leelanau

I talked this over with my endo, and she is as supportive as I expected. She understands that I feel this may be my last resort for losing any significant weight, and that at this point, I need help to make sure I break the cycle of eating once a day permanently. I know it sounds ridiculous, but I truly am NOT hungry, except at night when I haven't eaten all day. My body has been in starvation mode for soooo long that I can eat one meal a day and be perfectly happy - except I cannot lose an ounce! I know my PCP doesn't understand my struggle, because he directly told me that he didn't care if i ate all 1500 in one meal, I would still lose weight. He absolutely did not believe that I had been trying to break that exact cyle for years. I cannot be the only person out there on this board with this problem, as my endo thinks it is far more common in busy women than people think. She has several women like myself that are trying to kick start their metabolism again, and actually asks me to forward any information I find on increasing metabolism on to her so she can review it for everyone. My family doesn't understand the issue at all, and thinks I'm a closet eater, which I feel like at times when I'm stuffing my only meal in my face at 8pm because I'm suddenly ravenous. I understand the post-band diet perfectly, and it fits neatly with the program my dietician designed, and I was trying to implement one step at a time. A decade of habit cannot be changed overnight, and adding one small thing to my pattern seemed to be finallly making progress, as seen in my now slow weight loss success. The dietician explained I'd gain before I'd lose, as my body would need to adapt to the continued food additions through the day, and I gained 10 lbs before the losses started. I still have 3 lbs to go before I'm back at my 'start' weight. Now that I have to restrict the calories even farther, it seems like my body is protesting yet again, and can't keep the blood sugar even. As it took me months to be able to eat Breakfast without gagging it up, I know 6 months isn't long enough to get used to a lot more carbs just to be able to stay under the 1500 max. Good Protein is 'expensive' in terms of calories, especially after I had been told to count carbs per meal/snack and take in a minimum of cals to get the fire burning. I know many of you drink the slimfast and others, but the sugar count in those would send me into hypogylcemia in an hour with the reaction to too many carbs at once. It would be a great option if my system could handle it, but real food seems to keep me level for now. I am going to continue on for the remainder, but it looks like for now I will have to try and find some of those pre-packaged meal supplements to try and kick out at least two more additional lost pounds next month. I thought approx 3 lbs a month was good progress, as I could potentially lose 18 instead of the required 15 for that practice, but I guess that isn't fast enough for my PCP. I hope I am able to find some things that I can physically get down that have enough grams of protein in them to keep me even, or I get the impression he will not be willing to write up a referral letter for me. I am going to another seminar this evening (the fourth one....) to investigate yet another practice. I'm going to ask some hard questions of the dietician on staff of their standard practice on the pre-surgery weight loss and see if I can stir up some new ideas. I have read many of you do not have a minimum number of pounds to lose, which would be good in my case, as I am more than happy to keep working hard toward weight loss. I wouldn't consider this surgery if I wasn't willing to make myself eat small meals all day, the fact that it leaves me no other choice was the best part.

I guess I didn't make myself clear enough the first time around. My dietician's (over the last three years) did not want me eating less than 1500 cals, as it was hard to keep my blood sugar on an even keel. I have a tendancy to be hypoglycemic, and get shaking and sweaty when my sugar is dropping. This has been happening on the 1500 max diet, which is what I tried to tell him today. I always eat my Protein first as to give it the max amount of time to work before the carbs are added, but it doesn't seem to help on this program. I was having much better luck controlling my diabetes when I was eating a min of 1500, with at least three meals and trying to get at least two Snacks in too. I don't think the 1500 max would be a problem for another patient, but that shipped sailed long ago. My metabolism was wrecked years ago, and have been trying to get it burning again for two years. Like I said, I was thrilled to see the scale going back down instead of up! Sometimes I think doctors forget each of us has our own unique body, and history that can't be made equal to another person. I am the ONLY large person in a large family of thin people (I'm the tallest female though) - mainly because my metabolism is burnt out. I started looking at Lapband as a way to keep small meals in my body consistently in order to get it burning correctly again. I don't want to ruin the progress I worked so hard to achieve. Quoting one of the thousands of studies on weight loss does not mean it will work for me - especially if its the program he uses for himself. Men and women are not the same creatures. I'm not looking for excuses, but solutions. I don't think this physician is looking to help a patient recovering from what is essentially anorexia (one meal a day) overcome their struggle, but to neatly fit me into their profile. He clearly stated that he doesn't have the time to read my reports from my endo, obgyn, dermatologis or neurologist, and thinks that my PCOS, migraines and diabetes were caused from my weight - not as a result of it. My endo and I have clearly marked the illness I had that resulted in 30 lbs lost in 30 days in my late teens, and weight gain/complications that resulted every year since. It clearly shows the progression of my diabetes, along with the increased symptoms of PCOS. This history will not be solved with a diet that isn't tailored to my individual needs - like the ones my dieticians have given me.

