Dukemom

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I have to say that having my RUNY in 12/13 is the best thing I've ever done for myself.  It cured my severe GERD, gastroprosis, sleep apnea, hypertension, and other medical difficulties.

I reached my goal of ~130 in September of 2014.  Since then, I have maintained my weight between 125-128.

If you want to ask my any questions, please email me @ [email protected]

After Mayo re-coded the pre-op visits from 10/7 (just changed the order of diagnosis codes), BC/BS paid at 100%. 

I spent yesterday morning back at Mayo:  more lab work, pre-admission paperwork, saw anesthesia and the surgeon.  I have been officially cleared by all of them.  The best news?  Since I have been doing a liquid diet on my own since my initial bariatric consultation in early October, I have lost over 10% of my body weight.  (More if you go from my highest weight in August.).  So - no Medifast prep and no bowel prep.  Woo hoo!

Today I have to bust out the shovel.  Our son and his girlfriend are coming for Thanksgiving.  The scary part is they are bringing their respective dogs, and we already have an English Golden.  This house should be wild until Sunday!

Happy Thanksgiving!

When I first started thinking about WLS, I called BC/BS and asked if my policy covered the procedure.  The answer was yes, and all that was required was a letter of medical necessity.

Before my first round of pre-op exams and consultations, I received Mayo's packet of information.  They had specific questions for me to ask my insurance company re:  accepted codes, pre-op nutritional and psychological consultations, whether my plan had any exclusions, etc.  According to the woman I spoke with, all was covered with no restrictions.

My bill for my first pre-op visit at Mayo arrived and all the claims were denied.  I have spent HOURS on the phone with BC and the best they could come up with was that the claims were denied because the code that was listed first (for morbid obesity) wasn't covered.  Now if the code was even 2nd in the list of codes, it would have been fine (so they say).  I pointed out that I had done my due diligence and called and asked all the right questions.  I acted on the information given to me by one of their representatives.  I also pointed out that the code for morbid obesity is required for the letter of medical necessity to have the surgery.  If they cover the surgery, and an in-network physician in an in-network facility tells me there is a series of exams, consults and evaluations that are medically necessary and that  I MUST complete in order to  have the surgery, why on earth would they not be covered?

Mayo was much nicer and more helpful.  For starters they have put my account on hold until January, so I don't have to cough up the cash until the issue is resolved with the BC.  The billing person said if BC said the problem was the code that was listed first, he would send the claims back to the coding department to re-code them.  The re-coding has been completed and the claims will be submitted to BC again in a week or so.  If BC denies them again, my first stop with be with a supervisor in the claims department at BC.  If that fails, I fill an official appeal and lay out that I was told by them versus reality.  I shall not go down quietly, and I shall not quit.  There are apparently several levels of appeal after the initial appeal, and I will bury them in paper.

Regardless of BC being so difficult with the required pre-op workups, I am excited  for my final round of appoints pre-surgery, Tuesday 11/19.  The only other pre-op requirement is a day long nutritional workshop to which I have to drag my husband .  (He's fine with me doing my own thing with food.)

I'm in full fight mode with BC/BS - and I will fight to the end. 

I am still pre-op for 12/18, but I've been trying to live the post-op lifestyle for a couple of months now.  I've lost 32 lbs (only ~ 120 lbs to go).  My mother says she sees the weight loss in my face.  The only place I've noticed a difference?  My wrist!  My watch, which was once tight, now slides around so the face of the watch is facing downward.  I easily spin it back to the right position easily (only to have it fall back anyway).  Of all the places I need to lose weight, my wrists would be my last choice!! 

A message from a friend here on OH prompted me to write this blog.  She has been struggling with whether or not to tell a group of friends about her upcoming surgery.  I've been wrestling with the same decision.  I have told my family and close friends, but I've been wondering how to handle things with my church.  I have told my Priest and one other person, a very good friend.  Our church is small and we are like family.  If someone is missing on a given Sunday and the priest doesn't know how she/he is - he will ask out loud if anyone knows about that person. 

My absence on a Sunday and Christmas Eve will be noticed. While I know everyone will support me, I still find it hard to share the information.  Why is there still such a stigma regarding WLS?  It's not like it's cheating or 'taking the easy way out'; it's a lot of hard work for the rest of our lives.  I've come to the conclusion that the more of us who share our stories, and inform the public that there is nothing easy about WLS, and that we have to change how and what we eat for the rest of lives - THEN maybe the stigma will go away and the public will see WLS for what it is:  a tool, not a magic panacea.

The surgeon's assistant called me today.  They are saving December 18th for me, as long as I clear my final medical clearance on November 19th.  Assuming I get that, I have to go back two weeks later to meet with the surgeon and take my long nutritional class (with husband in tow).

I am blessed with a loving and supportive family.  Our son, daughter, SIL, and grandson (who will be 1 in December) are coming for Christmas.  Both have offered to take off from work (they each live in different parts of the country from us) to stay at our home to help my 89 year old mom and watch our dog.  They both also offered to have Christmas in Jacksonville if needed.

I am being selfish and putting my own health and well being over my kids and husband.  I know I'm throwing Christmas into a tailspin this year, but I finally believe I'm worth it.  Besides, if all goes well I'll be home on December 23rd, and Santa will know where to find us. 

I am sure we all get to the decision to have WLS via different avenues. 

My history with my weight is much like that of everyone else.  I have struggled with my weight almost my entire life.  Up until and through elementary school, I was a “normal” weight.  In middle and upper school, I wasn’t ‘fat’, but probably was 5-10 pounds heavier than I should have been.

In college, I gained about 20 lbs over the first two years (living in a dorm).  My last two years were in an apartment.  I got married right after graduation from college, and my weight was 155 lbs.

My highest weight when pregnant with our first child was 181.  With our second and last born, I broke the 200 lbs. mark.

While our children were growing up my weight was constantly up and down.  My ‘thin’ times I was 155-160; for the most part I was able to keep my weight under 180.  In the late 1990’s, I let my weight get up to 240.  With a drastic diet and a ton of exercise, I dropped 100 lbs. in 5 months.  I was only able to maintain my weight in the 140’s for a short period of time.   After that, my weight started to creep again.  I bounced around between 150 and the 190’s for years.  I have kept a written record of my weight struggles beginning in November, 2005 – when my weight was 225.

Over the years, I have tried Jenny Craig and Nutri System several times.  I have done Weight Watchers online.  I have been on the HCG diet, administered with acupuncture.  My internist has had me on Phentermine, 37.5 mg, for several of my weight loss successes.  Every time I have lost weight and kept it off for a period of time, I had to exercise religiously.  Currently I have been on Phentermine for months without any success.

Due to an autoimmune disease, I have been on Prednisone for 2 years.  Needless to say, my weight continued to climb.  I have been going to The Mayo Clinic for referrals with various specialists.  The GI doctor I saw there said I needed surgery for GERD, but because of my weight I can't have the standard surgery done.  He said the only way to fix my severe GERD is with the Roux-en-Y; he then referred me to the Bariatric Team there.  I go back November 19th.  They are expediting the process because my current insurance policy won't be offered after December 31st and all the "Metal" insurance plans being sold by BC/BS exclude bariatric surgery.

The good news of all of this is that if all goes according to plan, I will finally be rid of my GERD and gastroparisis (a condition secondary to my autoimmune disease, in which my stomach does not empty properly).  Changing my lifestyle and my life and losing weight are all wonderful co-benefits of the surgery.

When I saw the GI doctor at Mayo in August, I was at my all time high of 290 lbs (I am 5' 8").  Today my weight is 267; I have been trying to eat the way I will post surgery since my first Bariatric Consultations earlier this month.  My goal is to lose another 17 pounds between now and my surgery, which hopefully will be in late December.