ArcusX

Today I'm sending the following letter off to the VP of HR and CC'ing the CEO. Hopefully you will never need to do anything similar, but in case you do, feel free to purger me. Enjoy! Dear <VP of HR>: My name is John and I have been with <my company> for a little over two years. I love working for <my company>. The people I work with are all second to none. We have a fantastic team here, and I wouldn’t trade it for anything. I’ve been married for 14 years and I have two boys, ages 7 and 9. I’m a Den Leader and Committee Member in my children’s Cub Scout Pack. Unfortunately, before the kids came along – in fact just after I married – I broke my foot and was in a cast for a long time – nearly 18 months. During that time, and the months that followed, I gained around 60 pounds, and have managed to slowly put on another 40 over the past 12 years. Now I’m what you would call Morbidly Obese. Worse, over the past 6 years I have also developed Type 2 Diabetes, Obstructive sleep Apnea and Gastroesophageal Reflux Disease (Acid Reflux). The diabetes and sleep apnea are serious conditions with potentially life threatening affects on the body. Besides the medical issues, it’s difficult to do things with my kids; it’s not fun staking a tent with 100 pounds of belly in your way. My weight was floating at around 290 pounds, which at 5’11” tall put my BMI over 40. When I saw my doctor in the fall and knowing that my weight was the main reason for all of my medical issues, I asked if he thought I was a candidate for some form of Weight Loss Surgery. You see, I’ve been with him for a while, and he’s always advised me to go the way of “eat less, move more.” Not in so many words, but that’s a good summary. This time he considered the thought and said he would refer me to someone he knew. I started down the road of research, attended a seminar, and following the seminar had a consultation with a bariatric surgeon. I was told that insurance had been verified, and since the first week of October, I have gone through all of the steps – and incurred the costs – needed to prepare for surgery. I’ve had an EGD and gallbladder ultrasound, a chest x-ray, a psychological evaluation and worked with a nutritionist for three months. I even lost about 25 pounds by the time all of my documentation was submitted to Cigna for approval, only to find that bariatric surgery of any kind is specifically excluded from my coverage. When I confirmed this finding with HR, I asked why bariatric surgery is excluded, this was the answer I got: “We don't cover it due to the other complications that can arise from this particular surgery which in turn can cause higher claims.” I have found it difficult to understand this policy. Research shows that bariatric surgery resolves – not just improves, but resolves – Type 2 Diabetes in 83% of cases, Sleep Apnea in 74-98% of cases, and GERD in 72-98% of cases. I would like to think that the decision to omit bariatric surgeries was made so many years ago and that the data has improved so much since then, if it were to be reconsidered and reevaluated today, <my company> might add this service to the benefits covered by the medical insurance offerings. The information below will illustrate that there is a cost associated with NOT offering bariatric surgery as a treatment option. Diabetes alone costs <company name> and its employees an estimated $2.6 Million annually. I have spent many hours gathering this information, and I hope that you at least take the few minutes it will take to read through the information herein: Obesity is one of the greatest public health and economic threats facing the United States. Approximately 72 million Americans are obese and, according to the American Society for Metabolic & Bariatric Surgery (ASMBS), about 18 million have morbid obesity (roughly 6% of the population). Obese individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals as well as an increased risk of developing more than 40 obesity-related diseases and conditions including Type 2 diabetes, heart disease and cancer. The federal government estimated that in 2008, annual obesity-related health spending reached $147 billion, double what it was a decade ago, and projects spending to rise to $344 billion each year by 2018. Co-morbidities associated with obesity: The evidence is overwhelming on the association of obesity to a number of medical conditions. These include: insulin resistance, glucose intolerance, diabetes mellitus (specific statistics for this co-morbidity provided below), hypertension, dyslipidemia (high cholesterol), sleep apnea, arthritis, hyperuricemia (gout), gall bladder disease, and certain types of cancer. The independent association of obesity seems also clearly established for coronary artery disease, heart failure, cardiac arrhythmia, stroke, and menstrual irregularities. http://www.ncbi.nlm....pubmed/10593535 Diabetes Statistics: Total: 25.8 million children and adults in the United States—8.3% of the population—have diabetes. <my company> having some 4,800 employees, statistically, 398 of them have diabetes. New Cases: 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older in 2010. Morbidity and Mortality of Diabetes 575]· In 2007, diabetes was listed as the underlying cause on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths. Complications of Diabetes Heart disease and stroke 025]· In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older. 025]· In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older. 025]· Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. 025]· The risk for stroke is 2 to 4 times higher among people with diabetes. High blood pressure 025]· In 2005-2008, of adults aged 20 years or older with self-reported diabetes, 67% had blood pressure greater than or equal to 140/90 mmHg or used prescription medications for hypertension. Blindness 025]· Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years. 025]· In 2005-2008, 4.2 million (28.5%) people with diabetes aged 40 years or older had diabetic retinopathy, and of these, almost 0.7 million (4.4% of those with diabetes) had advanced diabetic retinopathy that could lead to severe vision loss. Kidney disease 025]· Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008. 025]· In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease in the United States. 025]· In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States. Nervous system disease (Neuropathy) 025]· About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. Amputation 025]· More than 60% of nontraumatic lower-limb amputations occur in people with diabetes. 