Wheetsin

As soon as you can make sure that bariatrics/sleeve aren't excluded. WHen you change companies, you're also changing plans, and there can be major differences. Tests, diagnoses, etc. should be good universally. Those are done by doctors, not insurance companies, so they just don't matter in the same way. Being able to start where you left off - in some ways, probably not in other ways. I don't know your status under your current insurance, but if you're pre-approved, you will not be pre-approved under your new provider, and they may have different criteria for approval (if it isn't excluded). Re: waiting periods -- there are two kinds. Well, three, but two that might apply to you. Not all companies/plans use them, but more and more are starting to. 1. Employer waiting period - required by the employer before your benefits kick in. Usually less than 3 mos. 2. Provider waiting period (also called "affiliation") - required by the provider, but not the employer. I think these are only in force with HMOs. Cannot be longer than 3 mos. You'll want to look into it asap.

I bought a MB before my lap-band surgery, used it every day for about 4 years, and a handful of times a week since. I'm having a hard time just doing pros and cons because there are some "didn't realize until..." that aren't really value judgments. Cons - The biggest con for me so far - sometimes when you're using it the base can come loose. This has happened several times, regardless of how tighlty I screw it on. Then whem I blend, it leaks and Protein drink or whatever gets down into the unit. This can prevent it from working. It's fairly easy to fix -- I just stream hot Water into it (unplugged of course), then let dry completely. Still a bit of a PITA but it wouldn't stop me from getting another one. If you have to process something long enough that the motor warms up, whatever is in there will taste like hot motor. You may need to use a liquid or thinner if you are trying to process too much at once (ice, nuts, etc.) All the seals that came with mine broke. They're really cheap to replace so it doesn't matter much, but still a tiny nuisance when you have a drink ready to go, and no spare seals on hand. It's pretty loud Pros - Super quick. 2 or 3 pulses and even the grittiest Protein powder is mixed in. I've shopped for alternatives to keep at work that can handle the protein powders, like the Oster cup blender or whatever it is, and the only other thing I've found that comes close to getting as good of a mix in a as short of time is an immersion blender. Very versatile. I've used it from everything from Protein drinks to Soups to chai mix (I make my own & then blend it to get the poweder consistency) to spices, guacamole, maragaritas, butter, etc. I could not have done all of that with other mix type gadgets I have. I personally think that for something I used every day for 4 years, and very frequently since, it's a great value. (And they're cheaper now then when I got mine) I'm impressed that something with the usage stats in the line above is still working well. Many other things have not lasted that long. Multiple cups and blades, so I can just toss the dirty ones in the dishwasher and make something else before it's done washing. THings I thought I would care about but I don't - The "cup" containers and rims. I don't like drinking out of them anyway. I always pour it into something else, or use a straw. The various attachments. I pretty much use just the cups, the short blade & the long blade (one is for blending, and one is for ice IIRC).

Add another can of soup, thus diluting the sweetness. Saltiness will usually cut sweetness. You can try NuSalt or equivalant if you're watching sodium. Cutting is probably your best bet.

Did you see the questions I posted to you on this same topic in the revisions forum?

I'm 5 - 6 years out and except for 3 people with whom I've lost touch with, everyone I know who had their surgery around the time I did or before has lost or needs to lose their band. That includes a few slips and an erosion that were just diagnosed in the last few weeks. I help the admin of this site moderate a board for lab-band and though I'm not terribly active there, I do monitor posts and the prospects look absolutely miserable. I think I've seen all of 2 people banded in the 5 - 7 year range who still have their bands. Granted, a lot of them have quit coming to the board so there are a lot of people we'll never know about. I see a lot of "oldies" wondering if there's anyone out there who still has their band. I lost weight with it, then gained some back with a pregnancy and now have no fill. My stats are in my signature. I think it's a great short-term tool, but who wants short term?? Diets are short term, too - and cheaper. I have a friend who was banded by Dr. Malley about 6 or 7 years ago IIRC. I considered switching my lap-band aftercare to him, but at the time his wait list to see other surgeons' patients was about 8 months and I couldn't wait that long Yikes. I've heard good things about him. I've never heard of Dr. Fearing. My lap-band was done by Dr. Hoehn through Shawnee Mission Medical Center. He also did my GB, and did my EGD. At this point I plan on having him also do my sleeve, but we'll see once I can actually talk with him about how he does it. One of the surgeons who was with Dr. Hoehn (Dr. Hitchcock) was with Dr. Malley at one point, but I don't know if he still is or not. So Malley is doing the sleeve now? That's interesting, I wonder when he started. As of about 2007 I think he was still only doing the lap-band. Does he actually do it, or does he have a sleeve surgeon in his practice?