I just got back from the doctors, and while I showed a weight loss, he is still being 'assertive' with me that if I just ate 1500 cals a day, I would lose more. As I am one of the notorious one meal a day eaters, I think this is an unfair assessment. I have worked very hard since my hyster surgery in Dec to start eating regularly, and have been thrilled with the fact that I have started losing weight at all. My main focus has been identifying the signs of hunger, trying to chew slowly and completely (for practice), and to make sure I don't skip any meals. I am also making better choices with my meals, and trying to eat low carb Snacks and no-sugar Desserts. As my dietician told me to eat a MINIMUM of 1500 cals a day, and now the doctor says a MAX of 1500, I don't know what to think. I'm trying to change a decade of not eating, and feel caught between two very different views on weight loss. I know that my doctor will be the final say on the surgery due to the insurance company, so I need to keep him happy, but I'm struggling. I just got back from vacation and had the best time of my life, but there was NO way I was going to try to count calories on a whitewater rafting trip, climbing cliffs and caving. I was very happy with the fact that I had made good enough choices during my time away that I didn't gain an ounce, but it seems the doctor is not of the same opinion, and chastised me on not losing more. Has anyone switched doctors mid-stream during their six months of supervised weight loss? Does it have to be a doctor? Can it be a dietician? I love this doctor for the family, but I'm having a hard time being patient with him when he admitted today that he just doesn't have the time to read the reports from my specialists to get up to date on my treatments. If he hasn't takent the time to read their recommendations, how is he supposed to understand I've been struggling with this weight issue for so long?

Hello again! I just got off the phone with UM and found out a few interesting details. They no longer require a fee to become a part of their program. Evidentally the fee used to be required due to the Remedy MD software/online reporting they were using for patient/doctor correspondence. They no longer use this program, so the fee has been eliminated. Dr. Finks did his Fellowship in Laproscopic surgery in WA state, of which an extensive part of the training was in Gastric Banding. As I had a Fellow participating in my hysterecomy in Dec at UM with no complications or worries, this training would be sufficient for me to feel that he is proficient at the procedure. If necessary, I'm sure his credentials would be forwarded upon request which would allow anyone to get references from his Fellowship program in WA. The UM program will not use my date of referral from the PCP as the 'start date' of the six months they require for the doctor supervised weight loss program THEIR program requires. This is separate from the insurance requirement, and additionally, they require you loose 5% of your baseline, which is 15 lbs for me, before surgery. I was hoping to use the referral date, as I wanted to schedule the psych, nutrionist, medical eval, etc. all on the same day and it would require up to 8 weeks in advance of the appt to schedule those together. At $4 a gallon, it would be worth it to wait, however, they do not want the 'packet' sent in any earlier than 3 months after the beginning of my doc supervised weight loss (required before you are admitted into the program), which sets me back a month if I want to minimize my trips south. So.... I could have the surgery several weeks earlier if I'm willing to drive the 2 1/2 hrs several times instead of once. Since I want to minimize my out of pocket ($2400 year), I will have to make a bunch of trips south to make sure this is accomplished before 12/31/08. I also found out that they are not a Center of Excellence, but are eligible for patients of Blue Network now. They must do a minimum of 100 lapbands a year to get that ranking, and while they are on target to get that distiction for this calendar year, it still means that any Medicare patients cannot use UM for their bariatric surgery. Should they successfully complete the 100 required surgeries during the 2008 calendar year, and because they have already met the other requirements, they would be considered a Center of Excellence starting in 2009. This is all according to the person I talked with this afternoon of course... I hope this helps anyone else interested in UM for their lapband make their decision on whether to investigate UM Bariatric as a possible program. I tried to think of all the questions I could, but I'll admit, I was most interested in the questions that directly affected me individually. It was interesting to find out that just over a year ago they were still trying to get approval to become a bariatric program for gastric banding. They had to do 3 surgeries before approval, but who would want to be those first three people???? Both doctors had done the gastric band in other hospitals before, not together, but still... It wouldn't have been me as the guinea pig!

