My Pre-Op Experience Diary - By Visit Date

[UpandAtom 126]

Hello everyone! I thought it would be helpful to have a detailed account of my experiences from first pre-op meeting through surgery (have a date but have not yet been sleeved) and perhaps beyond. These are my experiences which I think are fairly typical though yours may differ. Much of this same information is available here on bariatric pal but may take a bit more digging than I hope to lay it out here. So, let's begin.

May of 2012: I began to seriously consider bariatric surgery and began hunting around for information and resources. It was then that I found Bariatric Pal. I thought my mind was made up about getting the lap band but after reading numerous posts here, I also began to consider gastric sleeve. The band seemed simplest and safest to me. After reading many, many posts here, I learned that that was not only untrue but that the band simply didn't work for most people.

June of 2013: I finally got up the courage to see a surgeon about the surgery. After seeing him I was sold on the sleeve. It has a great long term success rate of an acerage of 60-70% (depending on the study) excess weight lost for five years or more. He highly discouraged the band and simply said it just doesn't have the success rate and he is not recommending them.

August of 2013: I learned that my insurance at the time would not cover the sleeve, band or any other bariatric surgeries or weight loss programs. I was very upset but renewed my determination to lose weight "on my own". I did. I went from 385 lbs down to 305 and felt like a million bucks. I was absolutely positive I would shrink all the way down to my then goal weight of 225. Hah.

Mid 2014: I ballooned back up to about 365/370 and began experiencing extreme knee pain, occasional chest pain, increased sleep apnea and rising blood pressure. My quality of life sucked.

December 2014: I had a total right knee replacement. It was horrible. My weight prevented from attending the inpatient rehab clinics that I wanted to attend which had weight restrictions. I wound up in what was essentially an "old folks" convalescent home that made me feel old and invalid. I was ashamed to be there.

February 2015: I severely injured my replaced knee while leaving physical therapy. I tore my hamstring and the tendon which attaches to the knee cap. It sucked and I know it was largely due to my weight. The injury still has not healed properly and I continue to feel very handicapped and I am only 48. I can not run at all and standing and walking long distances is out. I again renewed my efforts to lose weight. I went from about 375 to 345 by May and was feeling pretty good.

May 2015: I learned I had a diaphragmatic hernia which is like a hiatal hernia but not as close to the esophagus. I had it repaired, which went well but developed an incisional hernia at the site of the laproscopic repair. My efforts at losing weight again turned around. It was at this time that I renewed my intention to get bariatric surgery. I came back to bariatric pal and researched Mexico.

July 2015: I was just about set to go to Mexico. I did a skype consultation with Dr Altamirano in TJ and joined his FB group. I began putting the money aside in hopes of going in Mexico for surgery in December. I had strong reservations about Mexico at first but got over it after much reading on here, the consultation and the FB group. Still, I worried about follow up care if there were complications. I had new insurance at work but it still did not cover bariatric surgery.

November 2015: I learned from some folks on here that they bought an insurance plan off the Obamacare insurance exchange and used it to cover their surgery right here in the U.S. Some of them even had it as a secondary insurance policy and it worked. My interest was piqued and I began exploring the exchange for an affordable policy that covered bariatric surgery. Some of the others I referred to had success with BC/BS of Illinois and I learned that Illinois requires companies participating in the exchange to cover bariatric surgery. Since I live in Illinois, this was great news! I found a policy that covered the surgery at 100% after a deductible of $3500. Steep but doable. The premium is $398 per month.

January 2016: Now we're getting to the meat of the potato. I bought the plan off the exchange, receiving no discount, and it took effect on Feb 1st of 2016. It was the BC/BS IL PPO Silver Plan. Pretty good coverage after deductible.

February 2016: I called the insurance company to verify benefits, and they were confirmed. I learned that they did not require a six month diet, or many of the other things that many insurance companies require. They simply said the require a "letter of pre-determination". I also learned that they do not cover the hospital or the surgeon that I initially consulted with. I researched their website and found out that Elmhurst Hospital, and their surgeons were covered. Hallelujah, I live in Elmhurst!

I will pick up here later with details of my visits so far!

[UpandAtom 126]

February 8, 2016: I attended the Elmhurst Hospital free bariatric seminar. This is where the surgeons, bariatric Dr and nutritionists talk about what to expect before, during and after the surgical process. It was clear that this group greatly preferred the sleeve and the RNY bypass. In their opinions, the band just doesn't work. I'm sure others on this board would disagree but they said that failure in the long term was the norm rather than the exception. They explained the available support groups and the topics they covered. They discussed potential complications, the success rates, what the procedures entail and the pre and post op diets. Honestly, I already knew everything they covered from obsessively reading right here on bariatric pal.