I have a very high pain tolerance, and (so far) have recovered very quickly from surgeries. With both my lap-band and agllbladder surgeries I slept in a recliner. I could get up/down, walk around, do stairs, etc. with no problems but getting in to bed was too uncomfortable until about day 4. Sitting up from the recliner hurt, but not nearly as bad as trying to lay in bed. On day 4 (maybe it was 3, maybe it was 5) after lap-band I slept in bed with several pillows propping me up, and a body pillow to support the weight of my pannus. After GB I slept in bed the 2nd night. I'm not sure why the bed was so uncomfortable. The day after surgery I went walking around in Target, and went to GNC. The next day we took an hour car trip out of town and spent the day with my parents and I was fine. Pain levels all tolerable. Unless I tried to get into/out of bed.

Sorry Tiffykins, I didn't mean to duplicate you. I started responding, then had to step away, and didn't see your reply.

According to BMI charts, these men are all morbidly obese or super morbidly obese. I'm guessing they have > 5% body fat, and probably closer to 2% - 4% (guessing). Do you think they are accurate measurement tools?

Hi dalistone, I'm in the KC area. Since one of the only surgeons around who does the sleeve is in KS I'm sure there are several people who are "here" geographically, but not "here" on this board. I currently have a lap-band, and know about 40 people in MO and KS who are also banded or have been banded, but don't personally know any sleevers -- that I know about. My band has slipped and I'm working on a sleeve revision. I think. Communication-wise it's a 1 way street so far, so I hope I'm not just in limbo. 35 y/o female here.

99% of what GPs see is the same thing day in, day out. They have very broad, general backgrounds. Back when I had my lap-band, my GP had heard of it because some of her other patients had already had it done. Because of them, she wanted to read up on it and its stats, and she was actually pretty well informed when I talked to her (she thought it was great, was impressed by the numbers, actually explained to me a little more about the technical/medical side, etc.) I would assume so many people know about lap-band & RNY now because they're in the media, and not unrelated - they're the "procedures of choice." From commercials to reality shows to dramatic series - I've seen RNY or lap-band on all of them, and I watch very little TV. Funny enough, what I hear is usually wrong. E.g. "She had gastric bypass, which means there's a band around her stomach." A good friend of mine is a GP. When I talked to her about the sleeve, she didn't know what it was and assumed it was some sort of a tube that was inserted into the stonach and "lined" it, like a reversed shirt sleeve. I also have a good friend who is an ER doc. She and I have talked about my band many times (I"ve actually been able to help her a few times when she's gotten "stuck" patients into the ER seeking emergency unfills). She knows I'm looking into the sleeve, and so far (knock on wood) isn't aware of any patients passing through her ER because of their procedure.

I'm seeing two needs. One is the immediate need of living with the band until something can be done. Two is your insurance. You sound either slipped, or way too tight to me. I have a hard time focusing on "wall of text" posts (no offense) -- so I may have missed it -- but do you currently have fill or are you unfilled? If you have fill, get it taken out. Are you actually vomiting (are you purging the contents of your stomach) or are you "PBing" or bringing up the stuck band stuff (saliva, perhaps a few bits of food, foam, etc.)? Vomiting and PBing are two completely different things, and it's important to know which you're actually experiencing. In either case, if you're truly bringing up either vomit or "stuck band stuff" routinely, then you're also swollen routinely, and that will be exacerbated by more eating, yakking, vicious cycle ad infinitum. I personally would suggest you go on liquids for a week, or better - two. Give yourself a chance to recover, unswell (is there a term for that?), etc. Then gradually work your way through mushies and on to solids over the course of a few more days, and see if that helps. If your band is toast, it's toast -- but a "back to basics" routine can do wonders to make things more tolerable. Did your surgeon order an EGD, or at least an xray or fluoroscopy or anything to diagnose what's happening? Your band isn't actually malfunctioning, I don't think (e.g.it sounds like fluid makes its way to the band, and the band is doing its job of restricting) so something else is happening and you need to figure out what. MOST (all that I know of, but there may be an exception) insurance companies will require medical evidence of a slip or erosion to approve removal/revision. You can't just tell them it's not working, and neither can your surgeon, and have that be enough. They won't "take someone's word" so to speak. My insurance company required an EGD as proof - even the xray showing it in the wrong position was not enough, nor was a 2+ year history of documented onset of reflux related to the band. It doesn't sound like your surgeon's office submitted anything like that (because it doesn't sound like they had anything to submit). Find out what your insurance company requires as proof of medical need, and then schedule it with your surgeon. Better yet, ask your surgeon's office why they didn't do it to begin with, and then inform them that they will be doing it. Until you meet their requirements, you will be denied. It will be the same as asking them, "Please? I really want it." Meeting the BMI of the surgery sounds like a miscommunication. There is no BMI requirement for removal, and I would doubt there's one for revision IF revision is done for reason of medical necessity (unless excluded). I'm thinking there's a chance that, since (apparently) no proof of medical need was documented/submitted, your request may have been interpretted as a voluntary removal, and "medically necessary" second procedure -- which will be treated as an initial procedure (at best), and for which standard requirements most likely apply. HTH, and let us know what you find out.

