where he is with that process. She verified they do have the letter from my therapist that I sent. I really hope he approves it today. The more weeks that pass by, the more stressed and anxious I get when I think about it.

There is still hope I won't have to wait until winter to get this surgery done. Keep your fingers crossed for me. I need some positive news in my life right now. My personal life is so stressful I'm losing hair at an alarming rate.

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!