Theresa's Story...scared But Desperate...

[dexter 205]

I'm self pay as well. My insurance has a writer in it that says they will not cover any type of WLS nor anything related to WLS (ie doctor consults, psych consults that are leading up to WLS)

I am looking into an insurance extra called BLIS. For a little less than $1500, they will cover complications Should they arise. Perhaps something to look into.

[Wolfgirl1978 256]

thanks for the feedback' date=' suegirl and Jonathan

my insurance specifically excludes coverage of any type of bariatric surgery for any reason--no matter if it is medically necessary or not...I work for the State of Louisiana (the obesity capital of the south outside of Mississippi), and none of the insurance plans offered to state government workers covers any type of bariatric surgery...it is ridiculous since the benefit payments they have made to cover all of my comorbidities from the diabetes and obesity are staggering...go figure[/quote']

I also work for the State of Louisiana, and I was also self pay because, like you said, our policy excludes bariatric surgery no matter what. I paid $14K ( which I borrowed from DOC credit union) for a surgeon in Lake Charles to do my surgery. I just said a prayer and made up my mind I'd be forever indebted to the hospitals and such if I had complications. Luckily, I did not, and have not so far. I'm three months out, and don't regret my decision.

[pretty-pink 43]

I started my process mentally last January and decided to go self pay route in Mexico in May-June. My surgery is this Tuesday, 9/25. I needed time to prepare myself and that included several food funerals! I know that puts my weight up some before my surgery, BUT I am now completely at peace with never having another pepsi or junk food again because of those food funerals. And I am happy to say I have lost 20# from my pre op full liquid diet! :-)

[Katie713 423]

tigerbelle...my beginning stats were very close to yours, I am 5 feet and at the same time last year, Sept 2011 I was at 276. That was so much weight to be carrying on my small frame and it was simply no longer tolerable for me, I prayed for the strength and the options available to me to be able to lose this excess weight that has been holding me down. I re-joined Weight Watchers and got back on plan.

Shortly thereafter I heard from someone that my ***, Kaiser Permanente covered WLS. I had always thought that only PPO insurance covered this kind of elective surgery, and had never thought to even ask my primary about my options for weight management, other than doing the approved, but expensive medi-fast program. I was hoping for the lap-band at this point, not RNY which I felt was too drastic.

I scheduled my annual physical with my primary as I usually do with the intent of asking if I would qualify for the lap-band. At the conclusion of my visit, I brought it up, and she quickly agreed that this would be an excellent option for me and with a BMI over 50 and high blood pressure and high cholesterol, I easily met the criteria for acceptance into the bariatric program. She referred me to the program that afternoon.

Kaiser's program called "Options" is a mandatory 12 week program with weekly classes and structured weight management obligations. The group classes were held in the evenings once a week, back and forth, one week with a behavioral therapist, the next with a nutritional counselor. We were asked to participate in a calorie controlled diet and exercise program with a mandatory weight loss expectation of 10% before being scheduled for surgery. This included daily food and exercise journaling and weekly weigh ins so there was definately the accountability factor. I got a huge notebook of information, learned so much about nutrition and handling the emotions that come with a life change like this, and I am so glad that I had the time to study up on the surgery and really ready myself. I started the program 9/27 and finished up just before Christmas, and mind you, I had to be on a diet all Fall, through Halloween, Thanksgiving and Christmas/New Years, but once I was committed, I found the strength I needed to stay on course. I was referred to the surgeon in early January and met the criteria of pre-op loss at 27 pounds lost and completion of the 12 week program with all logs completed and adherence to the process.

I knew that I had some things pending early in the year, I had to move on March 1st and I had a huge conference commitment at work on 4/4 and 4/5, so when I saw the surgeon for my consultation, he asked if I would like the surgery in late January or early February and I elected to delay the surgery for 3 months knowing that I might not have the strength to get through my move and work commitments if I ran into complications, or not knowing if I would be extremely weak. The doctor said no problem, with the directive to not gain any weight, and in fact lose a bit more if I could to shrink my liver even more before the surgery.

