Monday, June 19, 2017

Fill tomorrow

I have my first fill in almost a year tomorrow. I'm a little nervous, a little excited, a lot hopeful. I know this is going to be a struggle - I KNOW. But I have to prove to myself and my husband that I can do this (again) and show some damn self control.

I haven't had time to work out consistently and I won't for a while (ever?) so I know I need to get my diet under control if I want to get these 50 lbs off (again). As a bit of motivation I got the requirements of a medically necessary panniculectomy per my insurance. I was worried it wouldn't be covered at all - but it is!

Medically Necessary:
A.  Panniculectomy is considered medically necessary for the individual who meets the following criteria:
  1. The panniculus hangs below the level of the pubis (which is documented in photographs); and
  2. One of the following:
    1. there are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers, that do not respond to conventional treatment (for example, dressing changes; topical, oral or systemic antibiotics, corticosteroids or antifungals) for a period of 3 months; or
    2. there is documented difficulty with ambulation and interference with the activities of daily living;
  3. Symptoms or functional impairment persists despite significant* weight loss which has been stable for at least 3 months or well-documented attempts at weight loss (medically supervised diet or bariatric surgery) have been unsuccessful; and
  4. If the individual has had bariatric surgery, he/she is at least 18 months post-operative or has documented stable weight for at least 3 months
*Significant weight loss varies based on the individual clinical circumstances and may be documented when the individual:
  1. Reaches a body mass index (BMI) less than or equal to 30 kg/m2; or
  2. Has documented at least a 100 pound weight loss; or
  3. Has achieved a weight loss which is 40% or greater of the excess body weight that was present prior to the individual's weight loss program or surgical intervention.
B.  Panniculectomy is considered medically necessary as an adjunct to a medically necessary surgery when needed for exposure in extraordinary circumstances.


So according to this, if you take my original surgery weight into account, I need to lose these 50 lbs (or more), maintain for 3 months, and maybe have some type of rash with it (which I already have occasionally). The only clarification I need is if those numbers (1-4) ALL have to be met or just one of them? Things to think about while I do this. 

As usual, I have some doubts in the back of my mind but I'm trying to think positively. I did this once and my life was stressful, I can do it again. I am stronger than I was before in so many ways, there is no reason I shouldn't be able to do this. I just need to think about myself for a change and make a better effort to THINK when I eat instead of eating mindlessly to avoid getting stuck and being miserable. 

I'm not even worried about all the food I won't be able/shouldn't eat. I've been to the point where I can't and don't want carbs or chocolate or whatever else I shove in my face even if I'm surrounded by it, so I know I can handle it. Here's hoping this one little push of a fill will be what I need to finally need to get back in control. 

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