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Well, the PCM might not like it, but is at least willing to refer you! Explain you considered the drugs, but that addiction runs in your family and you are not interested in something that will only work for as long as you take it. The bloodwork will be needed anyway, so no harm, no foul. Did they check your height? You might discover you are not as tall as you think, and your BMI will be 40 or greater. Then, done deal. Keep us posted.

My insurance now allows for self-referral to a specialist, the co-pay is higher. Some require a letter from the PCP. It really does depend on the company and the surgeon.

Great work!!! Keep it up!!!

If you have a surgeon picked out, give the office a call and find out what they require. I went through my insurance, so I had to attend the seminar and have a referral from my primary care doctor first. If you are self-pay, perhaps not. When I asked my primary care for a referral, I had already gone to one seminar, but he preferred a different surgeon in the group, so I went to him instead. That meant I went to two seminars, but I was good with that. If you have no idea what surgeon you want to use and are going through your insurance, see your primary care doctor for a referral. He or she should know who your practice uses. Going through insurance is usually not a quick process. Just be prepared for that. I did not have to do a 6 month supervised diet, but it still took me about 6 months from start to finish.

I kept trying to respond last night, but something was wrong with my connection. My response is usually along the lines of..Thank you for your concern for me. My decision might not be right for you, but after my research, I have decided it is right for me. No one can argue with the logic that a decision is right for you. They are not in your skin or brain. Just as when I asked a co-worked to trade shifts and her response was, "no, that won't work for me." I knew she didn't have anything going on at the time I needed to be not working, but I could not argue with her (not that I would have anyway). It was, a perfect response...

Dave_NW is pretty up on Tricare info. There are also tons of posts about Tricare here. Do a search and see what you can find. The search can be cumbersome, but give it a whirl. Here is a link to what is said to be a recent change to Tricare's definition of Morbid Obesity for coverage. To have a BMI equal to or great than 40, you need to weigh 212. So, I am not suggesting fraud, but do not do what we usually do when seeing our doctors--dress as lightly as we can. Wear jeans, a shirt, and a sweatshirt over it. Wear your heaviest shoes, and when they measure your height, don't stretch yourself to as tall as you can possibly make yourself. Have a big Breakfast and drink loads of Water. We are so used to trying to minimize ourselves. In this case, you don't want to do that. 5'0" and 208 is a BMI of 40.6, 5' 1/2" and 209 is 40.1. You are right on the cusp of a 40 BMI. http://www.federalregister.gov/articles/2011/02/14/2011-3207/tricare-program-surgery-for-morbid-obesity it states: ( Covered bariatric surgical procedures are payable only when the patient has completed growth (18 years of age or documentation of completion of bone growth) and has met one of the following selection criteria: Show citation box (1) The patient has a BMI that is equal to or exceeds 40 kg/m 2 and has previously been unsuccessful with medical treatment for obesity. Show citation box (2) The patient has a BMI of 35 to 39.9 kg/m [2] , has at least one high-risk co-morbid condition associated with morbid obesity, and has previously been unsuccessful with medical treatment for obesity.

Surgery is painful. Everyone experiences pain differently. For me, the pain medicines made me comfortable. I am in my 40s, I was back to normal in about 2 weeks. The weight does not fall off at first. With a band, it can take several months to get to the appropriate fill level for the band to give the most help. The band is a strictly restrictive procedure. the weight loss you achieve is based on calorie restriction, not on restriction and malabsorption like gastric bypass. Lapband patients are advised to expect losses of 1-2 pounds per week. Being at a higher weight, you might lose faster at first, once your calorie consumption is under control. If you are looking for rapid weight loss, gastric bypass or vertical sleeve is the way to go, not banding. Exercise, you do what you can. Even lifting weights or dancing in a chair will help until you can start weight bearing exercises. The band is not meant to be a temporary item. It seems when most people get their bands removed or unfilled, old habits creep back in and weight gain occurs. When there is no Fluid in a band, for most of us, it is like we have no band. We can generally eat the same amounts we could before surgery. There are some here who have restriction without any fill in their bands, but they seem to be the exception, not the rule. I have never had all the fill removed from my band since I had it installed. Having unfills for special events in life is just not something I would consider. My new way of eating is for life, and it is not dependent on chances to eat more food or new foods. I can experience plenty of food without unfilling it. Steak...well, it can be problematic for many banded people. Like a previous poster, I can eat it if I cut it into very small pieces and chew VERY well. I tend to get tired of chewing before my portion is gone. It is a lot of work to eat. You might be able to eat it, you might not. It is something you will have to be willing to give up if it turns out to be something you cannot eat. Keep the questions coming, the better informed you are, the better decision you can make!!

