Sooo Many Questions

[HuneComz 103]

Good Evening Folks. First post on this site, but I have certainly read MANY and I appreciate everyone's candid experiences and posts.

I have been overweight since puberty. Since the birth of my children and, well, due to life...I have gained way more than I am proud of. I have tried so many diets and work outs and see little success and darnit...I LOVE TO EAT. But my mother died at 63. She had heart disease, diabetes, Hashimotos, high blood pressure, and cancer of an unknown origin. She was a completely different person for the last 7 years of her life and no medical professional could give us any reason. Her personality did a 180, she could barely walk, her speech was greatly impacted and her self-hygiene was terrible. When they found the cancer, it was in her liver and in many of her bones and it was too late to do anything for her. She died four months later. I didn't see it when I was younger...but now that I am older and maybe heavier..I see that I look just like her. This also makes me fear that I am pre-dispositioned to everything she had - that I am just like her on the inside, too. I want to live long into retirement. I want to be a Grandmother. I don't want to be a burden on my children.

I began my journey in May with my consultation. I was told my insurance requirements and began my appointments in June. I was told approximately 3 appointments with physician, dietician and psychological testing over approximately 4 months. I have my 3rd appointment on 9/21 and I will receive the results from my psychological testing then. I had my EKG, blood work and sleep apnea test, which was negative. I think I get nervous at the appointments and don't think of questions - but I certainly have lots as I read these posts.

1. What do I expect? If my next appointment is presumably my last to meet the insurance requirements - what comes next? I am reading so many things on this forum!

2. I have Aetna and my doctor's office keeps assuring me that the insurance companies have requirements and you meet them or you don't. Other than a higher BMI...I am one healthy big girl (now). Blood pressure is great, cholestorol is in ok-range, not diabetic, etc. I am very anxious that I will have gone through all of this only for insurance to say no.

3. I have a friend who was sleeved a couple years ago and was not required to do a liquid diet two weeks prior to surgery but that seems to be the standard now - is that the new normal?

4. Maybe not a question - but I am very nervous about losing my hair and having hanging skin. I feel my long, thick, naturally curly hair is my only good physical feature, so I feel some anxiety about possibly losing gobs of it. And I need to lose about 120# to be around where I was years ago when I thought I was "fat" and where as I have no expectation of wearing tube tops or anything, I also want to feel good about myself so I am worried about having skin issues. My aforementioned friend claims to have zero skin issues. Anyone else so lucky?

5. Any advice for expectations? I see the posts about two week liquid diets pre-op and up to 4 weeks liquid diet post-op. I have seen posts about no vegetables post-op and issues with bowel movements and all sorts of stuff that makes me question what I am about to do.

6. My husband is supportive in the fact that he wants me to be happy but he is not happy that I am willing to go to this extreme. He partially feels like he has let me down in not trying harder himself to diet with me or work out with me or help to motivate me with any of my 100 diet attempts over the years. He is scared because he doesn't know the long term effects a greatly reduced stomach may have, he is scared because of the normal surgery risks, he is scared because I run the show here at the house for him and our 3 boys. Anyone have any input they can relay from their spouses?

7. I am worried about missing too much work. I hope to have 3 weeks of vacation time saved by the time I anticipate having the surgery. I heard 2 weeks off is a reasonable expectation. My only surgical experience is robotic gall bladder surgery a few years ago. I couldn't believe how sore I was and missed an entire week of work. Are my expectations for missed time for a sleeve reasonable?

I know I have a lot of random questions, but any input anyone can provide is greatly appreciated and being absorbed. This is such a big decision, I want to make sure I am making the right one.

[James Marusek 5,244]

That is a lot of questions!

1. What do I expect? This will vary by surgeon and insurance requirements. After my initial consultation, I underwent psychological testing. I had to undergo a 6 month medically supervised weight loss and exercise program. I attended Bariatric Surgery Support Group meetings during that time. I then went through almost a day of pre-op testing. Because several problem areas were identified, I then went through a second round of pre-op testing with specialist in their respective fields (such as sleep apnea). Then I went through a half day of classes. Then when my insurance was finally approved a date of surgery was set.