I asked questions, introduced myself to the surgeons, bariatric dr. and nuts and left feeling very good about their competency and the prospects for being successful. Oh my God, I may actually succeed in losing 150 plus lbs.!

February 16, 2016: My first appointment with my bariatric surgeon. I learned very little here but this is where we got to know each other a bit better and he explained the process I have to follow. I learned about visiting the bariatric dr (who acts as a kinf of coordinator), the psych, the nuts, cardioliology, pulmonology, etc. It felt overwhelming because I knew making and keeping all those appts. was going to be a big challenge. I also learned that the two surgeons at the seminar always do surgery together. I liked that because I was really unsure if I had picked the right one of the two, though both seem excellent.

This is also the appointment where I filled out massive health history forms and talked a bit about my weight history and struggles with losing.

February 18: Visited my PCP to get his blessing. He gave it. He also gave me an ekg and referred me to cardiology for clearances and did some basic bloodwork. I was afraid he would not approve, and he was hesitant but he came through with the support.

February 25: Visited my pulmonologist. Easiest appointment yet. He listened to my heart and lungs and reviewed my CPAP record. All looked good and he signed off on surgery. He seemed very pleased that I was doing it and suggested that my sleep apnea would improve immensely.

February 29: Visit with the bariatric dr. This guy does not do surgery but is kind of the "glue" that holds everything together in the practice. It was an hour and a half appt.! We covered nutrition counseling, weight history, basic psych profile and he asked tons of questions to determine if I was ready for this big step. When I left, I made an appt. to see him again as he required.

February 29: Killed two birds with one stone and saw new cardiologist today. He checked the swelling in my legs, listened to my heart and lungs and ordered both a nuclear stress test and an echocardiogram. The nuclear is a two day test and the echo a siple sonogram of the heart.

March 2: Appointment with Nutritionist. This seemed like a waste of time to me. She covered the same things that the bariatric dr. covered. But she did give me a "big book of bariatric surgery" that covered all the steps leading up to and immediately after the surgery. She covered how I would eat for the rest of my life and covered the basic stages of Bariatric Eating. I already know most of this stuff from Bariatric Pal. She had me make some excercise and eating commitments.

March 8: First half of my nuclear stress test. I couldn't eat or drink any coffee. They had me walk on a treadmill and injected me with something that made my heart race and made me out of breath. This simulated exercise in lieu of traditional running on a treadmill, which I can not do because of my obesity and bad knees. I was injected with a nuclear dye then I laid on a table and was scanned with a machine kind of like a Cat Scan. This first part of the test images the heart under stress. The next part, two days from now will image the heart at rest and they compare the two to determine heart health.

More later

[DRene 12]

Dear UpandAtom

Your journey sounds similar to mine. I am in Missouri, just outside of St Louis, I finally had s surgery date of April 25th and started my pre-op liquid. I found out today my PCP has changed his mind and will NOT give clearance until I see a neurosurgeon regarding some MRI results of my neck and upper spine. I'm so frustrated with this roller coaster but I've come too far to turn around now. I too have knee replacements. 3 of them. Both knees were replaced when I was 40. My left was replaced again in 2011 which caused me spinal injuries and I became disabled. I am 52 and feel like this VGS will be the tool I need to turn my health and my life around. Do you have a date yet or is it done already?

Sent from my iPhone using the BariatricPal App

[lasmith0802 67]

Love reading your story...

Edited April 14, 2016 by lasmith0802

[UpandAtom 126]

@@DRene I am sorry to hear of your troubles! I wish the orthopedic docs would strongly recommend weight loss surgery before replacements. I think both you and I and many others would be much better off for it! If your PCP doesn't get behind you, please find another one who will! All the best to you, I'll be thinking of you!

[UpandAtom 126]

@@lasmith0802 Thank You! I am enjoying sharing it. Therapeutic somehow. I will keep sharing!

[UpandAtom 126]

OK Now, where did I leave off...

March 10: Second half of my nuclear stress test. This one was even easier than the first half. I had radiactive dye injected but nothing that stimulated my heart to simulate excersize. I was injected with the dye and laid on the table for the scan. Quick and painless!

March 12: Echocardiogram today. I was laid on a table and the tech used the thing on my chest that they use to take pictures of babies in utero. It took about a half hour and was totally painless.