Last Supper Syndrome is pretty popular around here! You will be able to eat again, though. And you'll be able to eat most of your favorites. It's all about moderation and portion control. The band helps us with portion control. Best wishes for an easy surgery and great recover!

If you are in need of an emergency unfill, your best bet is to call your surgeon's office for instruction. Even if after hours, there will be someone on call. I'd rather meet someone from my surgeon's office at the ER than have an ER doc attempt it. ER folk are FANTASTIC, but finding that little port...I'd at least want my surgeon's office involved.

Glad you are back on track, Tracy. Stick around here for support!

What Cindy said! As long as you aren't in pain. But DO get liquids in. Dehydration is dangerous. Sip, sip, sip, all day long.

When I get that lump feeling, I'll pat my tummy to encourage a burp. Sometimes you will take too big a gulp of something and have a mouthful of air with it. It is uncomfortable/painful. Shakes being very thick, need especially small sips while you are learning your new eating habits.

Can you get liquids down? If yes, then you can wait a bit and see how things go. If not, call right away. Dehydration can happen quickly and can be deadly. All offices are different in their post-fill instructions. My surgeon had me do liquids the remainder of the fill day then back to regular food the next day. His nurse practitioner did my last fill. She had me to Clear Liquids for two days, full liquids for three days, then back to solids. We were coming up on a holiday weekend and she didn't want me ending up in the ER for an emergency unfill.

This is a big fear for me also. I am 3.5 years out. I think I would go to Weight Watchers or Overeaters Anonymous or some other program to try to keep it in check. I'd be lost without my band. Will you be able to get rebanded or revise to another procedure?

Daphne's Greek Cafe is great. The have street gyros that are small, perfect for bandsters. They'll also let adults (any adult) order off the child's menu for small portions. Pick-up-Stix is another great choice, they have nutrition info on their menu. Being a take out, I'll grab a kids meal to go. Outback Steakouse portions are huge here, and they charge to split. They also charge $2.00 to order off the child's menu. (no I don't use the lapband, please give me a child's menu portion, card). So, what DH and I do is I order either a Soup or side salad, and he orders an entree. That gets me flatware and a little plate. We ask for my dish to come with his dinner. I then have a bit of his entree with my choice. If we do Outback take away, I order from the child's menu. I get two meals out if...yum! About the only place I really have trouble putting together a meal is In-N-Out Burgers. ALL they do is burgers and fries. I often have issues with hamburger. So, if I go there it is understood it will be a splurge meal at great risk of getting stuck. But ooooohhhhhhhhh so worth it.

I agree it could be the pain meds. Also, did you do SF stuff before? It could be the artificial sweetener. Call your surgeon's office and let them know what is happening. They can change up your medications, which might help. Peppermint tea is helpful for nausea as well. Hope you feel better soon!

Very glad you are feeling better! Gastritis is inflammation (irritation and/or swelling) of the stomach, no matter the cause. So it really doesn't matter if it was from food poisoning, the flu, or getting stuck. Something irritated the heck out of your stomach, enough to swell it up so much that it closed off access to your stomach. A deadly situation if left too long as you cannot get liquids in for hydration. It sounds as though he doesn't think it was a slip, that is great news! When you go back for your refill talk about the daily slime issues. Maybe try a fill level just a little bit less than you had and see how that goes? Or perhaps he'll tell you it's fine as long as you aren't in pain. For my band slime=stuck=pain. I rarely get slime that I don't have pain and a stuck episode to follow. So my experience is different from yours. I am so glad you went with your gut and called your doctor yesterday knowing something was not right. (no pun intended!)

It depends on what your doctor has ordered. I was told clear liquids only for 7 days. When my surgeon called me at 3 days post-op I was doing so well that I got moved to full liquids. Go by what YOUR surgeon has told you to do. The post-op sucks, but you need to let the stitches holding your band in place heal.

