lefty

Sorry that you have had a bad time of it. I am confused a little, though. Did they remove your band and port, then? It's very gracious of you not to blame your Doc, but hey, what exactly went on to cause not one, but two perforations? I think you have every right to whine, you've had a miserable go of it and it sounds like you have a ways to go before you fully recover. It is fortunate that you are a nurse and know what to look for if things start going south again. I hope you have a speedy recovery and are feeling better soon.

You're right, you could get that infection anywhere. Have you been in touch with the original surgeon? Will he put your port back in at any significant savings? Is the new doctor willing to follow up on you regardless of where you get the new port installed? If it is a matter of the money, then the original Dr is probably cheaper, but, once bitten, twice shy. I would be more comfortable with the closest surgeon that can monitor my recovery. Not much help, am I?

Hey, I'm all those things and I new it, so maybe that is why they let me make my own health decision..........

I think if you are getting hungry too soon and are having to really work at sticking to the bandster portions, then regardless of your loss, you need a fill. It sounds like you are having to work at the loss and while 4 pounds is OK, it's not optimal, either. But, as the other bandster said, you have to be careful not to get too much of a fill and end up having to get some removed--it's hard to have to go back in and say, guess you were right. I don't think he is trying to cheat you out of any fills, but certainly was wrong to compare your journey with others. Perhaps just a bad choice of words on his part?

Audrey, nice name, (my 18 month grandbaby's name) Anyhow, If I hadn't had an emergency appendectomy last year, I probably would have been really afraid about the surgery. But, that experience helped ease those fears. However, I did have major trepidation about the lifelong changes needed to live comfortably with the band. Personally, I felt it was right up there with getting married. (29 years, this month). When I got married, (really small, 5 people including the chaplain and us) I was so distraught, I got hives in the morning and my knees shook throughout the whole ceremony. My mind kept chanting, "am I doing the right thing, am I doing the right thing?" Then it was done and over with. I was banded on 4/23/07 and so far, it has been smooth sailing. I didn't have much post surgical pain and have not had any problems introducing food back into my system as scheduled. I hope to not treat this as another 'diet' but as a way of helping me to learn to eat normal servings at normal intervals. I will get my first fill 6/6/07 and my Doc will do it under fluoro. Frankly, I think the thought of that is more worrisome to me than the actual surgery procedure. Who wants to drink barium? I think it is great that this life changing surgery is available to you at your age. And, I agree, why wait to start living an improved life, when you can do it now? Congratulations on your decision and don't let people who don't 'get it' get you down. Cathy

Another thing that my nutritionist told me was that you need to keep your metabolism 'fueled' by eating at least 3 times a day at regular intervals. One of my pre-surgery issues was only eating when I was hungry--about once a day. Not good for weight loss efforts. I'm sure you will be able to do whatever is necessary to qualify for your surgery. Cathy

Youtalk, I found posted on the incision thread a post by Babygotback, she was a 31 BMI at the time of surgery. She got it done in Mexico. There is some discussion there that you can read at this link: http://www.lapbandtalk.com/showthread.php?t=6117&page=20 While it's true, that insurance won't help you with WLS at a lower BMI, there are some surgeons in the U.S. that will consider it for cash payers. In WA. state, one such place is at: http://thelapband.com/ .

Good luck to you! Although, I'm sure you don't need it. I had my band placed on the 23rd. I am doing ok, pain about a 3. Went ahead and went to my monthly support meeting (I was bored and hadn't had any pain meds yet, so what the heck) Stopped at a casino on the way home and made $150., but was dragging at about a 5 (on the scale) by the time I got home, so NOW I am appreciating the meds. lol. Been burping alot, but think that is normal with getting rid of the gas. Let us know how you make out. Cathy H.

Both are nurses. Both have lapbands. Both try to dispense helpful information for people. Jessie is at the yahoo group and Sandy is at obesity help. I know Jessie has written a book that is on an everyday level that has been published. Sandy has also written some things about lapband, but I haven't explored that further. There has been a lot of discussion about Sandy on the complaint forum here. About the only thing I don't like about smartbandsters is that they tend to push the one clinic so much, it feels as though it is a forum for that clinic only. I tend to read what I can to help me to know what to expect and to make my own decisions based on what my surgeon (and of course, they ALL have different opinions, as well) might recommend. Some of the info is very helpful, and some, well.................you know how that goes..........:huytsao Cathy H

I guess I'm a little loopy today, have sinus thing going on.........that surgery will be at Puget Sound Surgical at Steven's Hosp. I looked up the other one after posting, and see it's something entirely different. :phanvan

I'm having my surgery tomorrow at Pacific Surgical Clinic. Jessie isn't quite as preachy...... Cathy H.