March 15: Saw my surgeon again and he informed me that he had clearances from most of my dr.'s. He explained the procedure to me again. Essentially they put 3-5 holes in my abdomen, fill me up with air to blow me up like a balloon and give them room to work. They insert the tools needed into the other holes, lift my liver off my stomach and cut 80% of my stomach away. The removed portion is supposed to contain most of the stomach which produces the hunger producing hormone called ghrellin. This helps the body to not feel hungry but does nothing for pcychological "head hunger". The nurse checked my weight, down about three pounds, and he sent me on my way with a return appointment made for 4/5. I'm not to sure why they require all these appointments!

March 17: Follow up with the cardiologist. Half day off work and another copay just to learn that my tests were normal and I was in the office for about three seconds with the Dr. He wished me well and I reminded him to send an approval note over to the surgeon.

March 22: Follow up with the nutritionist. She covered the exact same things as in my first visit! I guess this counts as the "nutrition counselling" required by many insurance companies!. She showed me little plastic pieces of food that were sized to the size and weight I'm supposed to eat once healed from the surgery. She suggested eating on a small plate to trick myself into thinking I'm eating the same as before! The fake salmon on the mini plate was about the size of an old fashioned matchbox. There was 1/2 cup of fake green Beans and 1/4 cup of mashed potatoes. I feel skeptical that this tiny portion will leave me sated but I plan to work to get used to it! I think this was also the meeting she told me to buy and start taking bariatric Vitamins. She reccomended chewable optisource Vitamins, which aren't bad and are intended for post surgery patients but apparently also helps the body be ready. I suck on them like a hard candy until they are dissolved.

April 5th: Back to the surgeons office! I feel like this was a wasted visit, except, he gave me a date! Intitially he said we could look at a date in June. I objected to that and said that my work schedule would be better suited to an early May date. He gave me a date of May 9th and said as long as my insurance company signed off, we'd be good to go for then. In an earlier visit he was concerned that my diapragmatic hernia repair and incisional hernia repair might interfere with his ability to perform the sleeve. He was able to get the surgeons notes from those other surgeries and after review said he felt cautiously optimistic that he could perform the surgery without old scar tissue getting in the way. Apparently he gets a tad nervous when other abdominal surgeries have been performed. If scar tissue has adhered to the stomach, things can get a bit dicey. I don't tend to scar much so I am going to try to not worry about this much!

April 5th: Another two birds with one stone day! I also saw the bariatrician who informed me that all approvals were in, including the psych review-I talked about that, right? Hmmm. Looks like I may have missed that! I was worried about the psych eval because I, like many here, have a food addiction. It's real and I have battled it since I was a wee tot. I am also an alcoholic and I was afraid that the Psychologist would consider me too high a risk for realpse. Either with food post surgery or with alcohol since I will no longer be able to feed my addictions with food. I talked to her at length about that and she felt comfortable since I have been sober six years and intend to increase my meetings post surgery. She gave me four long questionnaires and talked to me for over an hour, She asked lots of questions! Anyway, I'm all approved from the medical side! Now it's all about the insurance!

April 5th: Ha! this was actually I three bird day! I saw the nut again in the afternoon. These appointments have been a real pain in the arse but are necessary and I just set them up and knocked them down one at a time. The nut just really talked to me about the pre-op diet in more detail today. I get 800-1000 calories a day all in liquid Protein for two weeks prior to surgery! I'm not too happy about that since the Surgeon had said i would get a Protein shake for dinner, one for lunch and then a small dinner of lean Protein and veggies. I told the nut that the surgeon had said that and she said that I was mistaken. I wasn't, but I'm not here to argue. Lets just move along please! So I plan on using Muscle Milk since it is approved and I sell it at work, so I can get it for real cheap! 4-5 of those a day and nothing else.

April 8th: Called the woman who handles the insurance submissions for the practice to insure that everything had been submitted to the insurance company. She assured me it was sent the day before and that i should follow up with them in a week.

April 19th: Today! I waited a bit longer than a week and today "chatted" with BC?BS IL through their website Chat feature. The person I chatted with said that the information was just received on the 14th and was still "pending review". This leads me to believe that either the insurance coordinator sent in the stuff a bit later than she said, or the insurance company actually received it a bit sooner. In any case, not much of a discrepancy. I asked how long the review takes and she said that their official time frame is 30 days. That would be a problem since it is after my surgery date of May 9th! But she also said that it usually only takes 7-10 business days. I am glad I contacted both parties as that might help keep things moving along. 7 business days from the 14th is the 25th and I intend to contact them again then. I want to stay on top of this in case they need more information that I might be able to get them in time to keep my original surgery date.

