Methadone And Lap Band

[Justin B. 1]

I am considering getting lap band surgery and I go for my consultation tomorrow. I know only what I have read and watched on the internet (which tends to be the truth severely bent in several different angles) about benefits, risks and special situations. I am nearly 100% sure that I will qualify for the surgery but one very important question remains for me. Not many people have my same situation but I am currently attending a methadone tratement facility on a daily basis and am treated with 80 mgs of liquid methadone for opiate dependency/heroin abuse.

What are the chances that I will get turned down solely because I am currently receiving treatment at a methadone facility.

Does this put me at any additionla risk that you know of?

I do not know what to expect as far as pain and my methadone works as a pain reliever but will block other opiate based meditcations but if it will be painful and I need something for the pain, do you know if they will prescribe more methadone?

Does anyone have any additional knowledge about going through the surgery while being treated for opiate dependency via liquid methadone? I'm a newbie to this but I have researched for about 8 hours now and I have watched about 3 surgery videos of the procedure including the info but there isnt much info out there in relation to this..

What special questions should I ask the doctor? Any suggestions or info is greatly appreciated.

[54Shirley 105]

Let the Dr. know what type of Meds your on, then he will make a decision on weather to go threw, or Waite a while.

Barbiturates is part of my meds since the age of 8. I will be 57 this year. Thats a long stretch for meds. He got me my stuff in liquid

form, and then in about 1 week, he had me crushing my pills, and mixing them in sugar free pudding. Worked Great.

Also they put me on a Morphine Pump in the Hospital.

This might give you some idea, on how it worked for me. It's up to your surgeon to make this decision.

How much longer are you going to be on this stuff? Hopefully not much longer...

[nallygirl 4]

Hi Justin,

If you are planning on using insurance to pay for surgery you may want to start there just to see if they cover the gastric banding. If they do, then you can ask about your specific situation as well. Have you gone to a seminar yet or met with a surgeon? This would be a great question to bring up with the surgeon during your one on one consultation. It would also be a good idea to discuss alternatives to narcotic pain relievers after surgery. My sister was on methadone when she had a major surgery and they were able to give her non-narcotic meds that still helped with her pain. Congratulations on seeking recovery! Stay strong and good luck with your journey!

[CheckYes 46]

Hi Justin,

I don't know the answer to the methadone part of your question. I would suggest you talk to your surgeon's office about that. Perhaps the methadone clinic might know how it works with surgery.

I was on liquid Lortab for one day - it didn't do much - then liquid Tylenol for one day after surgery. The pain, for me, was minimal and way less than I expected. I honestly believe that the skill of my surgeon had a lot to do with my post-op experience so I would suggest you get someone who specializes in WLS.

Best wishes to you!

[Justin B. 1]

Thank you very much for all of the informative replies. I wasn't aware what type of pain to expect from the surgery. after watching several surgeries performed via some videos, it looks as if the worst part was the stitching which doesn't really seem at all that bad. I was told by a few other people that there is pain but its more or less a feeling related to pain after doing alot of situps at one time which doesn't sound too bad at all but would any of you agree that the pain amounts only to that?

If possible, I plan to ask for non-narcotic medications because my methadone acts as a "blocker" and prevents the effects of other opiate medications from taking their normal effect. Its still possible for them to work, but only if I had them at more than twice the normal dose that I was used to and basically... I had built such a high tolerance that I could injest 4 80 mg oxycontins without feeling much of anything. That is why it worried me.

I have set up an appointment with my counselor at the methadone facility to discuss everything and see what knowledge they have in reference to this surgery and what they would recommend. My one on one consultation date has been set for March 16th so I am trying to compile a list of what to ask. I already have a plethora of questions but I want to get everything answered asap and educate myself to ensure this is the best possible route for me (I truly think it is).

My insurance company does cover gastric banding but I have Aetna and I was told today that Aetna has specific requirements that include a psych evaluation (which I expected) but they also have a requirement of a 3 month attempted diet. The thing is that I have tried the dieting which is why I am considering the surgery. And because of the fact that its required that you try 3 months of I guess "supervised" dieting, it isn't enough that I have tried dieting in the past. I was very discouraged to hear that it could be 6-7 months before I could have the surgery. **When they refer to the requirement for dieting, do they mean you have to have attempted a diet in the past for at least 3 months or do they mean that you have to go through another 3 months of dieting that has to be supervised by a doctor? I didn't fully understand that part. If they would realize that I have attempted dieting many times, it would speed the process up for me. I know that they don't care how quickly I get in there but it matters to me and I am just really excited at the thought of a healthier and skinnier life.

