JamieNP

Congrats!! When is your surgery?

I wonder why they didn't give you a potassium run before the procedure? Anyway, good luck to you!

Sue, How does that Tryke do on hills? It looks like fun, but the swerving back and forth could be dangerous in traffic.

We will pray that it lands on the right desk!

I have not heard about any. I am working on an appeal letter, and going to weigh in sometime this week. I need to gain 1 more pound.:smile2:.

There are lots of tricare threads. You can type in "tricare" in the labband search window and they should pop up. Some people have had good experiences, others are jumping through hoops. Good luck!

Tuger, Tricare, in the denial letter, gave me a weight amount that I needed to weigh to be approved. It was the low end of the med build. For instance, I should weigh 227 lbs for 5'5 ht. I weigh 220.5. I fit in the small frame (no doctor stated what frame size I was so I guess they went by the medium frame). They stated that I needed to weigh 227 lbs.

Amanda, if you don't mind me asking, were you under the requirement even by one pound? or did you fall within the range? I am working on gaining the 6.5 lbs, but I want to make sure that is enough. If I fall in range and they deny me, I will go through obesity law.

I was 220.5 at 5'5 with high blood pressure and obstructive sleep apnea (on cpap)

My surgeon and I thought for sure that I would be approved by Tricare. I have two major comorbidities. I am 3 pounds over the low end of the Met life scale...but Tricare told me today that I am 6.5 pounds under the requirement! You have got to be kidding me!!! So, do I try to gain the 6.5 pounds?? or just give up and go on ANOTHER diet!!

Tricre uses the Met life scale and uses the figures for medium frame. And if you are 6 lbs under...well, you will get denied.

I am on Twitter! NurseJamie is my screen name.

There are plenty of Tricare threads on here. You can search and read our trials and tribulations dealing with them. If you qualify with no questions asked, it is fast and great. I got denied for being 6.5 lbs under with 2 comorbids. I am appealing.

I thought I would share some research articles for people that are needing to put together appeal letters. I got them off of springerlink Obesity Surgery Journal

Obesity surgery: Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES) JournalSurgical Endoscopy PublisherSpringer New York ISSN0930-2794 (Print) 1432-2218 (Online) IssueVolume 19, Number 2 / February, 2005 CategoryE.A.E.S. Guidelines DOI10.1007/s00464-004-9194-1 Pages200-221 Subject CollectionMedicine SpringerLink DateMonday, December 06, 2004 S. Sauerland1, 2, L. Angrisani3, M. Belachew4, J. M. Chevallier5, F. Favretti6, N. Finer7, A. Fingerhut8, M. Garcia Caballero9, J. A. Guisado Macias10, R. Mittermair11, M. Morino12, S. Msika13, F. Rubino14, R. Tacchino15, R. Weiner16 and E. A. M. Neugebauer1, 2 Received: 1 August 2004 Accepted: 19 August 2004 Published online: 2 December 2004 AbstractBackground The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectivness and surrounding circumstances of the various types of obesity surgery. Methods A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. Recommendations After the patients multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life. Presented at the 12th International Congress of the European Association for Endoscopic Surgery (E.A.E.S.), Barcelona, Spain, 9-12 June 2004

