Lap_dancer

Lap-Band: Laparoscopic Gastric Banding [07 Sep 2006|08:41am] What is it? The Operation: The idea behind the operation is to create a small pouch in the upper part of the stomach with a controlled and adjustable stoma, without stapling, thus limiting food intake. A gastric band device is introduced through tiny (1cm) incisions in the abdomen and is placed around the upper part of the stomach. The resulting pouch (or the "new stomach") dramatically reduces the functional capacity of the stomach. The band has a balloon from the inside that is adjustable and can reduce stoma size, thus prolonging the period of fullness. The operation is performed under general anesthesia and can last between 30 minutes and 1 hour. The Band is fitted around the uppermost part of the stomach, forming a 15cc small pouch. It is designed so that it can be inflated or deflated at any time after the operation. This helps the patient continually lose weight until they reach their goals. The restriction takes place in the radiology suite and normally takes 15 minutes. This simple procedure is painless they inject saline into a port placed under the skin in the wall of the stomach. The tube that comes off of the band leads to the port. The positives: - No cutting of the stomach - No stapling of the stomach - Calibrated pouch and stoma size - Can be adjusted to patient's needs after surgery with no operation to adjust the stoma - Laparoscopic removal possible - Fully reversible - Short hospital stay (does not exceed 48 hours) Lap Dance That's what I'm calling it. I'm going to do the Lap Dance, I'm going to be Lap Dancing. Still waiting to hear from the physician's office. I will call them once I get home. I may take tomorrow off. I have an urgent urgency to get this done. Last night I told my daughter. It was almost 3 AM, I couldn't sleep. My intention was to tell no one, just my husband. I stayed up because I am so excellerated in my hyper mental state that my normal LULL to bed is gone. She was up from coffee. We sometimes adjourn to a room by ourselves for lovely talks that can go on for several hours. I hesitated in telling her. Because I have an absolute drive for no one to know (more on that later) I am fearful the secrecy will be compromised. But after assurances that she promises not to tell, I told her. I swore her to keep it a secret, to tell no one. She understood with almost no explanation necessary. And so now I wait for the call. I wait for the OK, GO. Waiting you'd think but I know better

and then they said NO[06 Sep 2006|04:23pm] Everything I have done in my life has led me up to this moment. My reading of positive books, my most preferred books by Gerry Spence "How to Argue and Win Everytime", there was a Gerry in my orientation group ( a sign?) there was an orientation class happening on a Monday that I happened to have off ( a sign?) that Monday was only a few days from when I first called this center ( a sign?), my ability to deal with insurance companies after being responsible for that when the business had insurance ( past ability that come to my aid now?) being a secretary for seven years and writing business letters ( so I can deal with corporations?) and appealing a "Not covered". When I spoke to my insurance company did I expect them to tell me it wasn't covered? Of course! Who am I kidding? I need this so bad so of course it isn't covered! Does NO ever mean NOOOO? Hell NO. Not in my world. This is where stubborn comes in handy. This is where putting on the b8tch hat of determination makes for a more positive result. Knowing that this person is a human being, knowing that she is doing her job and she didn't write the rules and knowing the last thing she wants to tell a 355 pound woman is "NO" your insurance doesn't cover this procedure that will likely lengthen your life; Knowing that gives me a calm when I speak to her. Her name is Darlene and she is the next level after customer service. There are always the other levels of people that you speak to. They work at banks and they reverse bounced check fees, they are supervisors that reverse policy under special circumstances, I was shooting for the special circumstance and I believed with all my heart that when I spoke to her yesterday, I WAS the special circumstance. I did something with Darlene that I have not done since I got this heavy, I cried. The human in me escaped and I wept. I apologized. She told me it was okay, to "let it out" and I did. I told her that I had never cried about this before but that I felt like "No" was a death sentence. "He told me ten years" and then I cried some more. She told me she too had dealt with something similar, not weight loss surgery but an illness. *there are real people on the other end and they know* I think everyone has a loved one in their family, extended family or friend who is obese. They love them and they worry. They see the stories on television and in the magazines "Woman loses 200 pounds" or worse still ( 1 ton man stuck in door frame) How did they get that way? I know I know!! One pound at a time, one mouthful at a time. So they said No and I cried. Then there is the BUT. The but is called "medically necessary". ((and I'm here to tell you that medically necessary is me)) The steps to follow are that my doctor (the one who recommended gastric surgery, the one who knows I have tried, the one who has been on this journey with me) needs to contact my insurance company and follow the procedure outling why I need this. (10 years?) So I compiled a letter and I sent it by fax to him. I'll eventually post them on here. Waiting now. No? Yes? If it is no, I swear to all that I will drive to an appeals hearing and I am completely prepared to strip naked in front of all of them. I will lift my stomach and offer that they can hold it if they want to "you can even touch it, here..it's okay!". How many think they would coil with repulsion? I do. They don't know how determined I am. Waiting.