Does anyone have details as to what transpires during the pysch evaluation? For what reason is it required and what questions are asked during it? I'm sorry for such a long post and all the questions but I am really excited to find out the answers to my questions. Any info is appreciated. Thanks!

[54Shirley 105]

You will have a lot more then getting weighed for 3 months to do. Mine was a year., and these specialists know exactly how to break it up so you see someone all the time, and get weighed while going through the process. Let me give you a idea: Psych, cardiologist, dietitian, Physical therapist, internal medicine, your surgical visit to set up surgery, he might have another appointment where you are weighed, and then he will make a decision on how much weight he wants you to loose before surgery. This way he knows if you are serious about weight loss, and visits to your Dr. monthly to monitor your weight. That's what I went through, and most people do the same also. Point though wherever you go "GET WEIGHED, AND ASK FOR A PRINTOUT". That way you can keep a file, and turn it over to your surgeons Insurance people,, so the one who is in charge of Insurance, she has something to work with. I hope that makes things a little more clear. You will have to see a lot of people to make your Ins. Company, and Dr. happy. How they break up all these appointments is up to them. They will schedule them. My Ins was a year waitet, so they had me see someone once a month. You could be every week, or every other week. Anyway it's a process.

By then you should be coming down the Methadone I hope.. I would think. Also check this with your Family Doctor, and your surgeon. He needs to know how to treat you.

As far as pain... It's not to bad. I have had worse.

I hope this helps answer your questions, and understand, it is a process.

Shirley..

[nallygirl 4]

My insurance company does cover gastric banding but I have Aetna and I was told today that Aetna has specific requirements that include a psych evaluation (which I expected) but they also have a requirement of a 3 month attempted diet. The thing is that I have tried the dieting which is why I am considering the surgery. And because of the fact that its required that you try 3 months of I guess "supervised" dieting, it isn't enough that I have tried dieting in the past. I was very discouraged to hear that it could be 6-7 months before I could have the surgery. **When they refer to the requirement for dieting, do they mean you have to have attempted a diet in the past for at least 3 months or do they mean that you have to go through another 3 months of dieting that has to be supervised by a doctor? I didn't fully understand that part. If they would realize that I have attempted dieting many times, it would speed the process up for me. I know that they don't care how quickly I get in there but it matters to me and I am just really excited at the thought of a healthier and skinnier life.

Does anyone have details as to what transpires during the pysch evaluation? For what reason is it required and what questions are asked during it? I'm sorry for such a long post and all the questions but I am really excited to find out the answers to my questions. Any info is appreciated. Thanks!

Hi Justin,

For me personally I had to do a 6 month medically supervised diet and exercise program per my insurance (Cigna). I did mine through my surgeon's office but others have done their's through a Primary Care Physician. For mine I went to a group meeting once a month at my surgeon's office. They would record my weight then we would have a class on a nutrition topic (reading food lables, importance of exercise, healthy options for eating out). Some in the class also had a weight loss goal set for them by their surgeon that they had to meet before the end of the 6 months, my surgeon did not have this requirement. At the end of the 6 months I had to get all my pre-op testing done so my PCP would write me a medical clearance for surgery. Not everyone's PCP made them do this. Some didn't do their testing until they received insurance approval. The testing included blood work, chest xrays, Upper GI and gallbladder ultrasound. Once that was done, my clearance letter written, the surgeon's office submitted all my paperwork to the insurance company for approval. I received an approval in a few days and my surgery was scheduled for the next month. From start to finish this process took me 8 months and I have my surgery on March 16th. Since you only have to do a 3 month supervised diet yours may take a much shorter amount of time. But I would plan on it being at least 5 months before your actual surgery date.