Cost-Effectiveness and Budget Impact of Obesity Surgery in Patients With Type-2 Diabetes in Three European Countries JournalObesity Surgery PublisherSpringer New York ISSN0960-8923 (Print) 1708-0428 (Online) IssueVolume 16, Number 11 / November, 2006 DOI10.1381/096089206778870067 Pages1488-1503 Subject CollectionMedicine SpringerLink DateTuesday, June 26, 2007 Add to marked items Add to shopping cart Add to saved items Permissions & Reprints Recommend this article Roger Ackroyd1, Jean Mouiel2, Jean-Marc Chevallier3 and Frederic Daoud4 (1) Royal Hallamshire Hospital, General Surgery, Sheffield, South Yorkshire, United Kingdom (2) University of Nice, Obesity Center, Nice, France (3) Hôpital Européen Georges-Pompidou, General Digestive Surgery, Paris, France (4) Medalliance, Paris, France Published online: 01 November 2006 Background: We aimed to establish a payer-perspective cost-effectiveness and budget impact (BI) model of adjustable gastric banding (AGB) and gastric bypass (GBP) vs conventional treatment (CT) in patients with BMI ≥35 kg/m2 and type-2 diabetes T2DM, in Germany, UK and France. Methods: Clinical evidence was obtained from literature and patient-reported EQ-5D scores given BMI and T2DM status from HODaR. Resource utilization data in AGB, GBP and CT were obtained from quoted publications so as to reflect practice in 2005. CT in each country was based on descriptions in HTA reports or based on co-authors' experience of current practice. Unit costs were obtained from published sources when available, or from co-authors' institutions. A deterministic algorithm with cost and utility discounting, enabled selection of inputs independently throughout the time scope for each of the 3 treatments, and included mean BMI, amounts of resources and unit costs. Results: The base case time-scope was 5 years, and the annual discount rate for utilities and costs was 3.5%. Compared to CT, GBP yielded +80.8 kg/m2.years, +2.6 T2DM-free-years and +1.34 QALYs. AGB yielded +57.8 kg/m2.years, +2.5 T2DM-free-years and +1.03 QALYs. In Germany and France, both GBP and AGB yielded a cost decrease, and were thus dominant in terms of ICER compared to CT. In the UK, GBP and AGB yielded a cost increase, but were cost-effective. Conclusion: In patients with T2DM and BMI ≥35 kg/m2, AGB and GBP are effective at 5-year follow-up in cost-saving in Germany and France, and are cost-effective in the UK with a moderate BI vs CT.

Paid Work Increases and State Benefit Claims Decrease after Bariatric Surgery JournalObesity Surgery PublisherSpringer New York ISSN0960-8923 (Print) 1708-0428 (Online) IssueVolume 17, Number 4 / April, 2007 DOI10.1007/s11695-007-9073-7 Pages434-437 Subject CollectionMedicine SpringerLink DateTuesday, May 01, 2007Simon C. Hawkins1, Alan Osborne1, Ian G. Finlay1, Swethan Alagaratnam1, Janet R. Edmond1 and Richard Welbourn1, 2 (1) Department of Upper Gastrointestinal Surgery, Musgrove Park Hospital, Taunton, Somerset, UK (2) Department of Upper Gastrointestinal Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK Received: 10 December 2006 Accepted: 3 January 2007 Published online: 1 May 2007 Background Bariatric surgery is a clinically effective treatment for obesity and has been shown to be costeffective. The impact of bariatric surgery on the subsequent ability to work and the uptake of state-funded benefits is not well documented. Methods A consecutive series of 79 patients who had undergone laparoscopic Roux-en-Y gastric bypass (LRYGBP) or laparoscopic adjustable gastric banding (LAGB) were surveyed to assess changes in their ability to work and the number and type of state benefits claimed after surgery. Results 59 patients (75%) responded, median age 45, median follow-up 14 months. There was a 32% increase in the number of respondents in paid work after surgery (P < 0.05).The mean weekly hours worked increased from 30.1 to 35.8 hours (P < 0.01). Respondents also reported a decrease in obesityrelated physical and emotional constraints on their ability to do work (P < 0.01). Fewer patients claimed state benefits postoperatively (P < 0.01). Conclusion More patients perform paid work after LRYGBP and LAGB than beforehand, and the number of weekly hours they work increases. After surgery, patients claim fewer state benefits.

Pathophysiology of Obesity: Why Surgery Remains the Most Effective Treatment JournalObesity Surgery PublisherSpringer New York ISSN0960-8923 (Print) 1708-0428 (Online) IssueVolume 17, Number 10 / October, 2007 CategoryReview DOI10.1007/s11695-007-9220-1 Pages1389-1398 Subject CollectionMedicine SpringerLink DateWednesday, November 14, 2007 Add to marked items Add to shopping cart Add to saved items Permissions & Reprints Recommend this article Talat Waseem1, Kris M. Mogensen2, David B. Lautz1 and Malcolm K. Robinson1, 2 (1) Program for Weight Management, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (2) Metabolic Support Service, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA Received: 26 March 2007 Accepted: 19 June 2007 Published online: 14 November 2007 Obesity is a rapidly increasing, worldwide epidemic. Despite recent scientific advances, no currently recommended dietary program or medication results in long-term weight loss of more than 10% of body weight for the vast majority of people who attempt these interventions. Hence, surgical intervention is recommended for patients with a BMI ≥40 kg/m2. Although surgery is an effective, sustainable treatment of obesity, it can be associated with potentially significant perioperative risks and long-term complications. Current research is focused on developing a medical therapy, which produces more effective and sustainable weight loss, yet avoids the risks inherent in major surgery. With a reduced risk profile, such therapy could also be appropriately offered to those who are less obese and, in theory, help those who have BMIs as low as 27 kg/m2. Toward that end, numerous scientists are working to both unravel the pathophysiology of obesity and to determine why surgical intervention is so effective. This review briefly examines the current status of obesity pathophysiology and management, the reasons for failure of conventional medical treatments, and the success of surgical intervention. Finally, future areas of research are discussed.