Totally dependent on the surgeon. My surgeon requires a 2 day post-op diet. I've known others to be required a 6 week diet. 1 - 3 days is generally sufficient for the initial shrinkage but as always - do what your surgeon requires.

Yes, you can include YOUR flight. If you elect to take spouse, children, etc. you cannot deduct their flights. (I'm assuming they don't specify flight along with taxi, bus, etc. because it's relatively unusual to fly somewhere for surgical treatment.) This reimbursement is still subject to the 7.5% limitation. Keep in mind this is a deduction, not a credit. That one really messes people up sometimes. A deduction reduces your taxable income. A credit is a dollar-for-dollar tax reduction. I take a $2000 deduction on $100,000 worth of income. My taxable income becomes $98,000. A $2000 tax credit would reduce my taxes owed by $2000. (We built a house in 2010, and qualified for the $6,500 homeowner credit, and a $1500 energy star credit, so our actual tax refund was increased by $8,000 over what it would have been otherwise). This is all really simplified, so forgive any technicalities I've left out. You guys owe me when I get my sleeve & have a bunch of sleeve questions.

I lost this in my inbox for a while, but in case any of you patiently waiting for approval, or trying to meet approval requirements haven't heard:

Chatty - in the lap-band world (and from what I've read it's in the sleeve world too, though I personally don't know yet) we have what's called a "soft stop." Soft stop being your body's warning sign that you're reaching your limit food-wise and need to pass on that next bite, or else. Hard stop being when you have to yak the food back up. Soft stops are usually one of these: Sneezes (usually either one, or a series of several) Watery eyes Hiccups An unintentional sigh Small burp that tastes like whatever bite you had last Combination hiccup/burp or "hiccurp" The best medical explanation I have read is that it's an effect of the vagus nerve having additional pressure applied from the expanding pouch or stomach. I don't know if that's what you're experiencing, but maybe - I know some sleevers do.

Don't worry about bombarding me - I'm happy to help if I can. But I'm not a tax preparer, or an insurance claims professional -- I work on the ancillary corporate performance side. I sat next to actuaries and underwriters and tax attorneys so I've picked up a lot of information, but it's not my profession directly. Having said that, these answers are to the best of my knowledge, but I would strongly advise you to follow-up with a pro before you take my word. 1. WLS is generally not considered a "weight loss program." That term tends to apply to things like Weight Watchers, and NutriSystem. You cannot (or could not, last I actually kept up with a lot of this stuff) deduct things like gym memberships or weightloss club fees, nor the cost of "diet food." In 2002 (IIRC) the IRS categorized obesity as a disease, which is when programs became deductible. Anything that's not a recognized "program" is not considered treatment of disease (just as you could not deduct aromatherapy for treatment of heart disease, even if it did help you remain calm and stress-free). I think it MAY also depend on the procedure. In... 2009? the IRS approved Gastric Bypass/RNY for tax deduction. I don't know if that approval is specific to RNY, or can be more widely applicable to bariatrics. But I will call a friend of mine who will know, and see what she says. I have great insurance and a good income, so my expenses have never exceeded the AGI threshhold so this is not one of the tax sectors I try to keep up on. 2. I actually looked into this around 2007 when I saw how horrible my skin was becoming with my weightloss from lap-band. At the time, the answer was no (assuming you're asking about plastics for saggy skin). I wonder, though, if someone armed with enough evidence could fight that. Could we make the argument that obesity is a disfiguring disease? I'm not sure. It depends on their use of disease (e.g. "cancer" is a disease, but cancer because of actions you have done to yourself, such as lung cancer from smoking cigarettes, can sometimes be excluded -- and I wonder if obesity would be too, since it's a self-inflicted disease.) Here's my best guess. Plastic surgery specifically for body function might be deductible. Plastic surgery for cosmetic reasons would not be. I think a panniculectomy may be deductible, since it is a procedure specifically for removing only skin, if you had medical evidence of necessity (e.g. a history of Dr. visits for treatment of skin sores, yeast infections in the area, etc.) I doubt a lower body lift would be deductible. Having said that, I know that breat augmentation following mastectomy has been successfully deducted, and one could argue that fake breasts are "unnecessary" and only for "improving the patient's appearance," and that absence of a breast or breasts "does not meaningfully promote the proper function of the body." 3, Yes! For procedures after 2002. Your travel costs can also be deducted, unless they are included in the cost of your procedure (e.g. if procedure cost includes hotel stay). Make sure to keep ALL of your paperwork - receipts, doctor/surgeon letters, etc. Oh and a little birdy once told me that if you call a tax office (rhymes with waych sand car lock), even if they don't do your taxes, they will answer your tax questions free of charge, year-round, though for help in the off season (roughly June - Oct) you'll need to get in touch with a district office. They have two types of tax offices: standard and premium. Premium offices have more experienced tax professionals. I can't attest to the accuracy of any of this, but you might want to tuck it away under "good to know."