025]· In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes. Cost of Diabetes 575]· $174 billion: Total costs of diagnosed diabetes in the United States in 2007. That’s $6744 per person who has diabetes per year. $2,684,186 for the 389 <my company> employees per year 575]· $116 billion for direct medical costs 575]· $58 billion for indirect costs (disability, work loss, premature mortality) After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes. Bariatric surgery is the only reliable treatment that offers sustained, long-term weight loss. This results in cure or improvement in almost all of the obesity-associated diseases and translates into reduction in the relative risk of death or increased longevity of the operated morbidly obese population. Since the treatment of obesity-associated conditions is very costly, bariatric surgery also results in significant reductions in healthcare costs with a return on investment of 3 years. It is not just weight loss, it is health gain. http://www.ncbi.nlm....pubmed/19440652 The treatment of obesity and related comorbidities are significant financial burdens and sources of resource expenditure. This study was conducted in order to assess the impact of weight-reduction surgery on health-related costs. Patients having undergone bariatric surgery had significant reductions in mean percent initial excess weight loss (67.1%, P <0.001) and in percent change in initial body mass index (34.6%, P <0.001). Bariatric surgery patients had higher total costs for hospitalizations (per 1,000 patients) in the first year following cohort inception (surgery cohort = CDN 12,461,938 dollars; control cohort = CDN 3,609,680 dollars). At 5 years after cohort inception, average cumulative costs for operated patients were CDN 19,516,667 dollars versus CDN 25,264,608 dollars, for an absolute difference of almost CDN 6,000,000 dollars per 1,000 patients. Conslusion: Weight-reduction surgery in morbidly obese patients produces effective weight loss and decreases long-term direct health-care costs. The initial costs of surgery can be amortized over 3.5 years. http://www.ncbi.nlm....pubmed/15329183 Bariatric Surgery As Treatment For Obesity And Therefore Other Co-Moridities Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions and results in significant weight loss. In the United States, about 200,000 adults have metabolic/bariatric surgery each year. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques. The risk of death is about 0.1 percent and the overall likelihood of major complications is about 4 percent. The 30-day mortality rate for sleeve gastrectomy was 0.08 percent, while the rate for gastric bypass was 0.14 percent and 0.03 percent for gastric banding. These mortality and complication rates are lower than those typically associated with gallbladder or hip replacement surgery. One study published in 2010 in the Journal of the Society of Laparoendoscopic Surgeons by the Surgeons Group of Baton Rouge, following the groups first 100 consecutive Laparoscopic Sleeve Gastrectomy, a relatively newer procedure included the following results: The percentage of excess body weight loss at the 3- and 6-month marks was 34.2% and 49.1%, respectively. Comorbidities were also improved at the 3- and 6-month marks. Hypertension resolved in 38%, hyperlipidemia resolved in 19%, and diabetes in 46%. Complication rate during the first 6 months was 10%. Major complications included 2 patients with postoperative bleeding, 2 patients with acute renal failure from dehydration, and 1 postoperative bleeding patient who developed a gastric fistula. No surgical reintervention was required for any complication. Conclusion: Our technique is a safe method that is easily reproducible and does not require any modification. Laparoscopic sleeve gastrectomy is an excellent surgical option with a low complication rate. http://www.ncbi.nlm....les/PMC3083039/ In the March 26, 2012 issue of the New England Journal of Medicine, Schauer et a published “Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes.” In this randomized controlled trial, the efficacy of intensive medical diabetes management alone versus laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes was performed. The results were enlightening. In this specific population, the sleeve gastrectomy outcomes were equivalent to Roux-en-Y gastric bypass, a CMS covered surgical benefit. At the end of the one-year trial, hemoglobin A1C was 7.5 for intensive medical diabetes management, 6.4 for Roux-en-Y gastric bypass, and 6.6 for sleeve gastrectomy. As expected, weight loss outcomes had similar results namely, an end-point BMI (kg/m2) of 34.4 for intensive medical diabetes management, 26.8 for Roux-en-Y gastric bypass, and 27.2 for sleeve gastrectomy. Of note, when examining serious adverse events requiring hospitalizations, intensive medical diabetes management (non surgical treatment) and sleeve gastrectomy (bariatric surgery) hospitalizations were equivalent! (9 vs. 8 %, respectively). This trial was published in the New England Journal of Medicine, which leads all general medical journals in its impact factor. There is no question that this trial is of the highest methodological quality and should be part of the External Technology Assessment of the proposed decision memo. In the April 16, 2012 issue of the Archives of Surgery, Leonetti and colleagues published Obesity, Type 2 Diabetes Mellitus, and Other Comorbidities: A Prospective Cohort Study of Laparoscopic Sleeve Gastrectomy (LSG) vs. Medical Treatment. From trial initiation to trial end at 18 months, the medical treatment control group gained weight (BMI, 39 to 39.8 kg/m2) and saw modest declines in Fasting Plasma Glucose (FPG) (183 to 150 mg/dL). In contradistinction, the LSG group saw substantial declines in both weight, BMI 41.3 to 28.3 kg/m2) and FPG (166 to 97 mg/dL) (note that 100-150 is considered “pre-diabetic,” and below 100 is “normal”). Cardiac risk factor assessment showed consistent superiority of Laparoscopic Sleeve Gastrectomy over medical therapy particularly for Triglycerides, mg/dl (LSG, 169 to 97; Medical, 199 to 173). http://asmbs.org/201...verage-decision Since February 21, 2006, the Centers for Medicaid and Medicare Services (CMS) have covered Open and laparoscopic Roux-en-Y gastric bypass (RYGBP), open and laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS), and laparoscopic adjustable gastric banding (LAGB) are covered for Medicare beneficiaries who have a body-mass index > 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity. Also, effective June 27, 2012, Laparoscopic Sleeve Gastrectomy has been added to the list for National Coverage Determination (NCD) for Bariatric Surgery for Treatment of Morbid Obesity (100.1). http://alturl.com/wnbko I urge you to consider adding bariatric surgery to the list of covered services to <my company> medical insurance offerings by leaving you to ponder the following: How many morbidly obese senior citizens do you know? How many do you even see? I’d be willing to bet the number is zero – I know that I don’t know any – because obesity has been proven to shorten a person’s life expectancy. Sincerely,

