May 9th, 2011
So after going round and round with the Drs office and the Ins company my PCP finally decided that he would write the referral letter to the WLS surgeons without completing the Sleep study. The WLS protocol is to screen me for it anyway prior to surgery so hopefully we can figure out the insurance and co insurance I owe by then.
But what that means is that the WLS surgeons are willing to see me for my initial consultation. My appt is this Friday at 2pm PST.
I have to say I am a little nervous but mostly excited to take this next step!
May 14th, 2011
So I went to my appointment this afternoon. The surgeon is super nice and I had an immediate connection to him. He has 3 kids in similar ages to mine. He answered all my questions fully and took lots of time explaining everything to me. We went over my medical history and talked about the RYN surgery in depth. Then he did a quick exam to check out my previous scars (gall bladder surgery) and to see how big my liver is. A few things to note.... The Dr told me I was one of the "healthiest" morbidly obese people he has seen. I have a BMI over 40+ but have no other co-morbidities. My BP was 122/72 today. He does not think I have sleep apnea. After we talked about my sleep etc. we both think that I am sleep deprived because I am a mom of 4 with a crazy volunteering schedule and a toddler who co-sleeps & nurses 1-2x per night, He said he will not require a sleep study! Woot!!!! Also he said that he doesn't care if Harlie is still nursing while I undergo surgery. He did say that my milk will likely dry up as I start to lose weight. But I am OK with that because it seems that would be a gradual process and Harlie would have no choice but to wean. Win-win I think! At any rate it is one less thing I have to worry about doing before the surgery. He also said that he wants me to lose some weight before the surgery. I guess it will help my liver become more healthy and therefore make the surgery easier. A healthy liver is a good "consistency" and since they have to retract the liver to get to my stomach they want the liver to be a good consistency. Apparently obese people's liver is enlarged and flabby. If I lose even a small amount of weight 15-20 pounds it can make a huge difference in the consistency of the liver. Who knew?!?!? LOL So he wants me on a smaller portion diet and wants me to try to eliminate carbs as much a possible. And exercise more The next step is to get the pre-pre- auth from my ins co. That is where they tell me what they will require before they authorize the surgery. Pysch evaluation, blood work, etc... This is also where they may require 3 or 6 mos supervised by Dr. diet and exercise plan. I will find out all of that next week. So I am feeling good about the appointment, I am anxious to move forward. It was weird to walk into a Dr office that caters to Obese people. Huge arm chairs. Extra wide Exam Tables. Wrist BP cuff instead of Arm one. Huge in-floor scale. I am still processing how I felt about all that... emotions ranging from embarrassment to shame to ..... I don't know. Like I wished I didn't need their services. Dr thinks that the timeline I am on and that most of his patients are on is 8-12 weeks out from surgery. I might have to do 3mo of diet with my Dr but he doubt that I will have to do 6. And because my last appt in March with my PCP was about weight loss... that should count and I am technically in my 2nd month of dr supervised diet. He thinks I should be able to have surgery this summer. Probably August. We will see. May 31st, 2011 After my appointment with the surgeon I made an appointment with my PCP to talk about weight loss. I basically did this so if my insurance company did require 3-6 months of a supervised diet I would have 2 months of it already started. They weighed me in and I had lost 8 pounds since my previous appointment. And my BP was even lower than last time. Something like 118/66 . Dr was pleased and told me that he will write up a letter to the surgeons to say that I have been on a supervised Diet/exercise plan since March, so 2 months into it. All good things. My PCP is still harping at me about the sleep study. He recently read a study that people trying to lose weight and have untreated sleep apnea have a very difficult time losing fat mass because of improper restorative sleep. Basically without restful/rejuvenating sleep your body holds onto the fat mass and instead losses muscle mass. PCP wants me to do the sleep study. So last week I called and schedule my sleep study for June 9th. Then the next day they called me back and told me they had a cancellation and could get me in on the 26th. So I did it. The sleep study was not fun. 15 or more wires attached to me with adhesives and paste. In my hair, on my face, on my legs. Some kind of monitor up my nostrils. Oh and 2 tight straps around my waist and upper chest. Ugh. The sleep tech of course could not "read the results" of the sleep study but I was not "bad enough" to have them add the cpap during the night. I guess if you have enough sleep apnea episodes during the the first 2 hr they put you on cpap to complete the last 4hrs of the study. I did not need cpap. Last week the surgery case worker called me to tell me that she got the preliminary requirements from my Insurance company. They are requesting a psych evaluation and a Physical Evaluation specifically of my heart and lungs to make sure I am healthy enough for surgery. ******They do not require ANY supervised diet and exercise program at all***** WOOT WOOT! Next week I have an appointment to get a physical and my sleep study results from my PCP. I called to get an appointment for the psych evaluation but the surgeons have to refer me for my Ins to cover it. So I am waiting for the referral. I am gonna follow up on that tomorrow. Once we have those things accomplished the surgeons group will send the whole packet of my history and all the required stuff to my Insurance company for approval. I think they can take up to 30 days to decide. Once we get approval then my Ins co will tell me how much of it is my responsibility to pay for. Then the surgeon group will start all the pre surgery tests, blood work, dietitian appts, and special liquid diet. Then they will schedule surgery. My portion of the $ is due 2 weeks prior to my surgery date. After I pay they will confirm my surgery date and time. I am excited. But nervous. I think I am holding my emotions back until we get the final go ahead from my Ins Co.
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