I had VSG (the best option I chose for ME) surgery the day after the conference 4/6/12 and I truly believe this was the perfect timing for MY life. I felt comfortable with changes to my diet, I was already on board with exercise and my move went without a hitch. I was ready.

5 months post-op and in total I have lost 86 pounds and my petite but curvy body is coming back, I've gone from a 3X-4X down to a 14 and I feel so much better. My surgery went well without complications and I feel happier than I have in decades.

This was the best decision I ever made for myself!! You decide when the time is right, but if you opt to delay, use that time to study up and start eating in a manner that is closer to what your post-op diet will be like, you can easily start by limiting your calorie intake to 1600 for about 4 weeks, then 1400 for 4 weeks, then 1200 for the remainder, but of course allow for your holiday splurges...we all have them, as long as you get right back on program. Try to lose what ever you can before surgery, and walk, walk, walk and drink at least 64 oz of water/sugar free drinks and take a multi-Vitamin as well.

Good luck on your journey...I hope it works out well and feel free to contact me if you have any questions!!

[chitowngirl 885]

Hello, I've heard some people getting BLIS insurance quick covers any complications related to wls. I have not used it so I cannot tell you exactly what is covered and how much it cost, but it maybe worth while to check out.

Second Ive heard via post that one of the dr's in Mexico includes any complications in his price, that maybe worth looking into.

It sounds like you have a bit of hesitation, you can take a vacation at any time, I couldn't wait for my surgery. Trust me you'll enjoy your vacation much more post op -50 pounds. But that's just my opinion. I feel like wls is like having a baby there really isn't a good time to have it. In the summer there are all sorts of bbq's, after the new year you have Easter. Ultimately there is some sacrafices for your recovery, but trust me the sooner the better, I say get it over with so you can enjoy your life to the fullest. Best o luck to you!!!

[iggychic 1,405]

I scheduled my surgery to include a long recovery period (3 weeks) "just in case) This week we cancelled house guests, we also cancelled a charity event that was to be held at our home last week. I have cancelled a business retreat due in early october in my home. This is all due to recovery from what was supposed to be a "no bid deal" surgery with little risk due to my low BMI. I am a month out and I am currently sitting in a hospital waiting to have another liter of Fluid drained from my lungs.

Waait until after your major events. You don't know that something like this won't happen to you and you will have the added burden of no local doctor.

[CowgirlJane 14,259]

Welcome to the site!

So, I think this timing thing is tough. I had a lot of preop anxiety and once I decided to "do it" I just needed to make it happen soon. I had other reasons that I did it mid December. However, my "christmas brunch" was a cup of warm chocolate Protein drink...woo hoo. I was also very tired the first few months post op. Once you decide when to do the surgery, you need to realistically plan for several weeks (even a month or two) of being not quite yourself... and adjust your expectations about your daily life accordingly.

Summer is my favorite season and must say I am really glad that I was 100 pounds lighter by summer!!!!

Part of me would advise you to just DO IT and you will be glad, but I would have felt sad missing out on my summer pleasures recovering from surgery. January-February were great months for me to be feeling a little blah.

[tigerbelle 328]

I worked for the state too until January. I had LSUfirst insurance which of course would laugh if you asked about coverage for WLS. Luckily when I changed jobs my husbands insurance picked me up and that is the reason I was able to have the surgery. I completely understand your fears. I was VERY scared and cried often during my pre-op period. I have a four year old and my biggest fear was leaving him without a mom. In the end I decided I'd rather be that mom who was healthy enough to keep up for years to come.

My dad is having the sleeve done in October. His insurance also does not cover this although his case is very urgent. He has many co-morbidities and needs a heart procedure done. But the heart doctor told him the procedure cannot be done until he gets the weight (atleast 75lbs of it) off. My dad is 63 and I am terrified for him BUT I know without this I may not have many years left with him.