2. Insurance. For me battling with he insurance companies was the biggest hustle. Even though the insurance company mandated that I undergo medically supervised weight loss program, they refused to pay for the doctor to conduct them. Actually that is not true. They paid for every other one. They said it was a clerical error that they made those payments. But like clockwork, the first was paid, the second was not, the third was paid, the fourth was not, the fifth was paid and the sixth was not. Made no sense to me. Also they tried to pay at the out of network rate when it clearly was in-network for some charges.

Even though insurance policies will vary somewhat, many are similar. These were the requirements from my health insurance company:

Surgical treatment of obesity (bariatric surgery) is covered only if:

- eligible enrollee is 18 of age or over

- clinical records support a body mass index of 40 or greater (or 35-40 when there is at least one co-morbidity related to obesity). Applicable co-morbid conditions include the following:

•Type II diabetes mellitus (by American Diabetes Association diagnostic criteria).

•Refractory hypertension (defined as blood pressure of 140 mmHg systolic and or 90 mmHg diastolic) despite medical treatment with maximal dose of three antihypertensive medications.

•Refractory hyperlipidemia (acceptable levels of lipids unachievable with diet and maximum doses of lipid lowering medications).

•Obesity–induced cardiomyopathy.

•Clinically significant obstructive sleep apnea.

•Severe arthopathy of the spine and or weight bearing joints (when obesity prohibits appropriate surgical management of joint dysfunction treatable but for obesity.

- Documentation of failure to lower the body mass index within the last 12 months through a medically supervised program of diet and exercise of at least 6 months duration.

So since it appears that you do not have any co-morbidities, then the decision is based on your BMI. If it is over 40 BMI, you will probably be approved. Some insurances will cover some forms of bariatric surgery and not others.

3. liquid diet. I did not undergo a liquid diet. This is sometimes called a liver shrink diet. But I had RNY surgery and also because I was in a mandatory weight loss program I lost 20 pounds already through the program.

4. hair Loss and Lose Skin. I didn't lose any hair after surgery. It is important to meet your daily Protein requirement otherwise you might. Most of my loose skin was below my belt line, so it was unimportant to me. After surgery I did develop very fine paper thin wrinkles on my face. I looked like I was 100 years old. My wife recommended I use a product called Bio Oil available at Walmart, CVS and other stores. I put it on once per morning when I got up and the wrinkles disappeared. Also, it is important to meet your daily Fluid requirements because this can lead to dehydration and wrinkles.

5. Advice. I will give you three bits of advice.

First, take a good before photograph of yourself. I would take a total body side view. Later after surgery, you can then take a good after photo. Many people do not really look at themselves and do not know how obese they really are. When the pounds drop off after surgery, they cannot see, the weight that they actually have lost. That is where the photograph comes in. Many carry the photos around with them or on their smart phones to show what they actually accomplished.

Second, walk 30 minutes each and every day. It will help with the recovery process after surgery. It will also help with minimizing pain after surgery. I had no pain medicine after I left the operating room. I didn't need any.

Third, if you haven't already, go cold turkey on any caffeine and carbonated beverages that you normally drink. It is a requirement of the program. I went cold turkey on my 6 diet coke a day habit at the start and I was extremely miserable for about a week. It was due to caffeine withdrawal. I suffered a week of severe headaches and body aches. You do not want to combine this withdrawal syndrome with the effects of surgery. So it is good to get this one out of the way now.

Well that is all for now. I have to go.

[HuneComz 103]

Thank you for the response James. My insurance requirements are similar, with the exception of a 90 day physician/dietician supervised diet. As I stated, I meet the other requirements simply by having a BMI of ~44.

I hope to be able to meet the post-op requirements of liquids and Protein so that I can have equally successful results!

I rarely drink anything carbonated. I do drink coffee and iced tea daily, so I will work on eliminating those. Quite honestly...the coffee is more out of habit than anything else. I enjoyed it much more when I was smoking but I quit a year ago. (Best health decision #1 - so far!)