Italian Group for Lap-Band System®: Results of Multicenter Study on Patients with BMI ≤35 kg/m2 JournalObesity Surgery PublisherSpringer New York ISSN0960-8923 (Print) 1708-0428 (Online) IssueVolume 14, Number 3 / March, 2004 DOI10.1381/096089204322917963 Pages415-418 Subject CollectionMedicine SpringerLink DateFriday, August 24, 2007 L Angrisani1, F Favretti2, F Furbetta3, A Iuppa4, S B Doldi5, M Paganelli6, N Basso7, M Lucchese8, M Zappa9, G Lesti10, F D Capizzi11, C Giardiello12, N Di Lorenzo13, A Paganini14, L Di Cosmo15, A Veneziani16, S Lacitignola17, G Silecchia18, M Alkilani19, P Forestieri20, F Puglisi21, A Gardinazzi22, M Toppino23, F Campanile24, B Marzano25, P Bernante26, G Perrotta27, V Borrelli28 and M Lorenzo29 Published online: 01 March 2004 Background: The Lap-Band System® is the most common bariatric operation world-wide. Current selection criteria do not include patients with BMI ≤ 35. We report the Italian multicentre experience with BMI ≤ 35 kg/m2 over the last 5 years. Patients and Methods: Data were obtained from 27 centres involved in the Italian Collaborative Study Group for Lap-Band System®. Detailed information was collected on a specially created electronic data sheet (MS Access 2000) on patients operated in Italy since January 1996. Items regarding patients with BMI ≤ 35 were selected. Data were expressed as mean ± SD except as otherwise indicated. Results: 225 (6.8%) out of 3,319 Lap-Band® patients were recruited from the data-base. 15 patients, previously submitted to another bariatric procedure (BIB =14; VBG= 1) were excluded. 210 patients were eligible for study (34M/176F, mean age 38.19±11.8, range 17-66 years, mean BMI 33.9±1.1, range 25.1-35 kg/m2, mean excess weight 29.5±7.1, range 8-41). 199 comorbidities were diagnosed preoperatively in 55/210 patients (26.2%). 1 patient (0.4%) (35 F) died 20 months postoperatively from sepsis following perforation of dilated gastric pouch. There were no conversions to laparotomy. Postoperative complications presented in 17/210 patients (8.1%). Follow-up was obtained at 6, 12, 24, 36, 48 and 60 months. At these time periods, mean BMI was 31.1±2.15, 29.7±2.19, 28.7±3.8, 26.7±4.3, 27.9±3.2, and 28.2±0.9 kg/m2 respectively. Co-morbidities completely resolved 1 year postoperatively in 49/55 patients (89.1%). At 60 months follow-up, only 1 patient (0.4%) has a BMI >30. Conclusions: Although surgical indications for BMI ≤ 35 remain questionable, the Lap-Band® in this study demonstrated that all but 1 patient achieved normal weight, and most lost their co-morbidities with a very low mortality rate.