I cannot give you advice toward which way you should choose. But these are our stories and why we chose how we did. I would really love for my dad to see my son graduate high school... and much more!

how coincidental...I also have LSUFirst, and they basically without hearing anything just said NO...unfortunately, switching jobs or being picked up on a spouse's plan are not options for me...I am less than two years from 30 years of service and full retirement...also I am not married nor foresee that happening any time soon...I pray for your dad's success and admire his courage

[tigerbelle 328]

I am humbled by the gracious welcome and appreciative of the advice, feedback and offers of support..y'all have brought up some very relevant factors to consider...I am going to continue reading the posts and devote some extra prayer time to this decision...for sure I agree that this is a decision only I can make based on my comfort level and my own needs...I am fortunate that this upcoming week I have a session with my therapist, and I am going to take that opportunity to talk through some of my issues with her...again thanks for all of the support and feedback...it always seems to help me each day to read the various posts and threads on this site

[tigerbelle 328]

I am about the same as you as far at stats go. I was 278 decision weight 261 surgery date and at the 3 months out mark I was down to 235. I would say talk to your dr about the travel and see what he says to wait post op. If I were you I would try to schedule it right when you get back from San Fran. I was good to go by the 6 weeks post op and at 4 weeks out feeling good. How do you deal with pain? Also how was recovery from any other surgeries?

Part of my fear is a direct result of complications I had for major surgery in February of 2009; it has taken me over three years to even consider surgery as an option...I had a paniculectomy to remove a massive lymphedema (over 30 lbs. of tissue and Fluid removed)...I had complications and ended up back several times for additional surgery...to sum it up, I spent a week in intensive care, another 3 weeks in a regular room at the hospital, a month at a rehab hospital, back to the regular hospital for a skin graft over my entire abdomen, after which I was immobilized on my back in the hospital bed for 2 weeks unable to leave that position for 2 weeks (yes, I had Valium)...I then spent an additional two months homebound with home health wound care before returning to work after a total of 5 months...I knew the risks of course, but what was supposed to be a week in the hospital and return to work in 6-8 weeks was an ordeal I never want to experience again

[tigerbelle 328]

since I had my initial consultation with the surgeon yesterday, I guess I have officially begun my "journey." I am still very apprehensive about the surgery, but feel like I am at the end of my rope now and that this is the only viable option I have for a healthy life. I know this is a somewhat different attitude than most of you whose posts I've read, but I am just being honest.

The surgeon I consulted only does VSG, but his partner does others, like the RNY...after doing research, I think VSG will be my best option, and my doctors seem to agree. I had some hesitation (1) because the procedure is a lot newer than RNY and (2) I wasn't sure that a restrictive-only WLS would be effective in not only weight loss but helping resolve some of my issues like type II diabetes. A lot more people have had VSG since I first started considering it, and the research shows that VSG has almost as high of a success rate in not only weight loss but resolving issues like diabetes as the RNY does.

The good news from my consult was that the surgeon believes he will be able to do my surgery laprosopically. I was afraid that that would not be possible since I had abdominal surgery with a resulting skin graft about 3 years ago. He won't know for sure until I have a CT scan of my abdomen, but the chances look very good. Also, he seemed quite confident in his skills and ability to perform the procedure, and he (knock on wood) has not had any patients with such serious complications as leakage. He explained the procedure to me graphically, and that helped me.

The bad news is mostly that my insurance definitely will not cover the surgery. I have made some previous posts in the forum about that. My concern is not so much thte initial cost of the surgery (I have been saving up for a while with thoughts that I would have to self-pay). I am just worried about unexpected complications and additional surgeries that could happen and that also wouldn't be covered by my insurance. From past experience, I know that such bills can build up rapidly and to levels well over $100,000. That would be a financial nightmare for me. I keep telling myself, though, that I just need to pray and have faith.

It is difficult for me to talk publicly about my weight and related stats, but others have been honest about it on this site, so I feel it might be helpful and supportive for me to also be honest and open about this. I am 5'2", and yesterday at the consultation, I weighed 277 lbs. and had a BMI of 51 (per my recollection). I turned 50 years old this year. I have several comorbidities, including type II diabetes, high blood pressure and poor circulation. I would be happy just to lose 100 lbs. but my goal would be more like a 125 lb. loss...I think I would be comfortable weighing around 150 lbs. More important, though, is that I would be able to get my a1c levels below 7 and be able to get off of insulin and maybe most of my other meds.