Just a word of caution if you are considering gaining the few pounds. Some companies require a BMI 35 or over for X years. So the fact that you are under now could start the clock at the point you go over.<br><br>Read your policy carefully. It truly sucks that we take positive steps to improve our health, have some success, need some help, and get shot in the butt for it.<br><br>In your appeal, be sure to mention the FDA's lowering of the BMI standard for lap banding. It might not make a difference, but throw everything you can into the letter! www.obesitylaw.com might have some info to help.<br><br>Best wishes!!! <div><br></div><div>Edited to add this link:</div><div><br></div><div>https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/Bariatric_Surgery_Jan_11.pdf</div><div><br></div><div>I am not sure if the above link applies to all Healthnet policies, but it does say a 2 year history. But it doesn't say in the past two years...so you can make the point of 2 years out of the previous 5 if that is the case.</div><div><br></div><div><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">For at least 2 years or greater, the patient has clinically severe obesity (morbid obesity) defined by <b>either </b>of the following:</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Helvetica">• •</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Body mass index (BMI)* >40 kg/m<span style="font: 6.5px Verdana">2</span>; or</p><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><br></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">BMI of > 35 kg/m2 and < 40 kg/m<span style="font: 6.5px Verdana">2 </span>with <b>one or more </b>of the following co- morbidities which are generally expected to be improved, curtailed or reversed by obesity surgical treatment:</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Severe, active coronary artery disease</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Obesity-related cardiomyopathy</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Congestive heart failure</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Obstructive sleep apnea with use of CPAP or polysomnogram showing apnea-hypopnea index (AHI) ≥ 15 per hour</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Pickwickian syndrome</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Type 2 diabetes mellitus</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Clinically significant asthma</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Chronic venous insufficiency with pain on weight bearing and persistent edema; or</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Respiratory insufficiency, as evidenced by pCO2 > 50 mmHg, FEV1/FVC < 65%, or DLCO < 60%</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Hypoxemia at rest, as evidenced by pO2 < 55 mmHg on room air</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Severe gastroesophageal reflux disease (GERD)</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Severe pain and limitation of motion in any weight-bearing joint or the lumbosacral spine documented by physical examination in association with radiologic findings showing degenerative osteoarthritis</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Patient has <b>at least one </b>of the following:</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Bariatric Surgery Mar 11</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">2</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">a.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">b. c.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">3.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">d.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">e.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">f. g.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Hypertension(bloodpressure>140mmHgsystolicand/or > 90 mmHg diastolic measured with appropriate size cuff) that has not responded to medical therapy Firstdegreerelativewithpremature(age<50) cardiovascular disease</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Hypercholesterolemia > 240 mg/dL that has not responded to medical therapy</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Hypertriglyceridemia>400mg/dLthathasnotresponded to medical therapy</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Lowdensitylipoprotein(LDL)>130thathasnotresponded to medical therapy</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Highdensitylipoprotein(HDL)<35thathasnotresponded to medical therapy</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Impaired fasting glucose > 125 Pulmonaryhypertension</p></div>

I am VERY glad you called! And glad he is meeting you to take the fluid out. ER docs are fantastic, but I don't think they have much experience with unfilling bands! Hope you feel better as soon as the fluid is out. Then once the irritation is gone, you should be able to put it back. An Upper GI can pick up a slip, I think. But if he is unfilling you, he might just leave it that way for a bit and see how you do. Feel better soon!!!

I woke up from surgery needing a fill!!! I was hungry from day one, and I believe that I had some fill in my band at surgery. My surgeon said he didn't care if I lost weight during "bandster hell" before my first fill. If I did it was just a bonus. Plus I did a 10 day cruise right before I saw him for my fill. I got back from my trip on Sunday or Monday and saw him on Tuesday or something like that. It is frustrating because we want to lose the weight soooo bad and soooo quickly. We go through the surgery, and all the pain and hoops to get it. It is pretty anticlimactic when we get all healed up and realize we are just as hungry and can eat as much as before we had the surgery. Then we wait for 6 weeks to get a fill, and for some us the first fill does nothing. Crud! Then 2 weeks to a month goes by, another fill. Still not much help! Sheesh. Finally 3rd fill does it! Yeah. Well, now you are maybe a year into this whole journey from when you went to the seminar. Maybe longer if you went to more than one or had some insurance glitches. For some the first fill will help, for others it is the sixth. We never know. For me, I think it was the second. I am 3.5 years out, so it's getting kind of fuzzy now. But this is a marathon, not a sprint. Patience is key.

Hi Jena, I am 3.5 years out. Hope you are feeling better. If you cannot get liquids down, call your doc. Even though it is the weekend, he'll have someone on call. You do NOT want to get dehydrated. It is just plain dangerous. You can go without food, but not liquid. It appears you are getting liquids down now, but if that changes, give the office # a call. There should be an answering service to put you in touch with someone who can give you advice. Even if it is just to go to urgent care for some fluids until you can see your surgeon. I'd do this even if the cause is food poisoning. No fluids in is NOT a good thing. Just something to consider, if you are having daily issues getting food down, you might think of a very slight unfill. Just a tad so that you aren't having daily trauma to your stomach and band. I get stuck about 1-2 times per month, and it is usually my fault. Taking too big of a bite or eating too fast.

Thanks for the clarification. If I were in that BMI category I'd want someone with a lot of experience myself. Well, even at a BMI of 36 to start, I wanted someone with lots of experience. It would be interesting for the OP to ask for a copy of the surgical report and find out what the surgeon saw inside. We can all comment on what we think should have happened, but the surgical team are the only ones who know what was found inside.

Yeah, challenge them to a weight loss contest!