Gastric Bypass in Patients with BMI <40 but >32 Without Life-threatening Co-morbidities: Preliminary Report JournalObesity Surgery PublisherSpringer New York ISSN0960-8923 (Print) 1708-0428 (Online) IssueVolume 12, Number 1 / February, 2002 DOI10.1381/096089202321144586 Pages52-56 Subject CollectionMedicine SpringerLink DateWednesday, August 29, 2007 Add to marked items Add to shopping cart Add to saved items Permissions & Reprints Recommend this article Disable Highlighting PDF (105.6 KB)Free Preview <a href="http://adfarm.mediaplex.com/ad/ck/8282-59403-3840-1?mpissn=1708-0428&mpt=1219328699.5990304"> <img src="http://adfarm.mediaplex.com/ad/!bn/8282-59403-3840-1?mpissn=1708-0428&mpt=1219328699.5990304" alt="Click Here" border="0"></a> Gastric Bypass in Patients with BMI <40 but >32 Without Life-threatening Co-morbidities: Preliminary Report Mal Fobi1, Hoil Lee2, Daniel Igwe3, Basil Felahy4, Elaine James5, Malgorzata Stanczyk6 and Nicole Fobi7 (1) Center for Surgical Treatment of Obesity, Hawaiian Gardens; Tri-City Regional Hospital, Hawaiian Gardens, CA; Bellwood General Hospital, CA; Cedars Sinai Medical Center, Los Angeles, CA, USA (2) Center for Surgical Treatment of Obesity, Hawaiian Gardens; Tri-City Regional Hospital, Hawaiian Gardens, CA; Bellwood General Hospital, CA; Cedars Sinai Medical Center, Los Angeles, CA, USA (3) Center for Surgical Treatment of Obesity, Hawaiian Gardens; Tri-City Regional Hospital, Hawaiian Gardens, CA; Bellwood General Hospital, CA; Cedars Sinai Medical Center, Los Angeles, CA, USA (4) Center for Surgical Treatment of Obesity, Hawaiian Gardens; Tri-City Regional Hospital, Hawaiian Gardens, CA; Bellwood General Hospital, CA; Cedars Sinai Medical Center, Los Angeles, CA, USA (5) Center for Surgical Treatment of Obesity, Hawaiian Gardens; Tri-City Regional Hospital, Hawaiian Gardens, CA; Bellwood General Hospital, CA; Cedars Sinai Medical Center, Los Angeles, CA, USA (6) Center for Surgical Treatment of Obesity, Hawaiian Gardens; Tri-City Regional Hospital, Hawaiian Gardens, CA; Bellwood General Hospital, CA; Cedars Sinai Medical Center, Los Angeles, CA, USA (7) Center for Surgical Treatment of Obesity, Hawaiian Gardens; Tri-City Regional Hospital, Hawaiian Gardens, CA; Bellwood General Hospital, CA; Cedars Sinai Medical Center, Los Angeles, CA, USA Published online: 01 February 2002 Background: Surgical intervention is currently indicated for patients with BMI >40 or >35 with life-threatening comorbidities. Patients with BMI 32-40 without these comorbidities not only have the increased propensity to develop them but also suffer from similar psychosocioeconomic consequences. These patients may not respond to non-surgical treatment of obesity any better than those with BMI>40. The question has been raised whether to offer them surgical intervention. Methods: A study was carried out to determine outcome of surgery on patients with BMI >32 but <40 without life-threatening comorbidities but with either psychological, economic or social impairments affecting their quality of life. The approval of our Hospital Internal Review Board was obtained. In addition to routine evaluation for surgical intervention, these patients were required to have the approval of their primary care physician, be seen pre-operatively by a psychiatrist, and have a member of the family or a very close friend present at the time of discussion of operative risks and follow-up requirements. Patients committed to at least a 5-year follow-up. They were to be self-paying patients. The transected silastic ring vertical gastric bypass with a temporary gastrostomy was used. Results: 50 patients, 49 women and one man, were entered into the study between May 1, 1999 and April 30, 2000. 50% were self-pay, and the other 50% were able to obtain coverage through their insurance companies. There were few peri-operative complica tions and no deaths. The late complications include incisional hernias, dumping and transient alopecia. Hospital stay averaged 3.7 days. Follow-up has been 18-27 months. Weight loss has been excellent. Conclusion: Preliminary results of surgical intervention extended to patients with BMI 32-40 without life-threatening comorbidities but with psychosocioeconomic ramifications are very promising. Long term follow-up and comparison with other bariatric patients are planned.