As for the psych eval, mine was very quick. It was a 30 minute session with a psychologist. She asked me questions about myself, what I do for a living, how long I have considered weight loss surgery, what else I have tried, why did I decided to do it now, have a researched the surgery. She also asked me questions about my history with weight, was I over weight as a child, what are/were my exercise habits. Then she asked if I had told anyone about wanting surgery and if they were supportive. Basically to me it seemed like they were trying to make sure I was aware this is a life changing decision, that I wasn't making an impulse decision to have it done and that I have a good support system in place after surgery. It's really not that bad at all.

Like you I was really upset when I found out I had to wait so long for the surgery. Once I decided this was right for me I wanted to have it done tomorrow! Looking back though and seeing how much I have learned over the past 8 months I am grateful to have had the time to prepare myself for this new lifestyle. I hope that helped to answer some of your questions. Good luck!

[Justin B. 1]

This was all EXTREMELY helpful and I thank you all very much for your replies. This has answered alot of the questions that I have but it has raised one or two others that I want to ask...

As far as the dieting goes... I guess what I was trying to ask was if they have you go onto a diet and you lose a certain amount of weight during that time... Would they say, "Hey, you've lost a good amount of weight during this time and you need to just continue dieting. I don't think weightloss surgery is for you." Is this something that they would do? I assumed that the insurance companies were having people do this so that they could get out of paying for the surgery. In a sense, I supposed it worried me to think that they would turn me down because I lose 10 or 15 lbs in 3 months or something like that. Is this done or am I completely wrong and they are only having you do this to decide how dedicated you are to getting surgery and losing weight but also KEEPING that weight off?

As I said before, I suppose its just that I am very excited which is why I want to get in there asap and get everything done so I can start the road to a better life for myself. I read the initial consultation dates vs. the surgery dates for alot of ppl and I see that alot of people have waited a good while and 3 months of dieting and then 2 or 3 more to have all my tests done isn't so bad (but is enough to keep me on edge the entire time, lol).

As far as the methadone is concerned... I don't know that I will be coming down by then. I have goals set for the methadone as well but the first thing that I have to do is keep myself stabilized on an amount that will keep my desires to use drugs in the back of my mind and far away from surfacing into stupid ideas. Until I can live my life without the thought and desire to use drugs, I will continue to have the methadone. I'm not using it as a crutch or an excuse because I've had plenty of crutched and excuses in my life, but getting checked into a clinic was by far a better decision then staying on the other stuff. So far, I've been clean (from doing the drugs) about 2 years and that for me has been a great accomplishment.

I will start a medically supervised withdrawal from the program once I reach a point where I can no longer remember or desire/want the buzz any longer. I still have cravings and desires to use which is why I won't start yet. The last time I did that, I ended up screwing up royally and going back to square 1 but that will not happen to me again because of the fact that I am smarter and more involved in my treatment. I know that not everyone will agree with that and I don't expect you to. everyone has their own opinion of methadone (most of them are one-sided and unwilling to look at all the facts) and the people who use it. Some people use it to get a fix and others use it to get better. Personally, I fall into the category of those people trying to get better whereas before I didn't. So... If anything, wish me luck *_^

Otherwise.. Once again, thank you everyone for your answers and information. If theres anything else that I need to know for my consultation, please let me know. I am compiling a list of questions and if theres anything that I need to ask you think should be listed here, please feel free to list them. Thanks alot!

[54Shirley 105]

Good Luck with your program that you are going threw, and you do what's best for you. Again let your surgeon know ! All Meds are a must, so he knows what to do, and the Anesthesiologist knows what to do.

It's mainly to see if you have self control. TIP: If he says lose 50lbs. ! Then Lose 40, This way he can say well you didn't quite hit my goal, but I see you are trying.

Another thing... Make sure your BMI doesn't go below your Ins. Company expectations. They could not qualify you then if your BMI level is beneath their standards

Shirley.

[nallygirl 4]

As far as the dieting goes... I guess what I was trying to ask was if they have you go onto a diet and you lose a certain amount of weight during that time... Would they say, "Hey, you've lost a good amount of weight during this time and you need to just continue dieting. I don't think weightloss surgery is for you." Is this something that they would do? I assumed that the insurance companies were having people do this so that they could get out of paying for the surgery. In a sense, I supposed it worried me to think that they would turn me down because I lose 10 or 15 lbs in 3 months or something like that. Is this done or am I completely wrong and they are only having you do this to decide how dedicated you are to getting surgery and losing weight but also KEEPING that weight off?