Because I will be self-pay, I don't have to meet any insurance company requirements and paper work. My doctor requires one visit with a NUT before scheduling surgery and then a follow-up visit with the NUT. Also, I need a letter from a mental health professional as to my psychological readiness for WLS. I have a therapist I have been seeing for many years, so I will discuss this matter at my next session. I am not sure what factors she will consider when making the recommendation.

The only other question I am having some difficulty with is the "when." Because I am self-pay with no insurance red tape, the surgeon said the decision of when would be up to me. Here are some of the factors I am considering. The earlier I have it, the less likely I am to lose my resolve, and the sooner I will begin the path to what I pray will be a healthier life. I also have this fear that I will have some more serious complications from my diabetes if I wait too long. The downside to me personally is simply the time of year and overall timing. Fall is my favorite season, and really the only season of year I enjoy. It is also the time when I take my vacation and any personal trips. I am scheduled for a trip to San Francisco in mid October, and I've already paid the deposit for a Caribbean cruise over the Thanksgiving week. I know I could cancel both of these and reschedule for next year, but I was looking forward to these trips. Plus, in trying to be realistic about the future, I don't know how long it could take me to recover from the surgery itself, especially if I should have unfortunate complications. If I delay the surgery until after Thanksgiving, then Christmas is upon us. Christmas is my favorite holiday, and it does sadden me to think of having surgery around Christmas time. I am leaning towards a January surgery date...the new year, new beginnings thing appeals to me. Really that is just about 3 months away so it's not a whole lot of prep time. Perhaps I need that long to prepare.

Sorry for such a long opening post. Any feedback of any type is welcome. I am thick-skinned and can't be offended.

****update****

Sorry I have been away from the forum discussions for a while...I wanted to give an update...before I could move any further with scheduled WLS, I developed an ulceration on my big left toe (complication of diabetes)...my podiatrist began treatment, but the healing process was going very slowly (again, diabetes complication)...my WLS would not schedule surgery until I resolved the matter...right before Christmas, the ulceration still was not completely healed, and I developed a bone infection...since then I have been on daily IV antibiotics and have completed 4 weeks of the 6-week regimen...my hopes and prayers are that the infection and the ulceration will be healed in the next 2 weeks, and I can proceed with the WLS process...more than ever, I am feeling like the WLS is a last resort for me, and I have additional fears now of developing another infection or complication before I can proceed...for now, I am going to probably be asking a lot more questions here, so please be patient with me

[aliandrews 98]

I hope you heal soon, so you can have your surgery.

[Diamondeyed 399]

Good luck

[tigerbelle 328]

***update***

Back again for another update. The blessed news is that my ulceration did heal at the end of January, and am off of antibiotics...during my healing time, I did more research on VSG and tried to keep up and read a lot of posts on this forum. A lot of friends and family--some who have had WLS--as well as my ob/gyn had encouraged me to consider choosing a surgeon whose sole practice is bariatrics and who has been doing WLS for many years. I decided to schedule a consultation with a local bariatric surgeon who is quite well respected and comes highly recommended, and I had my initial consult with him today...while I liked him and appreciated his honesty and no-sugar-coating approach, I did leave the appointment feeling a little down and discouraged

Because of some previous abdominal surgery and an abdominal skin graft, he is not sure that he will be able to do the surgery laparascopically and I may have to go on a strenuous pre-op diet to get my liver size reduced as much as possible to facilitate the surgery...both of these things scare me--mostly the possibility of having to do open surgery...he will know more when I get a CT scan which his office will coordinate setting up for me soon...they will probably call me on Monday to set a time for the scan...while I wait to do the scan and get the results back, I am continuing to visit this forum and read some more on VSG

Guidance from anyone who has had some similar concerns would be welcome and appreciated...thanks just for reading

[Lagranny 0]

I just finished my 6 mth with the dietician and now I wait for the insurance to see if they approve it. My Dr told me because of previous surgeries that he may not be able to do it laparoscopically but we wait to see what the ins says before going any further. Now I sit and play the waiting game