William C Frey1 and John Pilcher2 (1) Department of Pulmonary, Critical Care and Sleep Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA (2) Department of Pulmonary, Critical Care and Sleep Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA Published online: 01 October 2003 Background: Obesity is a well known risk factor for obstructive sleep apnea (OSA). Medical therapy is not effective for morbid obesity. Bariatric surgery is therefore a reasonable option for weight reduction for patients with clinically severe obesity. Unrecognized OSA, especially in those patients receiving abdominal surgery, has influenced perioperative morbidity and morality. The incidence of OSA for patients being evaluated for bariatric surgery has not been previously defined. Methods: 40 consecutive patients being evaluated for bariatric surgery were examined with a history, physical examination and laboratory data. Polysomnography (PSG) was conducted in all patients regardless of symptoms. Results: An obstructive sleep-related breathing disorder (OSRBD) was present in 88% of the patients. OSA was present in 29 of 41 (71%) and upper airway resistance syndrome (UARS) in 7 of 41 (17%). The mean low oxygen desaturation was 84% and continuous positive airway pressure (CPAP) was 10 cm H2O pressure. The majority of the patients were women and mean BMI was 47 kg/m2. Patient characteristics failed to predict the severity of OSRBD. Conclusions: This population of clinically severe obese patients being evaluated for bariatric surgery had an 88% incidence of an OSRBD, 71% with OSA. Appropriate therapy with CPAP perioperatively would theoretically prevent hypoxic complications associated with OSRBD. Providers should have a low threshold for ordering a PSG as part of the preoperative evaluation for bariatric surgery. Empiric CPAP at 10 cm H2O should be considered for those patients who cannot complete a PSG before surgery.

William C Frey1 and John Pilcher2 (1) Department of Pulmonary, Critical Care and Sleep Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA (2) Department of Pulmonary, Critical Care and Sleep Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA Published online: 01 October 2003 Background: Obesity is a well known risk factor for obstructive sleep apnea (OSA). Medical therapy is not effective for morbid obesity. Bariatric surgery is therefore a reasonable option for weight reduction for patients with clinically severe obesity. Unrecognized OSA, especially in those patients receiving abdominal surgery, has influenced perioperative morbidity and morality. The incidence of OSA for patients being evaluated for bariatric surgery has not been previously defined. Methods: 40 consecutive patients being evaluated for bariatric surgery were examined with a history, physical examination and laboratory data. Polysomnography (PSG) was conducted in all patients regardless of symptoms. Results: An obstructive sleep-related breathing disorder (OSRBD) was present in 88% of the patients. OSA was present in 29 of 41 (71%) and upper airway resistance syndrome (UARS) in 7 of 41 (17%). The mean low oxygen desaturation was 84% and continuous positive airway pressure (CPAP) was 10 cm H2O pressure. The majority of the patients were women and mean BMI was 47 kg/m2. Patient characteristics failed to predict the severity of OSRBD. Conclusions: This population of clinically severe obese patients being evaluated for bariatric surgery had an 88% incidence of an OSRBD, 71% with OSA. Appropriate therapy with CPAP perioperatively would theoretically prevent hypoxic complications associated with OSRBD. Providers should have a low threshold for ordering a PSG as part of the preoperative evaluation for bariatric surgery. Empiric CPAP at 10 cm H2O should be considered for those patients who cannot complete a PSG before surgery.

Kbott, This poll means nothing, except to give people a topic to talk about. The opinions here mean nothing. WLS is an individual thing, and the fact that there is a poll that is "judging" whether or not you are "fat enough" to have surgery is ridiculous. One of the choices listed (and some people actually agreed with!) is "no it is a waste of money" for someone 200lbs. What!! If wls keeps someone from being 250, 300, 400 lbs, then do it NOW before they have any permanent damage to their major organs! Do what you need to do for yourself so that you can live a healthier, longer life...and don't worry about what these poll takers think!

Do you snore? Are you tired during the day? Do you wake up with headaches? Many overweight people have obstructive sleep apnea. When you sleep, the tissue in the back of the throat relaxes and obstructs the airway. This can be helped with weight loss. OSA can cause major issues in the long run.

Karina, Have you talked to your surgeon's office? Tricare had faxed over a copy of the denial to them. They could probably tell you why. I would say it was the same reason I was, considering our stats were the same.