PRE pre-op -- advice and direction, please! - ThinnerTimes

cnvh · 01-25-2006, 09:38 PM

Greetings all, I am completely new to this forum and am in the "seriously thinking about it but haven't spoken to a single doctor yet" stage. Any advice anyone may have is greatly needed!

I am 30 years old and have been overweight my entire life, with many obese people, plus history of all the obesity-related diseases, on both sides of the family tree. When I graduated high school, I weighed around 220 lbs.; currently I am at around 330-- which, at 5'3", puts my BMI in the mid to upper 50's.

This is my current highest weight ever. Previous highest was 318 lbs., about 4 1/2 years ago. In my life I have only made about 5 prolonged attempts at losing weight, 2 of which were serious and dedicated-- once at age 24, when I lost about 25 lbs., and again at age 26, when I REALLY buckled down and lost 80 lbs.

The 80-lb. weight loss was the result more of exercise than anything else. Although I did diet and count calories, I went head-on into a daily exercise regimen, whether with walking (2 1/2 mile route, all hills), my elliptical machine for 45 minutes a day, aerobics twice a week, horseback riding, bicycling, etc. I found out that as long as I made a commitment to being active, I could have some flexibility in what I could eat, still lose weight, and feel really, really good in the process.

Well, it wasn't easy but it did get easier, and everything was great-- until I broke my collarbone and got derailed from the exercise routine. After two months of healing and some weight gain (maybe 20 lbs.), I started getting back into things but a few months later, I badly sprained an ankle. That happened right around the same time as I started to get really busy with wedding planning for our marriage in October 2004, and after two serious injuries in a 4-month period, my weight loss plans pretty much just went haywire.

Weeks after the wedding, we rather unexpectedly ended up buying a house (hundred-year-old fixer-upper), so to say that the last 18 months have been stressful is an understatement. However, although up until now I really haven't had ANY major health problems (minus injuries) like high blood pressure, diabetes, etc. However, in the months since our wedding/house purchase, I've had a severe escalation in joint and back pain-- probably due mainly to putting on almost 100 lbs. in 18 months. Therein lies my problem-- the joint pain is severely limiting my ability to exercise, and try as I might, I am just not able to commit to a strict diet alone in order to lose weight.

My PCP is a firm believer in the "diet and exercise alone can cure everything" philosophy. After the ankle sprain, I approached her to see if she would be willing to prescribe Zenical. (I was probably about 260 lbs. at that time.) Well I practically had to beg for it, and she would only write a script for a 60-day supply; I instead got the "it's all a matter of willpower" lecture. (I felt like screaming at her, "lady, I lost 80 lbs. with willpower; if I didn't think I needed your help, I wouldn't be asking!") Needless to say, I expect to have to switch PCP's. (The Zenical, by the way, didn't do much; I took it exactly as prescribed and only lost about 5 lbs.)

As for insurance, I have Highmark Blue Shield in PA-- I called and checked, they DO cover the RnY procedure, but only with qualifying precert requirements met. Of course they wouldn't tell me what they were.

So: with a BMI at around 57 and no underlying conditions except joint and back pain, can I reasonably expect to qualify? Or will I have to wait until I am REALLY sick, like diabetic? What should I be telling/asking my doctor? Have I not dieted enough times, and will the fact that I lost 80 lbs. on my own make it look like I should be able to do that again? (Didn't have the joint pain before; now it's a whole new ballgame as far as that goes.)

Physically I have never felt this bad in my whole life, and to spend my remaining years like this feels like a torture sentence. But I am terrified that I will find another doctor that will try and get me to "eat healthier and exercise more." I think that's great advice for someone who has 10 or 20 or even 50 pounds to lose, but I just don't see how I can lose 200 pounds on willpower alone. (Who am I kidding, I would love to just weigh under 200 for the first time since adolescence.)

Sorry this was so long. Thank you for taking the time to read all of it...

riotgrrl · 01-25-2006, 10:12 PM

welcome! i am from pa also. what part are you from? im from the poconos, stroudsburg to be exact.
i have first priority health bcbs.
their requirements for my plan are:
35 bmi with co-morbidities such as high blood pres, diabates, etc.
40 or higher without
you must have 3 serious attempts at weight loss. you must have proof. doctors notes, prescriptions, receipts for any plans you have tried.
ww, overeaters anymous, doctor prescriped, etc.
letter of recomendation from pcp

that being said my plan is an hmo and everything i went through as far as seeing specialists i had to get a referal from my pcp.

i don't know whether they will aprove me or not. i have 2 more appts left of specialists. the nutrionist and the cardiologist. from what i hear, bcbs is the easiest of all insurances to get approved. also my doctor and nurse told me that if i am not aproved right away i can go on a physican assisted diet and try again in six months.
also the nutrionist and psych eval were not on my plan so i had to pay out 150.00 for each

ajmoe · 01-26-2006, 04:33 AM

If you can I would start by changing PCP. Find someone in the area that supports your insurance and supports WLS. You should also get together and documentation of previous weight loss attempts. If possible get anything from any program you have tried or medical records showing the weight loss or whatever. Doing this without your PCP backing you is very very difficult and you may end up jumping through more hoops for him rather than for the insurance company. Joint and back pain is a problem and you want to have that documented. So see your current doctor about it and get it documented that you are having problems. Also research about the surgery, know some facts and make sure you understand and if needed explain that you know what you are getting into. I don't know what your insurance needs but the more information you go with the better your chances. Make sure they know of a family history or problems as well.
It may take a while. Don't expect it to happen overnight. If you read the forum a lot of people have to make an appeal to the insurance company and most of the time it takes a while.
Keep letting us all know what is going on. These are great people here and they will support you and give you lots of advice.
It is true that we might be able to lose all of our excess weight on willpower alone but keeping it off is nearly impossible. If you feel you can do it, that is wonderful. Read about the surgery and decide what you feel comfortable with doing.
I am 31 and have been overweight most of my life. I feel that WLS is right for me because I don't believe that I can accomplish what I want to accomplish with out this tool in my toolbox.