I do need to get more mobile. I have terrible plantars fasciitis but I have to stop making excuses and get walking.

Thanks again!

[KristenLe 5,979]

@@HuneComz Welcome! Have you talked to your surgeon about the different surgical options? Just curious why you decided on bypass.

1. They will prepare the paperwork and submit to Aetna for approval. A BMI over 40 is all that's usually required and to answer #2 - if you meet their requirements they can't really deny it and if they try to - appeal it.

#3 this depends on the surgeon and the patient. I don't have to do a pre-op diet (just Clear Liquids day before).

4. This is either going to happen or not - not much you can do to prevent it if you're the unlucky person to lose hair. Get you Protein, Vitamins, etc and hope for the best.

#5 my surgeon does 1st week liquids - weeks 2-6 purees. They also recommend veggies.

#6 Your husband is understandably nervous. Sadly - only 5% of morbidly obese people who lose weight on their own are able to keep it off. Surgery is your best option to lose weight and decrease your chances of developing comorbities and dying of an obesity related disease.

#7 I think 3 weeks will be enough. I'm told gallbladder recovery is worse.

Good luck on your journey!

[Djmohr 6,965]

[quote name="HuneComz" post="4243456"

1. What do I expect? If my next appointment is presumably my last to meet the insurance requirements - what comes next? I am reading so many things on this forum!

Honestly this is a hard one to answer because every surgeons office does things differently. I met my surgeon after the approval processed was completed. Up to that point I was meeting with Bariatric doctors that follow your care from beginning and post. I met the surgeon twice. After my approval and the day of surgery.

2. I have Aetna and my doctor's office keeps assuring me that the insurance companies have requirements and you meet them or you don't. Other than a higher BMI...I am one healthy big girl (now). Blood pressure is great, cholestorol is in ok-range, not diabetic, etc. I am very anxious that I will have gone through all of this only for insurance to say no.

You should be fine if in fact you followed all the requirements set by your insurance company and it sounds like you have. Because your BMI is over 40 you are not required to have comorbitities. So, all should go well if your surgical team completed their part correctly.

3. I have a friend who was sleeved a couple years ago and was not required to do a liquid diet two weeks prior to surgery but that seems to be the standard now - is that the new normal?

I think this depends on your current BMI as well. If the surgeon feels your liver needs some loss to shrink, you will likely have a liquid diet for a period of time. Mine was 2 weeks and I lost 13lbs during that time. Honestly it does help get rid of all the sugar toxins in your system so if you have to it is not a horrible thing. Just take one day at a time and don't focus on the whole two weeks or it can be overwhelming. After day 2 for me,it did not even bother me.

4. Maybe not a question - but I am very nervous about losing my hair and having hanging skin. I feel my long, thick, naturally curly hair is my only good physical feature, so I feel some anxiety about possibly losing gobs of it. And I need to lose about 120# to be around where I was years ago when I thought I was "fat" and where as I have no expectation of wearing tube tops or anything, I also want to feel good about myself so I am worried about having skin issues. My aforementioned friend claims to have zero skin issues. Anyone else so lucky?

Well...here is the thing with Hair loss. You won't know until it starts to happen and it is not as bad as people think. Make sure you get your Protein from the very beginning. If you do that and you are not someone like me who tends to shed hair during massive weight loss, then you won't.

If you are, it is going to happen and there really is nothing you can do about. Some people take Biotin to help with regrowth but it won't stop you from losing.

You will not go bald or have bald spots. If you are prone to this your hair will shed and it will shock you how much and how long this can go on. The good news is, the entire time it is happening regrowth is happening and you will notice it more than anyone else. If it bothers you, cut your hair short. I had a very thick head of hair and lost about 2/3. When it came back in I swear it is thicker but it is also now very very curly. I love my hair even more than I did before. It all came back and then some.

5. Any advice for expectations? I see the posts about two week liquid diets pre-op and up to 4 weeks liquid diet post-op. I have seen posts about no vegetables post-op and issues with bowel movements and all sorts of stuff that makes me question what I am about to do.

I don't get the no veggies thing at all.....my nut has had me on a balanced diet that includes Protein and good carbs like veggies and fruit since the day I could eat pureed foods.

Yes, people sometimes struggle with bowel movements and have to take a stool softener.

6. My husband is supportive in the fact that he wants me to be happy but he is not happy that I am willing to go to this extreme. He partially feels like he has let me down in not trying harder himself to diet with me or work out with me or help to motivate me with any of my 100 diet attempts over the years. He is scared because he doesn't know the long term effects a greatly reduced stomach may have, he is scared because of the normal surgery risks, he is scared because I run the show here at the house for him and our 3 boys. Anyone have any input they can relay from their spouses?

I would just say this. Obesity is a metabolic disease and as you already know, you can diet like crazy, lose the weight only to put it back on and then some. WLS can cure this issue. Yes there are risks associated with it but the risks of remaining morbidly obese are much worse. There will come a time when your health (like your mothers and my mother who died at 66 from complications of type 2 diabetes brought on by obesity) will deteriorate and you likely won't be able to lose nothing on your own. That is what happened to me and then the comorbitities pile on.

When that happens, hubby and children will be caring for you.

That is a much scarier situtation that having a surgery that has less risk than a hip replacement. If you follow the plan, you will do well and likely not have complications. If you smoke, quit NOW. That will help in recovery.

7. I am worried about missing too much work. I hope to have 3 weeks of vacation time saved by the time I anticipate having the surgery. I heard 2 weeks off is a reasonable expectation. My only surgical experience is robotic gall bladder surgery a few years ago. I couldn't believe how sore I was and missed an entire week of work. Are my expectations for missed time for a sleeve reasonable?

I could have gone back to work in a week post surgery easily. The biggest thing is getting used to the diet and spending enough time getting your fluids in those first weeks. If you don't, you become nauseated, tired, headache and weakness so your recovery depends on you doing what you need to.

Honestly, having weight loss surgery was the best thing that ever happened to me. I went in with type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, stage 3 kidney disease. All of those diseases are in remission. I lost 152lbs and have been at a normal healthy weight since March of this year.

The bad news is, I waited too long and did damage to my spine and other joints in my body. That damage cannot be undone. I was at nearly the same BMI as you but I was likely there for a lot longer as I was 51 when i finally moved forward.

My advice is don't wait and be scared enough to follow the rules. If you do, all should turn out great for you.

Don't be afraid of losing your hair, if you do it is very temporary and it is worth it.

Lastly depending on how young you are, some of your skin may bounce back but realistically you will have some loose hanging skin.

There are ways to deal with that surgically and most of us who have lost massive weight choose to finish our transformation. I just began that part of the journey having a arm lift 5 weeks ago. I will likely do my stomach and breasts as well down the road.

Once you lose all the weight you can decide that for yourself. Exercise does help as does your age but be realistic about this.

[HuneComz 103]

Thanks KristenLe. The surgeon reviewed the options he offers at my consultation. I have made so many attempts at losing weight and I don't see the success I feel I should or I "fall off the wagon" and lose all my progress and feel defeated. I feel I need something that will stop me from eating too much. I need to feel fuller with less food. A year ago I would have never considered this surgery. But after a few more attempts over the past year with almost no success...I have had it. I need to take control of my life. I have decided to be very honesty with myself - I don't want to work really really really hard to lose all this weight with diet and exercise and then have to work really really really hard the rest of my life to keep it off. I like the fact that I will still be able to (eventually) take a bite of something I really enjoy post-op, but I will have a tool to prevent me from taking 20 bites.

[HuneComz 103]

Thanks for the reply Djmohr - I feel like you are a super star on this page - I have read a lot of your posts. I am so excited at the idea of not being so heavy, of not being so uncomfortable in social situations, of sitting in a plane seat comfortably, of not having to shop in the plus section of the store and obviously improving my long term health and happiness!

I will certainly update as my journey progresses.