I am very nervous about insurance approval! I am afraid that since my main work policy didn't cover bariatrics, that they might not either. Or that they'll determine I wasn't eligible for an exchange plan in the first place and they shouldn't have sold me one! But they Did amd they have been paying some of the pre-surgical bills , so I'm hopeful. Still, I worry. A lot. Oddly, my work insurance changed again as of April 1st and this new policy DOES cover bariatric surgery! But since I've come this far with my exchange policy, I'm sticking with it unless I get denied, then I'll resubmit to the new insurance company which is BC/BS of NC. Until then I'm on pins and needles.

I'll keep you posted.

[kmorri 1,689]

@@UpandAtom be careful with which insurance you file with.....if your work insurance is primary the claim has to be filed with them first....once they process it, either pay or deny then it can be sent to the secondary. If both of your insurances cover the surgery now you're going to be in really good shape, but you may need an auth with both companies......just an fyi from a BCBS of Florida retiree.

[UpandAtom 126]

@@kmorri how do I know which one is the primary? Of the two policies I currently have, I had the exchange policy first if that means anything. Since both are BC/BS will they automatically know about the other?

[kmorri 1,689]

@@UpandAtom since I retired prior to the ACA plans hitting the market, I'm afraid to try to answer your question regarding who is primary....(my guess would be your work policy).....As far as the two different BCBS plans knowing about each other....not necessarily.... However, they do communicate with each other and do have the ability to find out about each other.....but each state has their own BCBS plan and are separate companies and just members of the same Blue Cross association.......Your HR department my be your best source for an answer without having to call either of the insurance companies....I'll also touch base with a couple of my contacts that are still working and see if I can find an answer for you.....I'll let you know if I find out anything.

[kmorri 1,689]

So I found this statement on the IL department of insurance website...each state has different rules so since you live in IL this would be for you....Your "exchange" policy is an individual policy and your work policy is a group policy, so the way I read this is they don't have to coordinate with each other.....(COB means Coordination of Benefits)

NOTE: Individual health insurance policies do not have to comply with the COB rules. Those policies may have special provisions in place if you have more than one policy. You should review your individual health insurance policy to see how it pays if other insurance is involved.

Here's a link to the document as well. http://insurance2.illinois.gov/healthinsurance/coord_benefits.asp

for some reason the link isn't working....if you copy and past the link in your browser rather than just clicking on it it should work...

Edited April 19, 2016 by kmorri

[UpandAtom 126]

@kmorri. Thank you for looking this up for me. I really appreciate it! Tomorrow I am going to contact the insurance coordinator at the practice to see what they recommend.

[Slimliz 17]

Thank you so much for sharing your pre op experience! I also have bad knees and will need to have the nuclear stress test. I am very apprehensive about the chemically induced portion of it.

Would you please share a little more details on how you felt when you had yours? Does it feel like your heart is racing?

Sent from my iPad using the BariatricPal App

[UpandAtom 126]

@@Slimliz the stress test was weird but not bad. I felt out of breath immediately after the injection and my heart raced a bit. Nothing much more than climbing a flight of stairs. I was scared too but it is much easier, less scary than you think! Good luck!

[UpandAtom 126]

Ok so I have a couple of new things to report. I called my Surgeons office to let them know of my dual insurance situation. They insisted on this since if the exchange policy finds out about the work policy, they may refuse to pay for some reason. So I called them and they assured me that the dual insurance would not result in nullification of my policy. They did say that they would do coordination of benefits with the other insurance. Meanwhile, the office contacted my new insurance to verify benefits with them and I am covered there as well. Each company has the same set of rules for covering the surgery. Still, the Obamacare policy, to which the office originally submitted, has not issued the approval so I am waiting on pins and needles still and very worried.

I also began my liquid Protein pre-op diet yesterday. OMG I am going to eat my freaking leg! As previously mentioned it is a bum leg anyway! Dang I'm hungry! I don't know how I can do this for two weeks. Also, it would totally suck if I did this liquid diet just to be denied! The good news is that if the obamacare policy denies me, I can drop them and use the other policy, for which I currently meet all requirements. Unfortunately that would delay the surgery at least a week or two. Also, the new policy has a lower deductible of 1500 vs 3500 but it only pays 80% after deductible vs 100 % of deductible on the other. Okay excuse me now while I season my leg.