and then they said NO[06 Sep 2006|04:23pm] Everything I have done in my life has led me up to this moment. My reading of positive books, my most preferred books by Gerry Spence "How to Argue and Win Everytime", there was a Gerry in my orientation group ( a sign?) there was an orientation class happening on a Monday that I happened to have off ( a sign?) that Monday was only a few days from when I first called this center ( a sign?), my ability to deal with insurance companies after being responsible for that when the business had insurance ( past ability that come to my aid now?) being a secretary for seven years and writing business letters ( so I can deal with corporations?) and appealing a "Not covered". When I spoke to my insurance company did I expect them to tell me it wasn't covered? Of course! Who am I kidding? I need this so bad so of course it isn't covered! Does NO ever mean NOOOO? Hell NO. Not in my world. This is where stubborn comes in handy. This is where putting on the b8tch hat of determination makes for a more positive result. Knowing that this person is a human being, knowing that she is doing her job and she didn't write the rules and knowing the last thing she wants to tell a 355 pound woman is "NO" your insurance doesn't cover this procedure that will likely lengthen your life; Knowing that gives me a calm when I speak to her. Her name is Darlene and she is the next level after customer service. There are always the other levels of people that you speak to. They work at banks and they reverse bounced check fees, they are supervisors that reverse policy under special circumstances, I was shooting for the special circumstance and I believed with all my heart that when I spoke to her yesterday, I WAS the special circumstance. I did something with Darlene that I have not done since I got this heavy, I cried. The human in me escaped and I wept. I apologized. She told me it was okay, to "let it out" and I did. I told her that I had never cried about this before but that I felt like "No" was a death sentence. "He told me ten years" and then I cried some more. She told me she too had dealt with something similar, not weight loss surgery but an illness. *there are real people on the other end and they know* I think everyone has a loved one in their family, extended family or friend who is obese. They love them and they worry. They see the stories on television and in the magazines "Woman loses 200 pounds" or worse still ( 1 ton man stuck in door frame) How did they get that way? I know I know!! One pound at a time, one mouthful at a time. So they said No and I cried. Then there is the BUT. The but is called "medically necessary". ((and I'm here to tell you that medically necessary is me)) The steps to follow are that my doctor (the one who recommended gastric surgery, the one who knows I have tried, the one who has been on this journey with me) needs to contact my insurance company and follow the procedure outling why I need this. (10 years?) So I compiled a letter and I sent it by fax to him. I'll eventually post them on here. Waiting now. No? Yes? If it is no, I swear to all that I will drive to an appeals hearing and I am completely prepared to strip naked in front of all of them. I will lift my stomach and offer that they can hold it if they want to "you can even touch it, here..it's okay!". How many think they would coil with repulsion? I do. They don't know how determined I am. Waiting.