I was thinking that, obviously, I'll still have the sleep apnea the days and even weeks after surgery. If I always wear the mask, how will I know when it's gone, if it goes, short of doing another sleep study? Sleep on the couch and have the kids tell you?

Greetings Sleevers! Well, I don't know if my former employer ever made any changes as a result of my letter. I left the company in July of 2013 and took a job with another company, that as it happens, DID cover bariatric surgery. In May, 2014 I had the RNY bypass surgery. My surgeon changed me from sleeve to bypass due to my GERD; according to him, sleeve makes GERD worse, which was contrary to everything I had read previous. Today, I'm sitting at about 178 pounds, from my high of 290. My lowest was probably about 169. It was expensive having to buy new clothes all the time - especially for work. My sleep apnea went away within about 2 weeks of surgery. When i was done with the GERD meds i had to take post-op for 90 days, it was gone too. My A1C is now normal, as are all my other bloodwork. I'm feeling great and have no regrets. Best

Sweet: how far out, post op are you? I was looking into those. I had found a site that reviewed several DVD's, including T25. I left a comment leaving my personal circumstance (then, 5 weeks post op), and he recommended just continuing to walk, maybe a few push ups here and there, then in the Fall, Power90 is supposed to come out. http://www.beachbody.com/product/fitness_programs/p90-workout.do I think the guy knows more about me that I do, because I tried exert myself a couple of times this week and just don't have the energy...