Oh, I DO know what you mean. LOL :biggrin1: Cathy H.

errrr----her name is spelled Jessie AHRONI-- and her book is: Laparoscopic Adjustable Gastric Banding: Achieving Permanent Weight Loss with Minimally Invasive Surgery sorry about the typo. Cathy H.

I live in Washington and subscribe to another chat group at; SmartBandsters@yahoogroups.com. There is a nurse there (Jessie Arhoni [ she also wrote a L.B. book] ) that also works for one of the surgical clinics (Northwest Weight Loss Surgery, http://www.thelapband.com ), and she has posted the following in a reply to a very similar question last Feb. (the blue was the statement she was responding to): "Vicky: //At 54 pounds over weight, no doctor in USA will give me a lapband even if i will self pay// Actually that's not true. I know three who will do it if your BMI is greater than 29.9. :clap2: If you BMI is <30 your risks from surgery are greater than your risk of remaining overweight. That is why they won't do it." I'm pretty sure if that is true here, it must be true in other areas of the country. Maybe you should make some phone calls, or plan a trip to the Great Northwest? HTH Cathy H.

You know, after realizing my error last night, I checked the Tricare policy manual and they definately list lapband as an exclusion . :think ( them dogs) I'm still gonna try to file a claim with them after my surgery is done through BCBS. (maybe they'll cover some of the remaining bill.) And then again, maybe they'll realize that the procedure has gone past being 'experimental'. Cathy

OKAY, SOOO sorry for confusion. THIS IS for CHAMPVA folks. Now I feel REALLY stupid.........But, seems like we should really push for TRICARE to adopt this, too. I mean, how much money can they be saving with the complications from RNY?? Cathy

Tricare had a change come out dated 8/30/06 that INCLUDES LapBand and FILLS. It is not listed in their handbook (yet), but some people across the country are saying that Tricare IS covering their lapbands. I think the major roadblock is what CPT code your surgeon is using. For instance, mine uses 43770 (which is a covered CPT), whereas, I see on other surgeons websites, they use various other CPT's (for instance, CPT 43999). I found this transmittal on the web when I was doing my research. When talking with the people at Tricare, you might want to mention this transmittal that also includes fills. Please remember, that WLS of ANY kind with Tricare needs to be PREAPPROVED (unless you have OHI) (then it goes by their rules). Anyhow, I will try to paste it on here, but if it doesn't come through, I will also paste the web address for it AND the changes for the CPT codes from the FACS that show the codes for banding and fills that ARE COVERED by Tricare per this portion of the transmittal: II. PROCEDURE CODE(S) 43644, 43770-43774 (these are the ones for LB and Fills) :clap2: , 43842-43843, 43846, 43848 and 43886-43888 So first the web addresses: http://www.facs.org/fellows_info/bulletin/2006/bothe0106.pdf The document is copy protected, BUT what you need to know is at the bottom of page 2, starting at the left hand side. The address for Tricare changes is: http://www.va.gov/hac/forbeneficiaries/champva/policymanual/cvapmchap2/1c2s29.15.pdf TRANSMITTAL #: 95 DATE:08/30/2006 TRICARE CHANGE #: C-42/43 2-29.15-1 CHAMPVA POLICY MANUAL CHAPTER: 2 SECTION: 29.15 TITLE: SURGERY FOR MORBID OBESITY AUTHORITY: 38 CFR 17.270(a) and 17.272(a)(22) RELATED AUTHORITY: 32 CFR 199.4(e)(15) I. EFFECTIVE DATE November 9, 1982 II. PROCEDURE CODE(S) 43644, 43770-43774, 43842-43843, 43846, 43848 and 43886-43888 III. DESCRIPTIONS A. Morbid obesity is defined as a body weight 100 pounds over ideal weight for height and bone structure. B. Bariatric surgery. Surgery for morbid obesity produces weight loss by either limiting the amount of food the stomach can hold (a restrictive procedure), or by creating a small pouch and bypassing part of the small intestine to limit the food hat is absorbed by the body (a gastric bypass). IV. POLICY A. CHAMPVA benefits for surgery for morbid obesity is limited to: 1. VBG (Vertical Banded Gastroplasty) or gastric stapling, without gastric bypass, (CPT 43842) this is an open procedure 2. Gastric restrictive procedure, without gastric bypass, other than vertical banded gastroplasty 3. Gastric restrictive procedure, with gastric bypass; with short limb (less than 150-cm) Roux-en-Y gastrojejunostomy (CPT 43644 laproscopic, or CPT 43846 open approach) TRANSMITTAL #: 95 DATE:08/30/2006 TRICARE CHANGE #: C-42/43 2-29.15-2 4. Adjustable silicone gastric banding (CPT 43843) using the FDA (Food and Drug Administration) approved LAP-BAND® Adjustable Gastric Banding (open or laparoscopic procedure); for severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised studies, exercise and behavior modification programs. The LAP-BAND system is contraindicated in patients with any of the medical conditions listed under Policy Considerations as well as patients under 18 years of age. 5. Revision of gastric restrictive procedure for morbid obesity (CPT 43848) B. Surgery benefits for morbid obesity may be extended only when one of the following conditions is met: 1. BMI is over 40 2. BMI over 35 with a serious medical condition associated with obesity, that is, hypertension, Type ll Diabetes Mellitus, severe arthritis of weight bearing joints 3. The patient has had an intestinal bypass or other surgery for obesity and, because of complications, requires a second surgery (a takedown). The surgeon will, in many cases, do a gastric bypass, gastric stapling or gastroplasty at the same time as the takedown to help the patient avoid regaining the weight that was lost. In this situation, payment is authorized even though the patient's condition may not technically meet the definition of morbid obesity because of the weight that was already lost following the initial surgery. C. Each claim related to the surgical treatment of morbid obesity will be medically reviewed to ensure that documentation supports the medical necessity and appropriateness of the surgical procedure. When necessary, additional clinical documentation will be requested. D. The surgery is an integral and necessary part of a course of treatment for a patient with one of the following life threatening or disabling co-morbid conditions: 1. Poorly controlled type II diabetes mellitus 2. Poorly controlled dyslipidermia 3. Poorly controlled hypertension 4. Serious cardiopulmonary disorder, such as coronary artery disease, cardiomyopathy, pulmonary hypertension) 5. Obstructive sleep apnea 6. Severe arthoplasty or weight-bearing joints (treatable but for the obesity) 7. Pseudotumor cerebri TRANSMITTAL #: 95 DATE:08/30/2006 TRICARE CHANGE #: C-42/43 2-29.15-3 VI. EXCLUSIONS A. Payment may not be made for non-surgical treatment of: 1. Obesity 2. Morbid obesity V. POLICY CONSIDERATIONS A. Even though the beneficiary may meet the morbid obesity criteria, gastric procedures are usually contraindicated when any of the conditions listed below are present. Cases in these groups shall not be categorically excluded. Review of the medical circumstances and medical appropriateness will be performed. If the documentation does not support the medical appropriateness of the surgery, the claim will be denied. 1. Active hepatitis 2. Chronic alcoholism 3. Cirrhosis of the liver 4. Dental disease 5. History of anorexia nervosa, bulimia or related eating disorder 6. Infection, particularly in the skin or elsewhere in the body 7. Inflammatory bowel disease 8. Malignant tumors 9. Mental retardation 10. Organic brain syndrome 11. Profound psychotic disturbance 12. Pulmonary embolization 13. Renal failure B. CHAMPVA will cover procedures that are medically necessary to correct skin complications, such as severe intertrigo, skin chafing, pain, abrasions, pockets of superficial ulceration, or scar revision, which may occur as a result of approved surgery for morbid obesity. TRANSMITTAL #: 95 DATE:08/30/2006 TRICARE CHANGE #: C-42/43 2-29.15-4 E. Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption (CPT procedure code 43847). 3. Dietary control 4. Weight reduction B. Biliopancreatic bypass (jejunoileal bypass, the Scopinaro procedure) CPT procedure codes 43633, 43645, 43845, or 43847. C. Mini-gastric bypass (gastric bypass using a Billroth II type of anastomosis). D. Gastric balloon or bubble for treatment of morbid obesity. F. Unlisted CPT procedure codes 43659 (laparoscopy procedure, stomach); partial biliopancreatic bypass (with or without duodenal switch) 43999; and 49329 (laparoscopy procedure, abdomen, peritoneum and omentum). G. Prescription medications used for weight reduction [38 CFR 17.272(a)(22)] H. Services and supplies in connection with cosmetic surgery that is performed to primarily improve physical appearance or for psychological purposes or to restore form without correcting or materially improving a bodily function [38 CFR 17.272(a) (19)(78)] I. Weight reduction clinics, programs, or health club memberships [38 CFR 17.272(a)(37)] J. Laparoscopy, surgical, gastric restrictive procedure with gastric bypass and small intestine reconstruction to limit absorption (CPT procedure code 43645). *END OF POLICY*