Time to start this journey [03 Sep 2006|10:57am] [music | The first time ever I saw your face [03 Sep 2006|10:57am When did it hit me? When Chris said, "think of all the things you would have done in Alaska had you not had a mobility issue"(?) Probably. It all seem to come to synchronicity (great album BTW). Half day at school, I needed to renew my prescriptions and see the doctor about that darn rash. I went to my dentist after school let out and had that off bite drilled down since it hadn't really felt right since doing the new filling. It took but a brief five minutes and I found myself back out in my car and heading towards Main Street. Left. I think I'll get those prescriptions in person rather than waiting for the pharmacy to call them in. Five blocks away and I was parking right next to the front door. How often does that happen? I walked up to the window and signed in and sat down. "Mrs. Reeves did you have an appointment?", a new receptionist peered out from the glass partition, "No I just happened to be in New Port Richey for a dentist appointment and need to have a rash looked at" (TMI I though to myself, too much information) but it seemed to appease her and I waited. Less than ten minutes and I was walking down the hallway past the examination rooms, going, going, to the last room which I know to be my doctor's preferred examination room. Wednesday, he's not there on Wednesdays, it's his day off. "What are you here for today?". I like the older staff. I know them, they take their time and I can ask about the issue "downunda" without feeling like the PHCC grad staff is "sewgrossing" about it at lunch. I tell her all of the truth, that I have a rash down there and that I have another rash on my arm. My back is killing me ( couldn't be that extra 200 pounds could it..answer your own question Patty, YES!) The list is long. She smiles, she comforts me and takes my blood pressure. She leaves. I'm waiting for the nurse practioner to come in but I hear my doctor's familiar pitch and tone. It's Wednesday, he isn't here on Wednesdays. The door opens and my nurse has returned, "Is Dr. Sichelman here?" "yes" "he isn't here on Wednesdays it's his day off" I tell her, "Dr. Galadi is on vacation so he is covering" she tells me. (how often does that happen?) This is going to be a day for unexpected things. My doctor comes in, I show him my rash on my arm, it's not really anything what else? There is the lump on my stomach in the mass of large fat on my belly I feel a pea like object, he feels it, it's nothing. He notices the rash below my stomach. I've been treating it with ointment for how long? (should I tell him years? Should I tell him two baths a day?) "it's been there awhile" I managed. He pulls at my underpants and notices another flush of skin below that. I admitted sex hadn't been what it use to be and he tells me to go to my OBGYN, "we really don't deal with that". Before I know it the conversation has turned with the problem at the moment and he begins examining me. This is a man of medicine, a healer at heart and I never appreciate him more than this moment. I have a staph infection and then a yeast infection. Before I leave there I will end up have a stack of nine separate prescriptions. I cover myself back up and sit down on the bench. He sits down at the other end and the nurse is stationed with my chart and a pen at the desk. The greater question, the greater issue, my weight. "So when are we going to get this weight off?" It's a question, a subject that he and I have talked about for years. My doctor of 16 years. Through the phase of Phen-Fen, Meridian, Redux, 1200 calories, 1800 calories, over the counter products into last year and the diagnosis of Type I Diabetes, rehabilitation to begin some type of activity until now. It's serious. My back is giving under the pressure, I take Lasix for water retention, blood pressure medication and he switches me today to two types of medication. "I know Doctor. I don't know what to do. I've tried, I've tried for years." This is a moment of honesty, the reality that my life is on the line. He tells me I'm looking at ten years. (ten years until my body breaks a blood vessel in my brain, tens years until my heart faults, ten years of semi goodness left in my body) He goes on to tell me about another patient. "He had the same problem as you. He had the gastric surgery, came in a few months back and I hardly recognized him." *A year ago I couldn't have, wouldn't have entertained this procedure* I can do this on my own I said. But a year later and an increase in 25 pounds told me that there comes a time when one has to admit they are in over their head. I was in over my head and I knew it. "Where did he go?" I was ready. I'll take some fries with that bypass [05 Sep 2006|11:59am] I refused to go to Community Hospital. Some how my brain is in 1983 with my first pregnancy and the halting news of things that had happened in this antiquated facility. But that was then, this is now. Reconstruction, new specialists are the norm for hospitals. This one has taken on the issue of obesity with a center for Weight Loss Surgery. I called three gastric doctors before realizing that there was going to be more than just a surgery. I went online and found the center's information site and read. I read for perhaps an hour. There was gastric bypass surgery, there was another type of surgery that was invasive. There was also the type of incision. I was quickly opting for laproscopic surgery. Small incision, scope to aid the doctor to see what was inside. Less invasive, quicker recovery(...I'll take some fries with that). I phoned the center and the voice on the other end was a rich accent (Jamaica?) and gentle. She asked all the questions I anticipated. I'd been down this road with my children and their pediatric disorders. Who? What? What kind of insurance? The quicker route would be to have my doctor's office call this center because everything is a referral. Making a decision to have a procedure like this is the first step the second, step is the business of it. Is it covered by insurance? The following Monday was a holiday and as it just happened to be, she was having a seminar with a few other patients. I would attend. That weekend went fast and Monday morning I was on my way down to New Port Richey, to the hospital, to the empty parking lot (holiday) to the office of Ivy. The first thing I did was sit down OF COURSE that is what fat people do when they first enter a room! (note to self: send that joke to Louis). We made our way across the hall to the meeting room. There is something about conference rooms that put me at ease. I expect a lecture, a Power Point because the screen is down and soon we are joined by a couple. Later I would exchange email addresses with "Patti" who happened to have a favorite color too...PURPLE! She saw my "Pattypreferspurple" email address on the sign up sheet and we clicked from that moment on. She had come with her husband. Then there was Gerry. I looked at them and we all seemed to have this spiritual connection. I was past being shy about my obesity, I'm big and I know it. After a few hours I was hungry and my sugar was getting low. I asked Ivy for a banana or something to raise my sugar, FOOD? She called down to the cafeteria and ordered up a few breakfast items and coffee. What do fat people love to do when they come together? ORDER IN! What did I care that there were pastries on the tray, I was here for a procedure that wouldn't allow me to eat more than 1 oz. of food, " A shot glass" as I put it. We laughed, ate, drank and got down to the business of filling out paperwork, copying identification cards and preparing ourselves for the business of weight loss. and it occurred to me. These people were smart, well articulated and with the collective as a group, we were already breaking down the percentages of the data on the Power Point and realizing that a large % of the group did not return post the procedure in the study group. So I admit that I too have the misperception that fat people are stupid, food numbed individuals who wile the hours away in front of a television doing everything but being nutritiously sound in mind and spirit. I'm beginning to learn a lot of WRONG things that like the rest of the world, I believe to be true.