Do you think it was something you did or ate differently that triggered your energy to come back, or do you think maybe the after effects of anesthesia just finally wore off?

I'm 6 weeks post op as of today. I had my 1mo follow up this week, and I was told that it's usually 6-8 weeks before I'll have the kind of energy I need to work out the way I want to. I tried running on Monday and it just flat pooped me out after about 2-3 minutes. Thursday, I did a little work trimming bushes in the back yard... same thing... pooped me out! I'm sure there's more I can do with my diet; making sure I'm getting more Protein and Water. It's much harder that I thought it would be to hit those protein and water goals....

I"m 6 weeks post op as of today, and my BM's have been the least consistent thing in my life. Mostly, I've had diarrhea if not just really loose. This week's been quiet, and of course yesterday was constipation. I bought stool softeners before surgery, but just haven't needed it. Now I'm not sure what to do...

So I'm supposed to be eating all three meals as pureed foods. Monday night I blended up a can of costco chicken with some of the Water it was packed in, with a little mayo. The taste isn't bad, but what a chore it turned out to be! Has anyone been successful eating baby food during this phase? It's the same thing, right? I didn't try any when my kids were the age to eat this stuff. I appreciate your thoughts and ideas.

I'm finding it's just easier, generally, to keep eating the "full liquids." Lite/Greek Yogurt, Cottage cheese, etc, than some of the soft meats. Nothing's come up, but I generally feel it's easier to eat and stay comfortable, whereas eggs and other soft meats just take a lot more work to get down and even then, I'm uncomfortable; mostly because I want to "wash it down" with some Water after I'm done. So my question is, is this something I have to push through to be able to progress, or will that just come with time, and comfort is fine for now? Appreciate your thoughts...

I'm not supposed to take any supplements. I'm supposed to be on shakes for Breakfast & lunch, plus 4-6 oz lean mean & leafy greens for dinner. I just feel totally drained... absolutely no energy. Is there anything I can do, or do I just ride it out?

I had my pre-op class the other day, and they recommend I take a probiotic for two weeks after the surgery. Any recommendations?

I was originally supposed to have the sleeve, but last minute, doc advised to go bypass because of my history of reflux. I'm glad I dodged that bullet.

That's not too many carbs? A couple of times in the past few days I got Immunizer™ from juice It Up: Apple, cucumber, spinach, celery, kale, lemon. Then, not wanting to spend $6 a pop, I picked up the ingredients to do Mean Green: cucumber, celery, apple, kale, lemon and ginger.

My surgery was Monday, 19-May and came home Wednesday. I think today or yesterday was the first day sans-Gas-X, so that's good. My first BM was Friday, but I haven't had even a semi-solid one since maybe the Thursday before the surgery. I'm still taking the pain meds, but feel I'm needing them less. My biggest issue is on my left side. Of my 7 incisions, that one is the biggest with four staples. I can't even lay on my left side yet, and if I have pain, 99% that's the origin, then radiating from there. Saturday, I felt okay and proceeded to build two Cornhole boards all the way up to priming them. I fully intended to paint Sunday, but as it turned out, I didn't feel like doing ANYTHING Sunday. Yesterday, I started out that way too, but basically forced myself to get up and do stuff. I think it had to do with my Breakfast both days; Cream of Wheat. My doc has me on "Full Liquids" from the day I got home, which includes CoW. I picked some up on Saturday, and ate it on both Sunday and Monday. Today, I just did a shake, and figured if it's going to make we want to sleep, I'll just have it for dinner instead! I'm sleeping pretty well overall. A couple of days I slept all propped up like in the hospital, but ultimately found that sleeping regular (on my RIGHT side) was more restful. I picked up some low-sugar Greek yogurts yesterday, and that's helped expand my diet nicely. So far, so good!

