DESPERATE for help!

[JWL08 0]

I apologize in advance for the long run down of how I've gotten to my current predicament. Please bear with me...

I had a successful lap band experience in 2009 and lost 100 pounds, reaching my goal weight of 150 pounds. I ran 5 times a week, did kickboxing, ran a fitness club for kids, and was back to my college- like self. I am one of those sick people who love working out, so I was in heaven! Most importantly, I was living the active lifestyle I had missed for so long.

My husband and I decided to try for baby #2, had unexplained infertility for over a year, then were overjoyed to hear we were expecting twins. My ovaries were on the brink of rupturing, so I was restricted from any physical activity of any kind; doctors feared I would lose the babies if they did. As a precaution my band doctor did a complete unfill and things were looking great. Sadly, three months in we lost one of the twins. After that I had additional complications with the remainder of the pregnancy- my pelvis separated months before it is supposed to, making walking impossible, so I was on bed rest for the final 3.5 months. It was all worth it though when our beautiful baby was placed in our arms! So blessed

Following the pregnancy, I had another hiccup... my bladder is prolapsed and needs surgery, so when I walk I feel like I am losing my insides. Exercise is impossible and I hate it. Fun times.

As for my band, I went for refills, took a couple tries to get it right, and even at my "sweet spot" number from before, the restriction didn't feel quite the same. Pressing on though, things were ok. Then that horrible 5 day stomach bug hit our household, violent vomiting and all, and I think the band slipped. I can only keep down mashed potatoes and simple Soup, rely on acid reflux meds 2X per day, and am miserable. Because of all the sick time I had to use for my kids and I being sick, I couldn't afford more time off to go to the band doctor. I've had to wait months. So stupid, I know, but in this economy, I can't risk losing my job. Since losing the initial baby Fluid, I've lost another 30 lbs of the excess weight I gained through restricted physical activity and bed rest, but clearly not in a healthy way since I can't seem to keep much down. I still have a ways to go. I called my band doc and he isn't available on my upcoming days off, so his partner is going to a complete unfill on Friday. I'm grateful his partner is willing to see me.

Here's where I'm nervous... my doctor said another surgery may be a good option, either the sleeve or bypass. I know minimal about each. I currently weigh 202 fully dressed and am 5' 5.5" tall, making my BMI 33.1. As such, my doctor said my insurance will likely not cover it with me being under a BMI of 35 and having no other issues like high blood pressure, cholesterol, diabetes, etc. He said he can try since I am having problems, plus draining the band might cause me to regain weight making me eligible again. The thought of gaining more weight makes me cry. I called the insurance company directly and they said it'd be covered if my doctor deemed it "medically necessary" and if it was coded in a way the insurance company agreed with. There are a lot of "ifs" there. So essentially I am having a complete unfill with no clue as to whether or not I am able to have a corrective surgery. Doesn't that mean my doc would also not want to refill the band if surgery isn't an option? As it is, I have to wait until summer for an appointment with my doctor, then the surgery (if applicable) since I can't take any time off of work. I imagine there will be pre-op testing and all of that, and I also heard some people needed to wait months between band to bypass surgery because of damage... I'll be back to work by thn and back in the same boat, all the while gaining weight! If I get drained on Friday, do you think it will give time to heal any possible scar tissue between now and June? Those that switched from band to bypass, did you have lots of pre-op testing, or none? SO sorry for the long winded story... it's been a bumpy road

[SoccerMomma73 1,867]

I'm the lucky girl that had the prolapsed band with urgent removal that was SUPPOSED to be a same day revision to RNY but in the end had to wait 6 months for revision because of all the damage from my freaking band (how's that for a mouthful???). Band removed aug. 1, RNY, Feb. 11, I'll be 6 weeks post-op Monday. So...a lot of ifs. My insurance company has a 1 bariatric surgery per lifetime exclusion that scared the heck out of me. Once I spoke with the insurance company myself they told me that since I had had fairly good success with my band, had followed up with my surgeon semi-regularly while I had my band, AND had experienced a mechanical failure they would cover the revision. (Thank The Lord)

My next hurdle was qualifying... Originally my BMI was around 50 and I had hypertension, at the time of removal and original revision date my BMI was 36 and my hypertension was resolved, I hadn't been on meds in a couple years. Again, after personal discussion with insurance they concluded that while I did not currently meet their requirements of BMI >40 or BMI >35 with at least 1 co-morbidity that likely without my band I would regain what I had lost and regain my co-morbidity as well. I was AMAZED that they were logical enough to view it like this. After all, they are an insurance company . In the end the removal was covered, no questions. The revision was covered but my doc did have to write a letter stating everything above that the insurance company and I had talked about....it was a medically necessary surgery, I was a good candidate for revision, without my band I would likely return to my previous weight and regain my comorbities...was actually a pretty easy process for me (and I am VERY lucky.

I did gain 30 pounds in those six months. About a pound a week or 500 extra calories a day. I look back and wonder where I'd be now if I had gotten the RNY in August or if I'd gotten it when I did but not been 30 pounds heavier...but oh we'll, it is what it is! I finally got it done and I'm down 30 pounds so I'm now starting from scratch! I feel so much better than I ever did with that damn band!!!!

Good luck with everything. I had an upper GI the day I got my last unfill and that showed the prolapsed band and herniated stomach. Please keep us updated!!!

HW 312, pre-op (lap-band) 294, pre-op (RNY) 255, surgery date 2/11/13, goal weight 154, current weight 225.8

[babysteps 48]

I have the sleeve Unfortunately for me it does not work properly I will be getting a Rny sometime later this year. My sleeve was not done wrong and I had done nothing wrong. My metabolism is so shot that I need the metabolic reset of the RNY. I wish I would have just done Rny to start with would saved me a lot of money time and frustration.

[JWL08 0]

Soccer Momma73, do you mind if I ask what insurance you have?

[SoccerMomma73 1,867]

Soccer Momma73' date=' do you mind if I ask what insurance you have?[/quote']

I have BCBS health advantage of Arkansas. I work for a large hospital system and they pretty much have their own plan. Typically I say our insurance is one of the worst. Our rx coverage sucks and getting scans and such approved is horrible. But for some reason, when it came to this they were very logical.

HW 312, pre-op (lap-band) 294, pre-op (RNY) 255, surgery date 2/11/13, goal weight 154, current weight 225.8