Time to start this journey [03 Sep 2006|10:57am] [music | The first time ever I saw your face [03 Sep 2006|10:57am When did it hit me? When Chris said, "think of all the things you would have done in Alaska had you not had a mobility issue"(?) Probably. It all seem to come to synchronicity (great album BTW). Half day at school, I needed to renew my prescriptions and see the doctor about that darn rash. I went to my dentist after school let out and had that off bite drilled down since it hadn't really felt right since doing the new filling. It took but a brief five minutes and I found myself back out in my car and heading towards Main Street. Left. I think I'll get those prescriptions in person rather than waiting for the pharmacy to call them in. Five blocks away and I was parking right next to the front door. How often does that happen? I walked up to the window and signed in and sat down. "Mrs. Reeves did you have an appointment?", a new receptionist peered out from the glass partition, "No I just happened to be in New Port Richey for a dentist appointment and need to have a rash looked at" (TMI I though to myself, too much information) but it seemed to appease her and I waited. Less than ten minutes and I was walking down the hallway past the examination rooms, going, going, to the last room which I know to be my doctor's preferred examination room. Wednesday, he's not there on Wednesdays, it's his day off. "What are you here for today?". I like the older staff. I know them, they take their time and I can ask about the issue "downunda" without feeling like the PHCC grad staff is "sewgrossing" about it at lunch. I tell her all of the truth, that I have a rash down there and that I have another rash on my arm. My back is killing me ( couldn't be that extra 200 pounds could it..answer your own question Patty, YES!) The list is long. She smiles, she comforts me and takes my blood pressure. She leaves. I'm waiting for the nurse practioner to come in but I hear my doctor's familiar pitch and tone. It's Wednesday, he isn't here on Wednesdays. The door opens and my nurse has returned, "Is Dr. Sichelman here?" "yes" "he isn't here on Wednesdays it's his day off" I tell her, "Dr. Galadi is on vacation so he is covering" she tells me. (how often does that happen?) This is going to be a day for unexpected things. My doctor comes in, I show him my rash on my arm, it's not really anything what else? There is the lump on my stomach in the mass of large fat on my belly I feel a pea like object, he feels it, it's nothing. He notices the rash below my stomach. I've been treating it with ointment for how long? (should I tell him years? Should I tell him two baths a day?) "it's been there awhile" I managed. He pulls at my underpants and notices another flush of skin below that. I admitted sex hadn't been what it use to be and he tells me to go to my OBGYN, "we really don't deal with that". Before I know it the conversation has turned with the problem at the moment and he begins examining me. This is a man of medicine, a healer at heart and I never appreciate him more than this moment. I have a staph infection and then a yeast infection. Before I leave there I will end up have a stack of nine separate prescriptions. I cover myself back up and sit down on the bench. He sits down at the other end and the nurse is stationed with my chart and a pen at the desk. The greater question, the greater issue, my weight. "So when are we going to get this weight off?" It's a question, a subject that he and I have talked about for years. My doctor of 16 years. Through the phase of Phen-Fen, Meridian, Redux, 1200 calories, 1800 calories, over the counter products into last year and the diagnosis of Type I Diabetes, rehabilitation to begin some type of activity until now. It's serious. My back is giving under the pressure, I take Lasix for water retention, blood pressure medication and he switches me today to two types of medication. "I know Doctor. I don't know what to do. I've tried, I've tried for years." This is a moment of honesty, the reality that my life is on the line. He tells me I'm looking at ten years. (ten years until my body breaks a blood vessel in my brain, tens years until my heart faults, ten years of semi goodness left in my body) He goes on to tell me about another patient. "He had the same problem as you. He had the gastric surgery, came in a few months back and I hardly recognized him." *A year ago I couldn't have, wouldn't have entertained this procedure* I can do this on my own I said. But a year later and an increase in 25 pounds told me that there comes a time when one has to admit they are in over their head. I was in over my head and I knew it. "Where did he go?" I was ready. I'll take some fries with that bypass [05 Sep 2006|11:59am] I refused to go to Community Hospital. Some how my brain is in 1983 with my first pregnancy and the halting news of things that had happened in this antiquated facility. But that was then, this is now. Reconstruction, new specialists are the norm for hospitals. This one has taken on the issue of obesity with a center for Weight Loss Surgery. I called three gastric doctors before realizing that there was going to be more than just a surgery. I went online and found the center's information site and read. I read for perhaps an hour. There was gastric bypass surgery, there was another type of surgery that was invasive. There was also the type of incision. I was quickly opting for laproscopic surgery. Small incision, scope to aid the doctor to see what was inside. Less invasive, quicker recovery(...I'll take some fries with that). I phoned the center and the voice on the other end was a rich accent (Jamaica?) and gentle. She asked all the questions I anticipated. I'd been down this road with my children and their pediatric disorders. Who? What? What kind of insurance? The quicker route would be to have my doctor's office call this center because everything is a referral. Making a decision to have a procedure like this is the first step the second, step is the business of it. Is it covered by insurance? The following Monday was a holiday and as it just happened to be, she was having a seminar with a few other patients. I would attend. That weekend went fast and Monday morning I was on my way down to New Port Richey, to the hospital, to the empty parking lot (holiday) to the office of Ivy. The first thing I did was sit down OF COURSE that is what fat people do when they first enter a room! (note to self: send that joke to Louis). We made our way across the hall to the meeting room. There is something about conference rooms that put me at ease. I expect a lecture, a Power Point because the screen is down and soon we are joined by a couple. Later I would exchange email addresses with "Patti" who happened to have a favorite color too...PURPLE! She saw my "Pattypreferspurple" email address on the sign up sheet and we clicked from that moment on. She had come with her husband. Then there was Gerry. I looked at them and we all seemed to have this spiritual connection. I was past being shy about my obesity, I'm big and I know it. After a few hours I was hungry and my sugar was getting low. I asked Ivy for a banana or something to raise my sugar, FOOD? She called down to the cafeteria and ordered up a few breakfast items and coffee. What do fat people love to do when they come together? ORDER IN! What did I care that there were pastries on the tray, I was here for a procedure that wouldn't allow me to eat more than 1 oz. of food, " A shot glass" as I put it. We laughed, ate, drank and got down to the business of filling out paperwork, copying identification cards and preparing ourselves for the business of weight loss. and it occurred to me. These people were smart, well articulated and with the collective as a group, we were already breaking down the percentages of the data on the Power Point and realizing that a large % of the group did not return post the procedure in the study group. So I admit that I too have the misperception that fat people are stupid, food numbed individuals who wile the hours away in front of a television doing everything but being nutritiously sound in mind and spirit. I'm beginning to learn a lot of WRONG things that like the rest of the world, I believe to be true.