Thanks for the info faith. They did explain at the seminar in May that they were now doing three bands every Monday and RNY bypass on Wednesdays, so they could concievably do a dozen bands a month. Maybe the secretary miscommunicated the information to you about the dozen lapbands. Dr. Birkmeyer was at the seminar and I asked some very pointed questions about the band and if revisions could be done to RNY should there be complications from the band. He explained that he and Dr. Finks were both present for every band operation and that they were the ones doing the procedures - together. I also heard from my PCP that Dr. Finks was very... meticulous and to the point. I assumed from that description (knowing my PCP) that althought the man was a very talented surgeon, but had little to no patient skills. Thus, I'm interpreting that I can expect to find the man abrasive, but my procedure done with the highest level of skill. A small price to pay for a job well done, as I do not expect to talk much to the surgeon anyway, and really only care that the job is done correctly the first time. As I am a UM patient for several other specialities, my PCP suggested I might find that the coordination of care would be far easier to implement as I am in their system and have been for more than a decade. Should any of my other physicians require information or need to see me in the hospital after my procedure for any reason, I would be in the best place possible, as all records are kept electronically. As I am diabetic, and other things, I do feel if there was an emergency, I would rather my own endocrinologist be available for that situation than another doctor. In effect, I would be more comfortable with UM as a hospital, even if it meant that I had to work with a practice that had less 'practice'. As far as them quoting the 130 lapbands, I did believe Dr. Birkmeyer when he gave that information. He realized that it was a small number, but immediately gave the statistics of their complication rate (which was a blood clot in one patient with a history of clotting), and the fact that they were relatively new to the procedure, but that they supported lapband as it was a good choice for so many patients. If you take into consideration the fact that they could do a minimum of 12 procedures a month, they can easily rack up the 130 he quoted. It is clear, however, that they are far more skilled at RNY due to the fact they have done so many of those surgeries over the last few years. I actually watched the lapband surgery online, and found it is really not very complicated. After hearing from my PCP the intense, lifesaving procedure that Dr. Finks completed on one of his family members, this procedure should be easy for them. I do wish I could find someone that had the lapband from them so they could confirm the costs, and any 'surprises' that they experienced along the way, as it is expensive anyway you look at it. I find it slightly irritating that each program requires you to attend their seminar, even if you have sat through several. It's the same info over and over, and boring if you have heard it more than once. I really do not find it necessary to sit through another, and Hurley is requiring the same as the others. It was illuminating, however, during one I was at last spring, they were actually trying to convince people that they would need to purchase their supplements directly from their program ONLY, and should they not follow their specific program using THEIR supplements, you would be asked to find another doctor. That was unacceptable!

Hello all, I am strongly considering having the band done by Dr. Finks, who was highly recommended by my PCP as a first rate surgeon. Has anyone else been a part of their new program at U of M in the last two years? At the seminar, I was informed that they had only done 130 bands between the two surgeons, but a lot of gastric bypass procedures. I know the risk is significantly lower with the band, but this group is pretty new to the game, so I'm trying to find someone with experience working with them. Thanks!

I meant 'start' instead of star... oh well.... I forgot to mention that the doctor was interested in the fact that the clinic was requiring nutrition training as well as a psych eval, as he didn't realize that was required. As he was the original referring physician to a particular surgeon in the group, he wanted to warn me that the surgeon was 'meticulous' which I inferred meant picky. My PCP definitely likes the time frame required by the group before surgery, as it will give me time to make the best decision, and the doctors plenty of time to make sure this is the right choice medically. In all, I feel it was a good day. On another note, my PCP no longer accepts cash payments, as he HAD to join a larger medical group/hospital in order to retain his client base during the latest insurance dustup. The main employer in our area changed services to BCBS after ConnectCare, and that meant that all area doctors had to take a pretty steep reduction in payoff. He wanted to retire, but is still too young, so he felt he had no choice but to change his practice to reflect the area. He said his projections are that he will need to work at least two extra years longer than planned just to save enough for his retirement. It's sad that insurance has such pull that it can change a very good doctors life plans overnight by reducing his income. Now that he is a member of the 'group', he can no longer accept patients without insurance either - which does seem to be the newest trend.

Well, due to the fact that the insurance seems a go, I went ahead and scheduled with my doctor to star the six month supervised weight loss today, along with several blood panels that the endocrinologist ordered. I will definitely post updates later should the insurance company decide that I do not qualify for medical necessity - even though I've been diabetic since age 29. My doctor was supportive during the exam today, and encouraged excercise and wanted my past visits with the dietician sent to his office. In all, I am hopeful that this will work out, but whether I decide to have the surgery or not, we have got the process started.

It was finally communicated to my husband (owner of the insurance policy) that the company had a restriction to 'medically neccessary' which of course I can prove - so the situation resolved itself. As I have had diabetes for years, and can make some of the other co-morb's fit, we should be able to make it work. What a load off my mind! The clinic I want to work with had made the decision to not accept cash due to the risk of something going wrong during the surgery that wasn't originally paid for. The told me that because of the risks involved, and the fact that the patient would be 'out' and couldn't give permission to proceed (guaranteeing payment), they decided they would work with insured customers only. As a business person I can understand their position, but it would be easy to have someone sign legal documents beforehand in the case of emergency to guarantee payment, or have a line of credit set up in advance. I think they will change this position over time, as it would mean turning away a LOT of patients.

I just checked that website, and it looks as if the closest doctor is in OH or WI - none listed in MI.

I just called the insurance carrier and was informed that our employer has prohibited any bariatric obesity related procedures - so no coverage. I then called the group I was most comfortable with after the seminars and found out they do not accept any cash patients. It's been over a year of research, and I'm back at square one. Does anyone know of clinics in MI that accept cash? sad and confused....:cursing:

Hello All, I have been considering bariatric surgery for a few years now, and just found a group I would like to work with. Now that I found physicians, I need to decide between Roux-en-Y or Lapband, which I found out is not as easy as I thought. I'll be visiting occassionally, as I homeschool and run a business, so I have limit my time online for 'other' things. I am, however, a voracious researcher, so I'll be reading a lot - but probably lurk most of the time. I look forward to hearing both the positive and negative from everyone in my quest to lose the equivalent of my younger sisters weight. Thanks, Leelanau