I did not. I just had my surgery 8 days ago. I ordered the Celebrate about 2 weeks prior, and tried one, and it wasn't bad. My pre-op instructions said no supplements, and post-op, I'm supposed to wait 2 week more, so I haven't really had them on a daily basis yet. I was wondering about these. Did you try the chewable or "gummy" type?

The catheter didn't come out until this morning. Now that I'm home, I've noticed that my scrotum is swollen. Anyone else experience that? I guess i need to sit with a bag of peas?

Allow myself... to introduce myself I've been a long time participant in the Sleeve forums. My surgery is scheduled for Monday, 19-May. Today I had my final pre-op appointment, and while the doc was reviewing my chart, he saw something he hadn't caught before. Polyps from my EGD, coupled with GERD, he started thinking bypass. A call to the other doc who did my EGD, and it was set. Just like that. So I've been studying and researching sleeve since I started this, and while I was somewhat familiar with RNY, I never put any time into it. Now I'm in crash-course mode!!! Any tips would be appreciated! Best, John

Prior to getting approval for surgery, my wife signed us up for a 5K Color Run, which is tomorrow. Also, for Mother's day, we typically "celebrate" with a family lunch with the in-laws, which turns out is going to be buffet about 3 hours before the 5K. Being that surgery is 5/19, I'm on my pre-op diet. What's a guy to do? Should I go to the buffet since I'll need fuel for the 5K anyway, or should I skip the buffet so as not to sit and watch everyone else eat, then just get through the 5K while adhering to the diet? BTW: the diet from my doctor is Breakfast: shake, Lunch: Shake, Dinner: 4-6 oz lean meat + leafy greens, no Snacks, lots of Water. Thoughts?

I did a poll a long time ago asking about the best tasting, and Celebrate came out on top. I had the first one on Thursday... not bad at all.

It had to do with the anti-bacterial soap, plus all of the antibiotics that are part of the preop and surgery. To replenish some good bacteria.

Miso soup - you get protein too!

Anybody try caffeinated soap? http://www.amazon.com/Bath-Buzz-Caffeinated-Soap/dp/B000H0ESTM/ref=sr_1_1?ie=UTF8&qid=1399153467&sr=8-1&keywords=caffeine+soap

HI All - While I'm sure the basic answer goes without saying - plan ahead and stick with your restrictions - from a practical stand-point (if you are a camper) would you have camped about two-months+ post-op? Car / Tent camping, that is... no RV, no backpacking, etc. The only real hard part is setting up and breaking down, since my 8 & 10 year old boys are virtually useless in this area... I'm thinking the rest would be pretty enjoyable. Appreciate your thoughts!

If you think it's bad now, wait until the first two days' AFTER you have the surgery. I got my approval last week, and surprisingly, I'm not that excited. I don't know if I'd go so far as to say I'm questioning the decision, but my plan is to stay focused on the underlying reasons why I decided I want to do this in the first place. When I focus on not having sleep apnea and being able to keep up with my boys, I know it's the only way those things are going to happen. If there were another way, I would have gotten there by now. Best

Hello again, fellow sleevers. I've been on and off this site since October, 2012. My story is long, and it's available in my blog link, so I won't bore anyone with it again. The latest highlights are that the job I started last July actually covers bariatric surgery. I was submitted in December with my past data, but was denied because the new insurance required 6 months with NUT, as opposed to the 3 months my previous insurer required. 6 consecutive months. After completing an additional three months, January through March, the office got around to resubmitting me around 4/10. I had actually lost so much faith in the front office staff, I continued making my NUT appointments, and actually had my 4th visit with her on Thursday, 4/17. Yesterday, 4/18, I got the call that I have actually been approved. I would have expected to be a little more excited, but I'm not really. I don't know if it's because I've been relatively successful in the dieting since January, or if I'm waiting to have the rug yanked out from under me again, or if it's just nerves. I don't feel like I'm going to back out of it or anything... just not excited. So I'm back. I know I need to brush up on all the knowledge I gained here in the past and have probably just plain forgotten. So my tentative surgery date is 5/19. Here I go!!!