Unpacking the bins I noticed notes on slips of paper, ornements and gift tags I had not used last year. It's be? It's been one year since all these things have been used and one more year of my life. It occurred to me while unwrapping the foil ornament of Cinderella that even she was showing wear with time. Finally, I am getting answers to the questions I had a year ago: Why do I hurt (there/here) not all of the time but some of the time? Why is it not getting so much easier for me to walk and only a little bit easier? Why is the band just right, I am a go for green zone but not losing as rapidly as I should? Why do I feel like I am crumbling? So now I know. If I can find my old Journal on LiveJournal I'm putting it here so the attic is all in one spot. More to come

Unpacking the bins I noticed notes on slips of paper, ornements and gift tags I had not used last year. It's be? It's been one year since all these things have been used and one more year of my life. It occurred to me while unwrapping the foil ornament of Cinderella that even she was showing wear with time. Finally, I am getting answers to the questions I had a year ago: Why do I hurt (there/here) not all of the time but some of the time? Why is it not getting so much easier for me to walk and only a little bit easier? Why is the band just right, I am a go for green zone but not losing as rapidly as I should? Why do I feel like I am crumbling? So now I know. If I can find my old Journal on LiveJournal I'm putting it here so the attic is all in one spot. More to come

Hey friends! Dropping in to wish you all a happy holiday. Success and new discoverys for 2009 and on. So much has happened I won't attempt to post it all here. I found my problem but it took going to the Cleveland Clinic to find out the cause of my pain. I'm going to BLOG here starting shortly. Meanwhile everyone enjoy their family time and those in the snow zones please stay safe. Hugs your way from Patty in Florida.

Oh this so knocks on the door of where I live. Amy BEAUTIFUL idea for the scholarship. Planners, make it so. Please PM me to let me know how I can help. Block rooms, YES. March should not be season in the NYC/NJ area.

Debbie Joy I wish you all the best. I had nasty reflux years ago but it was from my obesity and the foods I use to eat. It can be so painful. I was down to not touching anything remotely acid in content even juice. Fortunately I did six months of RX and it fiinally remedied. You have a big hug from me for wellness.

Wow, so it's like the Magical LapBandTalk Tour Roll up GOT EVERYTHING YOU NEED, roll up for the mystery tour. Roll up SATISFACTION GUARANTEED, roll up for the mystery tour. The magical mystery tour is hoping to take you away, Hoping to take you away.... Great cities: San Fransisco Seattle Vancouver Denver Chicago Austin New Orleans St. Augustine, Florida is divine for a small conference but Orlando is the obvious choice Boston Vegas and How cool would it be to do a cruise!! It's completely doable. Got a friend who does education cruises through ____ ___ cruiselines. It was the best experience. Is it possible once we get presenters to obtain workshop topics and outlines, I can receive CEU's for my job as "independent studies" if I have the info 45 days prior and submit the paperwork!!! I'm so excited about this. I love to travel and the band has become such a big part of my life. Wow.

Double check me but I think you no longer need a passport from Canada to the states.

