gdetty

I wanted to tell my story. I had to fight for one year to get my Vertical Sleeve and actually had to change Health Plans to get that approval. I had my surgery February 14th 2011 at Magee Hospital, Pittsburgh, Pa with Dr Ramesh Ramanathan. I recommend all of the above, the Fight, Sleeve, the Hospital, The Surgeon. Before I got my surgery I was over 300 pounds. I have lost 90 pounds and have been at a weight plateau, but I know it just takes a little change to lose more weight, meaning I don't watch what I eat. However, I don't go to the salad bar, I eat Protein first and if eating out I take home 1/2 of what is served. That's what the Sleeve does, controls portions. And surprisingly it changes what you can eat. The safest food I can eat that I can tolerate is salmon. I cannot tolerate Italian (i.e pasta). But is this a problem? Not at all. Before the procedure, I was on three Diabetes pills a day and 4 Insulin shots per day. In less than three-months post surgery, I became insulin-dependent FREE! No shots. No Pills. For the three follow up visits (3-month - 6-month - 1 year) my A1C fell to 6.6. My Cholesterol and Triglyceride levels have been fantastic and I don't eat to control this reduction. Meaning, it's the procedure that is keeping my levels down and the weight I lost. My PCP asked if I would do it again and I didn't hesitate. "In a minute." I can walk, I can move I can exercise I am finally healthy. I am still learning how to eat (don't rush) what to eat, (What I can tolerate) and portion wise, that's controlled by the surgery. I highly recommend Magee Hospital, Dr Ramanathan and his staff. Kelly Kaufman the PA helped me to get everything in order and it WAS a struggle but it was accomplished, thanks to her. When the approval came, she expedited me into surgery one day after my 30-day liquid diet. Nurse Ellen has worked with me and helped with questions. That carbohydrate rush that makes you instantly tired, - know what you can eat. Things I could eat before I can't tolerate now. That salad bar - you stay away. bread waste of bulk. My favorite meal spaghetti - well I can't eat it anymore, makes me sick but hey I take no Type 2 medicine, no shots and I do check my blood sugar but to make sure it is not low. It's never high. If I was to add anything it is research the procedures and the side effects of each procedure. The Vertical Sleeve met my lifestyle. Not being diabetic anymore, well the Medical community has no answer to why this happens but I can tell you it does happen. Faster than you can think it will.

I'm almost 1 1/2 years post op and I get nauseated all of the time. You need to know what to eat, what you can tolerate (I tolerate salmon as my most tolerated meal), how to eat and don't over do it. Portion control is controlled by the procedure meaning you can't overeat or it will not stay down. I've noticed that I eat something and get instantly tired. I asked my doctor and he said it's a carbohydrate rush. So I stay away from these foods that make me tired. I now know the meats I can eat and those choices are different than what I could eat before my procedure. Make sure all meats are wet. I cannot eat breaded chicken and tend to stay away from chicken entirely. What seems to help me is I eat my dinner and then eat pretzels that seems to calm my nausea. If you are eating sweets, that is one of the side effects of the Sleeve. Makes you sick. However, for me, if nausea is a lifestyle change I need to tolerate, and the Sleeve is not reversible, then I'm prepared to find the foods best suited for me and I will change my habits to that lifestyle. For me I try something and it goes down well. Then 15 to 1/2 hour later I get the nausea. I then take some Maalox and drink Water. Being nauseated is in levels. Slight, moderate and OMG I think I'm going to vomit. I can only add good luck. It may be a normal part of my new lifestyle but my life is a great deal better than it was before my operation. I can live with it and eat more things that do not bring on the OMG nausea. I don't think it goes away. I also. want to add, I eat @ the same thing every day for Breakfast and lunch. Dinner is a crap-shoot. Eating out, I choose very very carefully.

Does anyone have information that can help me? I called UPMC Health Plan (University of Pittsburgh) in January and asked if I was covered for the VSG. The answer was yes. I started my 6-month Pre-Surgical supervised diet, weight program; lost weight, lowered my blood glucose, had my psychological evaluation and even met the surgeon. I thought I was ready to go. At this time, I was told to call "again" because on February 5th 2010 UPMC stopped covering the VSG. This was confirmed by the Surgeon and his PA. I appealed. But of course my appeal was denied and I have no proof. Has anyone had a similar experience with UPMC and/or has anyone had the VSG procedure under the UPMC Plan? I am appealing to change my plan from UPMC to Blue Cross of Illinois who is approving the VSG.

I'm back at it. I meet next Thursday July 29th for my step 2 appeal for the VSG at UPMC. They asked if I wanted to be there in person ... you bet I do. I have my case prepared and also a trump card that if I'm denied by UPMC Health Insurance, next year I'll switch to the PPO that is offered which is approving the VSG. I have one of those Cadillac health plans as they are called. Yeah right Cadillac my a&%.

I can answer this way. I was sent, (from UPMC) instructional videos that demonstrated the procedures for Gastric Bypass and the LapBand, back in early 2009 from a counselor under one of their programs. After I viewed these procedures I adamantly declined to consider either of these procedures. My reasoning was side effects and these side effects would not be tolerable for what I deemed a quality of life for me and what I do. So although, when I called for pre-approval the first time (December 2009), I may not have known what questions to ask, however when I called UPMC Insurance the second time (January 2010), I knew to not misrepresent the procedure I was requesting e.g. VSG. I specifically asked for that procedure coverage (or hence I would not have started my 6-month supervised weight, diet, evaluation time period pre-surgery, because I had already declined the other two procedures). Having been denied for my appeal, directed at the UPMC insurance company, and since I have an option, when I called Blue Cross of Illinois, I made sure I asked (three-times) if I would be covered for Bariatric Surgery AND specifically the Vertical Sleeve procedure, Each time the party on the other end replied "yes." Maybe it comes down to different coverages under different Plans due to different payments, (or Group numbers). I can draw a parallel this way, my boss had his VSG surgery in December 2009 and it was approved and covered. I may need to call back and tape the conversation, but my intention now is to verify, verify, verify some way, since I will never consider the other options.