Good luck. We are all here for you on your journey.

Dave · 01-26-2006, 06:30 AM

My insurance only requires a BMI of 40+. I also have/had acid reflux and sleep apnea along with back and joint pain. I also had to have my doctor write a letter of recommendation. That's all it took for me to get approved.

I am about 6' and was at my all time high of 370 before I had WLS last month. Now I'm down about 37 lbs in a month. My last diet was the most successful one I had been on. I lost 70 lbs on Atkins and exercise. Then I had my tonsils removed and that threw me off and the weight gain started. I was down to 270 lbs during Atkins and then shot up to 370 lbs after I fell off the program. I felt out of control and desperate. That's when I started looking into WLS. So far I'm doing great and would do it again. Now I'm just working at getting down to my goal weight! Surgery is a big deal so do your research and think hard about it.

Bypassingme619 · 01-26-2006, 06:35 AM

I so agree change your PCP as soon as possible, no need to waste your time with someone who isn't going to support your decision. You have the rights to an outline of what your insurance company will cover. There is a name for it, you can call and request one to be sent to you. Don't take no for a answer in this WLS journey. There may be some bumps ahead but stay focused. I hope everything works out. Welcome aboard.

coptergirl · 01-26-2006, 07:46 AM

Yes yes yes - change PCP's as son as you can, start reseacrhcing the surgery now so that you can go in armed with info in case you need to educate him/her, make a list of all of your weightloss attempts, and attach proof if you have it. You will prove to your PCP thatyou're serious and understand the surgery and its risks. With a 57 BMI and your joint pain, I'd say you have a pretty good case. Try this PCP with the info and documentation forst and if doesn't work, switch.

Oh (hehehe), now that I am off my soapbox, welcome to the forum. There is ton of info here form real life experiences - this is life extended family!

cnvh · 01-26-2006, 11:56 AM

Thanks so much for everyone's responses. I did browse these forums for a while before posting and know that you are all a wealth of information, and I'm so glad to see the support is so free-flowing.

I had my annual checkup with my gynecologist this morning, and I shared my concerns with her. She is a wonderful, caring, and compassionate person, and really made me feel better that I may be on the right path in considering WLS. Oh, how I wish she was my PCP!! She gave me some good, specific points to discuss with my PCP, though, so the next step is to schedule an appointment with the PCP to discuss the joint and back pain issues. Before I even do that, I think I will have a few nights sitting down at the computer, detailing every major or minor attempt at losing weight, every ache and pain, etc., as many of you suggested. I'm sure that will help, and also give me confidence when/if the PCP tries to be dismissive. (I'm giving them one more shot, at least to address the joint issues and get it documented in my chart; if they blow me off, I'm switching.)

Oh, and I overestimated myself-- I had guessed I was around 330 lbs., I'm actually 318. WOOHOO, hahahaha.... BP was 138/88, which my OB/GYN calls "pre-hypertensive." (Usual BP for me, as in 50 lbs. ago, has always been on the low side, around 110/70.)

riotgrrl, I am also originally from the Poconos; I was born and raised there, about 20 minutes from Stroudsburg. Small world, huh?

amjoe, it's so true about the willpower issue. Once I got into the groove of things, (which took at least a month of cussing and b*tching on the elliptical machine), LOSING the weight really wasn't the hard part. KEEPING it off, however, has proved to be a different matter entirely. It's at the point now where it feels like every time I try and make some progress, something happens and I bounce back, put it all back on and then some. I guess that's what they mean by Yo-Yo...

I'll continue to update as things progress, and I'm enjoying reading everyone's posts... Being here definitely provides a sense of comfort that I'm not alone in this!

riotgrrl · 01-26-2006, 12:23 PM

thats awesome. i have lived in the poconos this time for about 5 years. it's nice but it has really changed since i was a a little girl living here.

proper documentation is the way to go. i really hope your doctor has been doing it all along.
unfortuntely my original pcp never documented anything! he left the practice and i was given a new pcp by my insurance but didn't see her for almost a year, they always sent me to the pa.. well she never documented anything either. i have yet to find out if that will harm me. everyone i have talked to seem pretty omptimistic now that i have it documented that it will be o.k.

your right about keeping it off. i lost 60 lbs last year but have gained almost half of it back.

janh · 01-26-2006, 01:47 PM

Just a quick note--I also have Highmark BC/BS of PA-so I can tell you what the requirements are. First of all-you do have to have a letter of support from your PCP-so if you can't get that-it is time to change Drs. A six month Dr. supervised diet is also required-where the Dr. takes notes on what he/she discussed with you at each appointment and notes your weight. Also, you will need to have a psyc. eval and a nutrition consult-after you meet with your surgeon. A BMI of 40 or greater is required unless you have a few comoribites-ie high blood pressure, diabetes, sleep apnea ect...

okiegrl · 01-26-2006, 01:47 PM

Quote:

Originally Posted by cnvh

My PCP is a firm believer in the "diet and exercise alone can cure everything" philosophy.

Change your PCP as soon as possible...there has to be one there that will agree with WLS. I had a PCP that was the same way and I went through hoops for them, only to do the yo-yo. I switched PCP's and after two visits, he agreed that WLS was the way for me. Best of luck in your search.