That is too funny....Kill the fat man.

I have another 100 to lose ( I was a big girl ) but I have already started the search process having gone to two PS which my insurance covered. It's not so much the cosmetic thing, which insurance won't pay for to make you feel good about yourself, but will pay for when you get that nasty wetness, rashes, blisters and on and on. There is a big difference between self pay and insurance criteria. Like previously said, they just want to make sure the check cleared.

EllieMae I'll be coming by myself. ............. I did not know there were conferences going on. Don't forget Florida! I can recommend Orlando for obvious reasons but Tampa is also a great city and close to several attractions. It's also less expensive than Orlando. Meanwhile I'm trying to get a feel for the conference. Are there several breakout sessions that run consecutively or is it one presenter after another? Do we do other activities as a group? Is there time for optional excursions like on cruises? Got any "prizes"..you know, raffles, silent auctions ? Could you please add Dr. S, our resident plastics guru to that presenters list? I am very interested in plastics. Oh, and will vendors be there?

Procedures: ARM LIFT (Brachioplasty) The best candidates for a brachioplasty are men or women who are in relatively good shape but are bothered by loose arm skin that won't respond to diet or exercise. The surgery is particularly helpful to individuals who have lost a significant amount of weight through diet and exercise alone or with a gastric bypass procedure and are left with an excessive amount of loose skin and fat under their arms. The surgery is also helpful for individuals who desire better contouring of their under arm region. Patients who intend to lose a lot of weight should postpone the surgery. Patients who have underwent a gastric bypass should wait at least six months after their weight has stabilized. Poor healing of the skin is most likely to affect smokers, so smokers must quit at least one month prior to surgery and refrain from smoking at least one month after the surgery. Incisions and Scars in Arm Lift: Scars are the greatest drawback of this operation. They will extend from the armpit to the elbow, along the inside of the arm. This operation exchanges one cosmetic problem (loose skin) for another (scars). In general, those with very loose saggy skin are most likely to find this exchange worthwhile. Those with a small amount of looseness will probably not want the scars. Source: Lakewood Ranch Plastic Surgery - Sarasota & Bradenton, Florida ........ BREAST PROCEDURES: Help to correct breast drooping (called ptosis) and loss of volume by adding fullness and lift. Breast Lift (Mastopexy) Breastlift is a surgical procedure intended to correct a drooping bust line, raise and reshape sagging breasts. Over the years, factors such as pregnancy, nursing, excessive weight loss or gain and the force of gravity cause a woman’s breasts to lose their natural elasticity. Breasts may lose their shape and firmness and begin to sag or hang. During the procedure, excess skin and tissue are trimmed away and the bustline is tightened and lifted. Breast Lift can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume--for example, after pregnancy--breast implants inserted in conjunction with a breast lift can increase both their firmness and their size. BREAST AUGMENTATION Breast Augmentation: Breast augmentation is a surgical procedure to enhance the size and shape of a woman's breasts. There are many reasons to choose breast augmentation: The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate. Poor healing of the skin is most likely to affect smokers, so smokers must quit at least one month prior to surgery and refrain from smoking at least one month after the surgery. Breast Lift (Mastopexy) Breastlift is a surgical procedure intended to correct a drooping bust line, raise and reshape sagging breasts. Over the years, factors such as pregnancy, nursing, excessive weight loss or gain and the force of gravity cause a woman’s breasts to lose their natural elasticity. Breasts may lose their shape and firmness and begin to sag or hang. During the procedure, excess skin and tissue are trimmed away and the bustline is tightened and lifted. Breast Lift can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume--for example, after pregnancy--breast implants inserted in conjunction with a breast lift can increase both their firmness and their size. Male Breast Reduction (Gynecomastia) Male breast overdevelopment, known medically as “gynecomastia,” is a very common condition affecting an estimated 40 to 60 percent of all men to some degree. Though certain drugs and medical conditions have been linked with gynecomastia, there is no known cause in most cases. For men who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured. SOURCE: Lakewood Ranch Plastic Surgery - Sarasota & Bradenton, Florida Abdominoplasty (tummy tuck) Eliminates excess skin and tightens muscles in the abdominal wall. The skin is pulled down, to achieve a flatter appearance, and the excess is cut away. If a hernia is present, it may be repaired at the same time. This procedure can also benefit a patient after pregnancy to remove unwanted skin. Lower Body Lift Flattens the abdomen and flanks by removing excess fat and skin and tightening muscles of abdominal wall. It also lifts the thighs and buttocks. Procedure: Flatten abdomen and flanks by removing excess fat and skin and tightening muscles of abdominal wall. Lifts thighs and buttocks. The best candidates for a lower body lift are men or women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won't respond to diet or exercise. The surgery is particularly helpful to individuals who have lost a significant amount of weight through diet and exercise alone or with a gastric bypass procedure and are left with an excessive amount of loose skin and fat around the lower abdomen, hips and buttocks. The surgery is also helpful for individuals who desire better contouring of their lower abdomen, outer hips and buttocks. Medial Thigh Lift Can lift the inner thighs and remove wrinkling and excess bagginess of the thighs. With only mild skin and fat excess confined to the inner thigh region and good skin elasticity, you may be a candidate for a minimal incision approach. As the preoperative condition worsens in severity, the incisions required to obtain proper correction must be larger. For the most severe type of hanging skin conditions, a circumferential incision may be required. Combining surgeries: Sometimes procedures can be combined in one operation which reduces total recovery time and cost. For example, a tummy tuck is often combined with liposuction and/or a breast lift (with or without implants). However, safety is of utmost importance and total duration under anesthesia is a key factor in making any decision about combining procedures. During a consultation with Dr. Kreithen, your own anatomy is assessed, as well as your priorities, and then a complete plan is created for total body contouring. Some procedures may be covered by medical insurance. Source: Lakewood Ranch Plastic Surgery - Sarasota & Bradenton, Florida There are also other sources: The American Society of Bariatric Plastic Surgeons (ASBPS) - Bariatric ... Organization of board-certified Plastic Surgeons who specialize in all aspects ... The American Society of Bariatric Plastic Surgeons | Executive Offices 1540 ... www.asbps.org Body Contouring After Major Weight Loss Plastic Surgery Procedure The American Society of Plastic Surgeons (ASPS) and Plastic Surgery Educational ... Are you a member of the American Society of Plastic Surgeons? ... plasticsurgery.org/patients_consumers/procedures/Body-Contouring.cfm American Society for Aesthetic Plastic Surgery (ASAPS) ... Member plastic surgeons are certified by the American Board of Plastic Surgery ... Male Breast Reduction (Gynecomastia), Post-Bariatric, Liposuction (Lipoplasty) ... www.surgery.org