Oh, do mash them down with a fork. If not, you will have ball cookies and they're kinda awkward to eat.

I've been making flourless PB Cookies forever. I have no idea what the food Network recipe is, but I don't mind sharing mine. <LI class="plaincharacterwrap ingredient">1 cup peanut butter<LI class="plaincharacterwrap ingredient">1 cup white sugar<LI class="plaincharacterwrap ingredient">1 egg Preheat to 350. Combine all ingredients. Make your cookies. Bake for 8 minutes. Make sure you let them cool completely before you take them off the rack or they'll come apart. I have substituted Splenda for sugar with no problems.

Slips are weird in that way. I have restriction. I'm not going to say a LOT, when I can eat I can eat about as much as I want, but there are still plenty of times when I'll just skip meals b/c it's too uncomfortable to eat. And I'm still full a LOT sooner than I would be with nothing ("as much as I want" is still under a full portion). Yesterday I ate a small plate of Cheez-Its just fine. About 45 mins later went to drink some apple juice and ended up sliming over it. I came |----| close to having to having to yak, which I haven't had to do in months & months & months. That's a slip, and no fill, and not TOM. I haven't heard anything about my removal since the EGD was scheduled. I need to call. I'm really not impressed with the way this is being handled. I know my surgeon's office is busy, but I don't think my expectations are too high when I saw that I just want to know what comes next... and maybe a guess as to when.

Out of pocket maximums only apply to covered procedures, that I know of. Elective procedures do not count towards them - elective meaning excluded from your plan. E.g. if your out of pocket maximum was $2000, you could not have breast implants and pay $6000, and consider yourself having met your maximum. You could pay $2000 toward a $40,000 procedure, pretending $2000 was your portion of the agreed charge, and consider yourself having met the maximum. Hope that helps. The statement should indicate the charges and what your balance is, if any. A statement of "anything over $10,000 should be deductible" is not accurate. Eligibility for deduction is on a percentage basis, not a flat rate. Here's the skinny... (Would you believe I've worked for both a very large insurance company, and a very large tax company? I swear it's true!) You can only deduct medical costs that exceed 7.5% of your AGI. So the formula is: AGI * .075 = 75% of AGI. Your expenses - 75% of AGI = allowed deduction. Let's say your AGI is $100,000, and your deductible medical expenses are $5000. (not all expenses are deductible) $100,000 * .075 = $7500. $5000 - $7500 = no deduction for you. Let's say your AGI is $20,000 and your deductible medical expenses are $5000. $20,000 * .075 = $1500. $5000 - $1500 = $3500 deduction. If what your CPA told you is accurate and $10,000 is 75% of your AGI, then anything over it should be deductible. Most taxpayers do not reach an OOP amount that's greater than 7.5% AGI. It tends to take a very low income, or very high medical expenses. More information, examples, and a list of deductible medical expenses can be found in IRS Pub 502 * disclaimer: I hope I didn't fat finger a number up there and completely throw off the math.

Typically criteria for approval does not include losses from the immediately prior WLS. For example, my father had a slipped band removed, and a few months later was re-banded. Although the criteria for band approval includes a BMI over 40, he was excluded from this due to his past. I am a soon to be band to sleeve revision (I'm mostly decided sleeve is what I want). My BMI is under 40 and I don't have comorbidities, but that will not be grounds for denial. However, if I had my band out 5 years ago, and had stayed at a normal weight since, and now wanted to be sleeved, I would most likely not be approved. (That's as my ins. co. explained it to me) I don't know what the statute of limiations, so to speak, is on duration you can go "unassisted" and maintain your BMI, and disqualification because of a low BMI.

All I have heard lately - and this is more through the grapevine/not official - many or most of the insurance companies are looking at excluding bariatrics alltogether, or imposing a "once in a lifetime" limitation that would include prior self-pay procedures. That's scary stuff!

Sorry, I have not checked here in a bit. Leslie - I have found out that my surgeon does revision surgeries at least 2 months apart. While I'm impatient, I do like that idea. A lot of surgeons will do them in one procedure and although I'm not a surgeon, requiring some down time seems like the way to do it. During the first surgery he removes the band, and repairs adhesions (the exterior damage to the organs & surrounding tissues that we're all going to have). The second procedure is to create the sleeve. I had my EGD two weeks ago, but haven't yet been able to meet with the surgeon. I won't until we receive the insurance approval (nice, huh?) My surgeon is very skilled and I am a "repeat customer" but I still have a ton of questions for him around the revision process. E.g. if the highest risk is leak, and a leak is repaired by applying mesh and blanket sutures, can you just do mesh & blanket sutures from the beginning? Leesha - good to hear from you. We have extremely similar stories except for our initial bandings. As I mentioned earlier, I have been given the option of keeping my slipped band, and even getting fills as tolerated. But when I started thinking about it, I just wasn't sure how that was an option. I'm at higher risk for additional prolapse, I already know I can't tolerate fills -- the EGD left me very swollen and it was about 8 days before I could eat solids. The swelling immediately brought back all the reflux and heartburn, and removed ANY thought I might have given to keeping the band because it's completely evident that anything brining about restriction (internal, like the EGD or a stuck piece of food -- or external, like a fill) is going to renew the symptoms I have. (Like you I have no pain, and no sickness... but I do have a feeling of pressure most of the time when I eat solids, and if that pressure isn't gone by bedtime, I will start refluxing within 10 minutes of falling asleep... it's truly like clockwork). I do need to follow up with a question to my surgeon's office. The xray showed a "profound" slip -- I didn't see the xrays, but I was told that the angle of the band was almost opposite of what it should be, and that based on the xray alone I would not be a candidate for repositioning/rebanding. The EGD showed a "partial" slip. So I don't know if the slip has actually improved since getting completely unfilled, or if those two things that seem a little contradictory actually aren't. There are still three people I know, banded longer than me, that I'd like to get back in touch with. Aside from those three, whose band status is "unknown" -- 100% of the people I know banded around my time or earlier have had slips and/or removals. EVERYONE. The band helped me get almost to goal weight. It definitely helped me conceive my daughter. I'm not anti-band, and I don't "hate" my band. I wish I had known then, the current stats for failure rates. If I could trust myself to keep the weight off, I would have it removed and never regret a thing, and never look back. But I don't trust myself with that (I'm still carrying my 40 lbs of "pregnancy" weight, and my DD will be 3 in October). Do I think it can help people lose weight -- I know it can. Do I think it's a long-term solution -- absolutely not.

I've had a lap-band for going on 6 years. Feel free to PM me if you have any questions. I will give you my opinion, or collective data - whichever you prefer. I'm here researching revision, so my experience isn't the best, but it has been good. I'm happy to answer any questions. I don't want to sound harsh, but you might want to put things on hold a bit. "I'll get whatever insurance covers, but I don't know what that is" is not going to set you up for the most success. RNY and VSG are apples and oranges, and your preparation for each, expectations, recovery, etc. are going to be really different. It's not something you want to be a surprise. Or - maybe you're equally prepared for either? BTW, I see you have 215 lbs to lose. I had 200 to lose, when I got my band. I am osing my band, and even if I weren't, I would not advocate for the band as a long term procedure -- but it is possible to be a higher BMI patient and reach goal with a band.

Protein will matter more than calories, and so will time (generically). For hairloss, that is. Neither may matter if your hairloss is the result of body trauma, and not a deficiency. It's pretty unusual for hairloss to last much longer than a year, if that helps you feel any better.