As far as the methadone is concerned... I don't know that I will be coming down by then. I have goals set for the methadone as well but the first thing that I have to do is keep myself stabilized on an amount that will keep my desires to use drugs in the back of my mind and far away from surfacing into stupid ideas. Until I can live my life without the thought and desire to use drugs, I will continue to have the methadone. I'm not using it as a crutch or an excuse because I've had plenty of crutched and excuses in my life, but getting checked into a clinic was by far a better decision then staying on the other stuff. So far, I've been clean (from doing the drugs) about 2 years and that for me has been a great accomplishment.

Hi Justin,

I'm so proud of your accomplishment!! It takes a lot of hard work and dedication to stay clean for 2 years. You are on the right track and making good decisions. Take your time withdrawling from the methadone...No one else will know what's right for you other than you!

As for the 3 month diet, in my personal opinion its just a hoop the insurance company makes you jump through. They are hoping you won't go through with it or you will look at self pay options. Like Shirley said though, I would find out what their minimum BMI is for approval and stay above that. For example, my insurance (Cigna) requires a minimum BMI of 40. Since my BMI when I started my 6 month diet was very close to that I only lost about 8 pounds in those 6 months so I could stay above the minimum. Losing weight did not affect my approval.

Good luck with everything!

Natalie

[MarcyLoo 12]

I take care of moms on methadone (labor & delivery), so c-sections come up. i know they STAY ON THEIR METHADONE. Sometimes they do take additional narcotics (opiates) but we usually have to accomodate with larger doses. I would for sure talk ot your clinic. There may be dose adjustments on methadone while you lose weight too.

My nurse psychologist DID tell me to STAY on antidepressants until well after goal weight. Not completely the same situation, but you don't want to mess with getting rid of one med that is helping stabilize you while you go thru the emotional roller coaster of the lap band....so my guess is it'll be wise for you to do this while on methadone as opposed to after weaning?

Kuddos to you!! Hang in there, ok?

[Justin B. 1]

Its been a while since I posted this thread and unfortunately I was unable to reply due to my internet going down and them taking until just now to fix it . However, I wanted to repost to thank everyone who posted in the thread with info/feedback and compliments. It really meant alot to me to see comments wishing me luck considering most people just trash the fact that I go to a methadone clinic and am trying to do better. People sometimes overlook the postives of the situation and go straight for the negative feedback.

Anyway... Since I have posted this, I have gone to my initial consultation, my nutritional evaluations, met with a dietician to get a diet plan for my 3-month diet requirement (as per Aetnas policy), attended nutritional support groups, interviewed and chosen my surgeon, went to my surgeon consultation, and done my psych evaluation. The only thing left for me to do is have two followup sessions with with my dietician to chart my progress and then my info will get submitted to Aetna for approval. I think I'm making good progress and have managed to lose a few lbs with the diet plan that I have set up to show Aetna that I am determined to do everything it takes to lose weight and not just get the band and sit on my butt and wait to lose weight. Though I'm nervous, I am very happy with my decision to follow through with everything.

On another note, I've started a medically supervised withdraw of the amount of methadone that I am on to get off of it. This will most certainly take a good bit of time but thats perfectly fine with me. I think I've come to a point (or very close to it) where I can go through the day without thinking about doing drugs and that is a very huge step in the right direction. It truly feels as if I am doing things for the better that are going to change my life drastically and I haven't been happier. If I'm this happy now, I can't wait to start losing weight, lol.

Anyway... I just wanted to stop back and thank everyone for their kind words and wishes and I wish everyone else the best of luck whether you have just started your endeavor, are partially through, or have made it to your goal.

Thanks So Much,

-Justin B.-

[CheckYes 46]

Great news on your progress, Justin!

[Lady_Dragyn 2]

Awesome. Well done and best of luck. Sounds like you've found a good path for you and for that I commend you!

[Justin B. 1]

Thanks everyone. I certainly appreciate it. And by the way, I hope everyone is sure to have a very Happy Easter!