So bottom line is it isn't that your insurance doesn't cover it, it's that it may not have been deemed "medically necessary." What is a beneficial thing is to be your own physician's ASSISTANT. By that I mean, take pictures when you have a rash down there or go to the doctor. If you can't sit comfortably for more than fifteen minutes, if you find it difficult to use a public toilet because the skin falls down and you get a chemical burn on the pannus (what I did from the cleansers used), if you get pimples or blisters down under....take pictures, or go to the doctor. These are the kinds of things that adversely effect your life. I don't believe any reasonable physician would expect someone to go the rest of their life dragging this piece of flesh along with them and putting lotion on, blow drying underneath it, using a towel to absorb the moisture...all the things that people do to go on with life and the extra folds of flesh. I believe failing to communicate ALL of the things that have been medical problems is a big influence on many adverse medical decisions.

I've spent the better part of two months looking up all the plastics info because of the pain in my back. Theory is my weight loss redistributed my body fat which now disturbs an area of my back with a bulging disc, compressed vertabrae...and so on. Meanwhile, here is what I found: For the sagging skin at the tummy that hangs down, that piece of skin is called the "pannus". Having it removed is called a panniculectomy. Clinical coverage: Determination of medical necessity for panniculectomy on a combintation of clinical data and the presence of indicators will effect the risks to benefits of this procedure. Example: Patient has a substantial weight loss, stable for atleast six months. The panniculus causes a chronic and persistant skin condition. The panniculus hangs to or below the level of the symphis pubis. * Skin conditions are those embarrassing smelly wetness that happens where the pannus rubs against your pelvic area. I'm sure some of you have heard of the white substance called "FROM-UNDA CHEESE":rolleyes: Documentation of any problems pertinent to the diagnosis, including any interference with mobility or activities of daily living. (ADL) ........................................................... Here is what I found on the definition of Medically Necessary: Medically Necessary health care services are deamed by a Physician, using prudent clinical judgement, for preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptons, and that are in accordance with acceptable medical practice; they are clinically appropriate, in terms of type, frequency, extent, site and duration and considered effective for the patient's illness, injury or disease and not primarily for the convenience of the patient, physician or other health care provider and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the patient's illness, injury or disease.

I agree with going to another doctor. Foremost you should feel comfortable with the doctor you have chosen. Secondly, you might consider making the drive or fly back to your band doctor since your fills in the beginning are or should be only every few months. If what you are doing isn't working, do something different. You'll feel better for following your GUT instinct. Best of luck.

I'm definately interested in attending. I do not know the area, have never been to NYC or NJ. I would say what venue gives you the better rate to reduce the costs for the attendees is the one to go with. As I understand it, New York and New Jersey are very close to eachother. Perhaps one evening could be dedicated to an excursion ( Bus?) into the city to something that everyone in NYC thinks is the 'must see' thing to do. That is if the cost is significantly different as far as savings from New York to New Jersey. Will meals be included in the package so people won't have to go out on their own? What about airport shuttle for those of us who will fly in? Does the hotel offer that? Do you have any ideas for topics thus far for the presenters? Anything bilingual for our spanish speaking friends? How exciting!!

Update: Dr. S, from your hotlinks provided I searched and found a surgeon in Florida who TAKES MY INSURANCE and a member of: American Society of Plastic Surgery American Society of Aesthetic Plastic Surgery Florida Society of Plastic Surgery Broward Society of Plastic Surgery Broward County Medical Association Undersea and Hyperbaric Medical Society American College of Surgeons, FACS – Fellow American Society of Bariatric Plastic Surgeons I can't thank you enough for the resource. > I remain very open minded about surgery with the goal of getting out of pain and stopping the itching I've endured for so long. Having sensation return 'down there' will be another benefit. Again thanks so much and I will reply back with my progress. Patty

Thanks Dr. S. I remain very optimistic and only look at the negative experiences as being learning experiences of what I do not want. Meanwhile, since that visit, I switched out my diet back to my post surgical plan ( baby food ) and must have jolted something. I've lost 8 lbs. since Thursday! I will do as you suggested and definately keep you posted. Thanks once again for being available to field or questions and concerns. Gratefully yours, Patty

Hello All: I had my Plastic Surgeon consultation today. It was not a positive experience. Doctor S. could you provide me with a good link to read more on the partial panniculectomy? ............. This surgeon's office indicated the doctor had extensive experience with gastric patients. In reality, he showed me one photo of a patient who had lost 300 pounds ( "what you still weigh" ). I had drafted a concise letter indicating the problem areas and where and why I was in pain. I listed all my medications, I am on Morphine, for the pain. I discussed my problem areas and what I expected to achieve at this first goal. It was as if he read nothing I had prepared or nothing my doctor had sent him. Rather, he asked me why I was on Morphine, and where was my pain and why was I in pain. He then asked me why I chose a Lap Band. I explained I had researched it and felt that it wasn't cutting any organs and was my preferance. He then began (selling me on) discussing a collegue in Tampa who did gastric bypass, the benefits of bypass and the rapid weight loss. He promoted this other doctor and his clinic, the support group and suggested I go to this doctor. (still no advice or examination on anything surgical) Oh, the panniculectomy? When I indicated I was not interested in a bypass and was there for a consult for the panniculectomy he said my rashes and skin irritations weren't that serious, he, infact, had seen patients who were hospitalized for such skin problems and those were the types of patients that qualified for removing the pannus but they had much larger hanging ones then I did. He further stated that my BMI was too high, he had a "rule" that he only performed surgeries on patients who were around 32 BMI. He further stated that if I had a partial panniculectomy now, I was looking at a three month recovery with narcotics, problems healing and packing deep into my stomach until my wound healed. I am mindful of Dr. S's words "run away fast". I left there feeling I had been dealt a very confrontational hand. Other than picking up the phone and dialing doctors, is there another method of finding a qualified surgeon? Oh, and the Morphine I am on for my pain? He has had plenty of patients on narcotics for pain! He also had seen "800 pound patients at the University of Iowa that had to be intubated from respitory distress." Dr. S, somewhere in there are some questions but I am so confused and discouraged that I cannot seem to find a local doctor with the level of experience or even close to it for WLS patients. Any suggestions on key words to ask so I can filter out those who seemingly want only to consult and not actually examine? Other than reducing my intake to 600 calories a day ( because I don't actually need to exercise to lose weight ) and sucking it up until I am a 32 BMI, do you have any direction to offer Dr. S? Thank you in advance for your assistance.

Dr. S: Goodmorning and thank you beyond words for advising me to "run far" if I come across a surgeon who tells me to suck it up and continue to lose weight. I had an appointment with my regular M.D. on Monday and after reviewing my weight loss, 92 lbs., reviewing my MRI on my spine, noting I had been treated for skin infections in that region, and seeing the P.T. indicating the redistribution of my weight after loss added stress to the area on my back where it is problematic...he concurred with going for a panniculectomy. Today is my appt. with a surgeon who has had experience in recontouring after major weight loss. To make it all the better they accept my insurance! This clinic is also a spa in another section of the facility. I signed a release of records for the PS and my physician has drafted a letter of support. The other documentation has been faxed to the surgeon and I some how feel that today, I will walk away with a plan. Hopefully I will have a surgical date as well. Thank you for your advice on here. You are helping us all in ways you will never truly know. Addressing the issue of poor body self image, infections in private areas and skin that droops and sags can be very self defeating and intimidating. Having the privacy of this small group and support of so many makes the journey lighter. I will post back my results. Appt. is at 3:15 in Tampa. All...think high thoughts, light candles and if you are so inclined say a prayer for Patty. Thank you!

No nervousness allowed! You've fought too hard for this one. Great job.:smile2: