Introducing myself & My Story so far...

[Tina254 0]

**My story so far with getting the Lapband**

(By no way am I trying to make any one feel sorry for me with telling my story but this is just a way to let out some of my feelings and possibly help someone else going through this journey:smile2:)

I have Tricare Prime with Triwest and this is my process so far...

I went in to my primary care giver and asked him about getting the lapband surgery in mid January 09, he told me to wait 3-4 months and exercise 5 days a week and eat lower calories. Which being overweight my whole life I would think he would understand I’ve tried everything and the reason I was asking him for this is because I have tried all of those things and this was my last resort but I walked out feeling embarrassed for even asking and went home and was thinking I would never go back and ask about the lapband again! :huh2:

About a month later my husband and I decided after 5 years together that it would be a nice time to try for a baby. We both always wanted to have kids so I agreed and I came off the Birth Control pill. After 4-5 months with no periods and no ovulation I went in to talk with my OB-GYN and told her I had no periods and I would like to know if she could help me regain my periods so I can try to conceive. I also thought that I could have PCOS. Most of you know if you have no periods you’re not ovulating and ultimately can’t get pregnant. Well she told me that I would have to lose weight before she would help me try for a baby and that if I don’t lose at least 100lbs that there was no hope of her sending me to a fertility doctor to help me get pregnant or find out if I had PCOS. She had read my chart from the previous doctor visit with my primary care giver about me asking about lap band and she advised me to get the surgery, lose weight and come back to see her. I was devastated! I still till this day feel disgusted with myself. I feel so at fault for not being able to conceive. I thought having a baby would kind of take my mind off of the first visit with my primary care giver and make me feel better about myself, cause I thought having a baby is at least something I can do right, but obviously obese women are off limits to having babies, according to my OBGYN.:sad:

So on July 1st, 2009 on my birthday (that was the only day they had available at the time) I went to talk with NEW primary care giver and he told me that I've done my time with waiting and was completely upset and disgusted about what my OBGYN told me so he personally walked me down to the referral desk and gave me the ok to go to the surgeon. I know a lot of people ask why am I getting the surgery and not fighting back with my OBGYN. Well I’ve told myself, I’m not doing this for her, I’m doing it for myself. I’ve struggled with weight all my life and I don’t want my weight to be a discrimtory thing I’ll have to deal again and later on in my life.

Well on to what I’ve done so far, on July 1st my new primary care giver wrote the referral to see the surgeon and I checked online with triwest that night and I found out I was approved for my first consult. :lol:I couldn’t have been happier because it was my birthday and that was the best birthday gift anyone could have given me. On July 8th I went to see the nutritionist, physical therapist (he told me how to exercise) and I saw the psychiatrist. On July 14th I go to see the lapbanding surgeon for my first consult and after that I have to wait to see if Tricare approves me then I’ll be able to schedule my appt for the surgery. I’m hoping for a beginning of August date.

Well there is my long story, I hope this helps someone else that is going through some tough times with lapband and life. Thanks for reading....I’ll keep yall updated on my progress, wish me luck!!

Edited July 13, 2009 by chrystinaw

[SpecialK 22]

Chrystina - good for you for hanging in there. I also had a PCP doc who turned me away about 4+ years ago when I wanted her referral for WLS which happened to be gastric bypass was the only option I knew about at that time. She adamantly refused saying I was too young, didn't know what I was thinking, it would be too hard to live the rest of my life, she had seen too many complications, etc. Then three years later, my OB/GYN was the one who suggested WLS and I've been a person who had irregular periods, etc. and he felt the surgery would really help even though I was past the point of being able to consider having children any longer. So, I did my own research, found about lapband, went to the surgeon on my own, and then "sprung" it on my PCP doc in a lettter saying I needed her 5 years of medical records sent to the surgeon's office documenting all the attempts and things I had tried for years to lose weight. At that point, I didn't need the PCP referral, thank goodness. I went ahead with the surgery and I've been the happiest little lapband lady since then. My OB/GYN hasn't seen me this year but I'm sure he will be shocked when he does see me. My PCP is happy for me for losing 100+ lbs but I think she still has thoughts that if I had tried harder, after 1000 tries at WW!!!-- I could have lost it without WLS and I'm just as convinced now that this was the right thing for me. I am the first lapband patient my PCP has had any exposure to so I'm taking this opportunity to educate her on it, and hopefully some other poor woman will be told by her that lapband is an option to get a significant amount of weight off, particularly to cure diabetes, and to get pregnant if that is their dream.

Good luck.

[Tina254 0]

**Update**

Surgeon Consult...

I went to my first consult with the surgeon today and I think everything is going to work out. He told me that I am a perfect candidate and he doesn't see a problem with me getting the surgery. Right now I'm just waiting for the nurse to call me back to schedule my surgery and for Tricare to approve me!! Wish me Luck!!! :frown::thumbdown:

[losing4life 0]

Good luck!

I got pregnant with my first child (surprise after 7 years of marriage) when I weighed 285 lbs. It was NOT easy. I imagine that is the reason your OB/Gyn was hard on you. I had all the unusual pregnancy symptoms-might've just as well chucked the "What to Expect" book out the window.

I'm glad you have new doctors, if you can't get compassion with all the $$$ they get from you, then On To The Next!

[sandiegokate 0]

Good for you for being your own advocate!!

I think the most important thing about healthcare is being your own advocate and realizing that you are a customer and if you don't get what you need from a physician, go elsewhere!! There is a lot of prejudice out there by doctors about weight and it takes finding the right doctor who really knows and understands all of the issues that can make a person overweight and that it often isn't just "exercise more and eat less". "As if" we all haven't tried that already?

Good luck on your pregnancy journey.. you are young, it WILL happen for you! I am 45 and still plan on getting pregnant, probably using donor egg at this point, but I will do it! Being young you have SO MANY options open to you. PCOS actually provides you with many advantages during procedures such as IVF since women with PCOS generally produce many eggs. If you ever need any fertility related information, send me a message, I'd be happy to help. I've done a lot of research and know a lot about it from my own experiences and others close to me. After losing weight many women do surprisingly become pregnant without any help though!:thumbup:

I will be banded in August as well! August 26th is my date!!

Take care and I look forward to getting to know you more!

Katie

[Tina254 0]

First of all I want to say thanks for all you guys for such encouraging words, it really does help me along in this process!!

Sandiegokate wrote: If you ever need any fertility related information, send me a message, I'd be happy to help. I've done a lot of research and know a lot about it from my own experiences and others close to me. After losing weight many women do surprisingly become pregnant without any help though!

Thanks Sandiegokate, for the advise I would really like someone to talk to about TTC after I have the lapband. I was planning on waiting about 6-8 months after the lapband to TTC because I want to lose a lot of the weight before I get pregnant. I'm hoping like you said that after losing most or some of the weight it will be easier to TTC without any help!!

*Update*

I went for my consult on the 14th and they told me the nurse would call me back within 24-48 hrs to set up my appt and get the paperwork in to my insurance company. I couldn't wait so I called on the 15th and the nurse told me that she needed my blood work from the base clinic and she would then send it into tricare. Right now I'm just waiting for her to get the blood work she needs and then get it into tricare. I hate this waiting game, once I decided to do the lapband I just wanted to do it that day, lol. I'm hoping I hear good news soon! Keep me in your prayers and wish me luck :wink2: I'll make sure to update you to tell you guys how everything is going!

Well it’s so nice to meet all of you and I hope all goes well for your surgery(s) and weight loss...Good Luck everyone that needs it!!! :scared2:

Edited July 17, 2009 by chrystinaw

[Tina254 0]

*Update*

I got a letter and a request in today from my surgeon's office from his nurse. The letter stated that I need to get blood work requested and have it faxed in to their office, I plan on going in the base clinic on Monday to see what I have on file as far as blood tests go because if they are 3 months and less old then I could use them. The blood work I have to get done is a *CBC & differential count, CMP, TSH, and H-pylori blood test. I honestly would have preferred it better if my surgeon's office would had told me ahead of my consult to have these blood tests done that way the process would have gone sooner/smoother but they didn't tell me that so now I have to wait even longer, sorry I'm being so impatient , lol. What makes me even a little more frustrated is that I asked my surgeon's office 2 weeks before my consult if I needed to have anything done prior to my visit and they told me all I needed done was the classes (nutrition, physical therapist, and phyc eval) so I did that ahead of time thinking that would hurry the process along, now the nurse tells me to have all this blood work done, urgh...oh well, I’m just hoping I can get all this done on Monday! I'm sharing this with you guys that are starting out and don't queit know the whole process yet and this info might be helpful to you that way you can have it done prior to your consult so you won't run into bumps like I have. I’m not going to complain too much because I will admit so far I haven't really ran into too much bumps after getting my referral so I'll just be thankful for that much.

So for people who are just starting out I'll give you the rundown of what to do so far so your process will run more smoothly. **Remember: some doctors and different regions might run differently from mine but I'm sure the whole process is very similar (I have tricare prime with triwest)**

1. First: See if you fit tricare’s criteria for bariatric surgery...

TRICARE defines "morbid obesity" as meeting one of the following conditions:

A. The body weight is 100 pounds over the listed weight for height and bone structure (according to the most current Metropolitan Life Table) with one or more of the accompanying severe medical conditions which are diabetes mellitus, hypertension, cholecystitis, narcolepsy, pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints—conditions shown to have higher mortality rates when associated with morbid obesity

B. The body weight is 200 percent or more of listed weight range for height and bone structure (according to the most current Metropolitan Life Table) Example: if your ideal weight is 112 and your weight is 224 or more than you are 200% over your ideal weight.

In addition, TRICARE will cover the gastric banding surgery if a patient has had an intestinal bypass or other surgery for obesity and, because of complications, requires a second surgery.

**Note: Tricare does not require a 6 month diet plan but you primary care physician might require it before they will give you a referral**

2. Second: 1st If you haven’t already, sign up for your region’s online service so you can know if your referrals have been approved (I’m triwest so my website is triwest.com if you don’t know your region go to tricare.mil and find out). 2nd If you think you fit one or more of the above conditions for tricare, go to your primary care physician and ask for a referral to a lap band surgeon. Your best bet for getting the referral is to show and tell that you’ve tried everything to lose weight and have dealt with weight for many years (usually 5 years or more).

3. Third: When you get your referral and get approved for your first consult, which you can check online to see if your approved at triwest.com, make an appt with your surgeon of choice and print or bring the approval letter to your surgeon’s office when you go for your appt. **Some people have to see a base doctor for their surgery so you don’t have to wait for approval from tricare if you have a base doctor doing your surgery, you would have to wait for approval from the base doctor them self’s**

4. Forth: After/during making your appt make sure to ask what tests (blood tests) and classes (seminars, pshyc eval, ect.) do you have to have or can have done prior to your visit to your doctor so that after you see the doctor it won’t take longer to get approved for your surgery.

The blood tests usually include (some doctors might want more blood work done): CBC & differential count, CMP, TSH, and H-pylori blood test.

· A CBC is a complete blood count that is a series of lab tests that measure the amount, shapes, and sizes of red and white blood cells in a sample. The differential is a blood test that measures the different types of white blood cells and compares their amounts to the total count.

· The CMP is a comprehensive metabolic panel blood test that provides information about: how the kidney and liver are functioning, sugar (glucose) and Protein levels in the blood, and the body's electrolyte and Fluid balance.

· The THS is a thyroid stimulating hormone test that is a common blood test used to evaluate how well the thyroid gland is working.

· The H-pylori blood test tests are used to detect a Helicobacter pylori infection in the stomach and upper part of the small intestine. H. pylori can cause peptic ulcers; however, most people with H. pylori in their digestive systems do not develop ulcers. The blood antibody test for H-pylori blood test checks to see whether your body has made antibodies to H. pylori bacteria. If you have antibodies to H. pylori in your blood, it means you either are currently infected or have been infected in the past.

5. Fifth: After your doctor’s office has all of your blood work, their required classes and evaluations in and you’ve been cleared by your surgeon as a good candidate for the surgery (which usually you will be cleared by your surgeon if you have a BMI of 35+ with a co-morbid OR have a BMI of 40+ and have been cleared by an nutritionist and physiatrist). The nurse or staff at your surgeon’s office will fax all the documentation to your insurance company (which would include your blood work, doctors notes, your comorbids (if any), weight, height, and bone structure, ect.)

6. Sixth: After your doctor’s office faxes your documentation to your insurance company the wait begins. For tricare I’ve heard all different things but most say they were approved within 24-48 hours. If you just can’t wait for a letter to come in the mail for your approval I would suggest to check online to see if you are approved (triwest.com or tricare.mil). If you see that you are denied don’t be alarmed just file a appeal. From what I’ve read most of the time the reason for denial’s are because your doctor’s office wrote down the wrong information (e.g. your weight is 250 but they put 225 or your height is 5’4 but they put down 5’7, ect.) or the doctor’s office left out information that is crucial to getting approved (e.g. They left out your weight or height, ect.). Just call tricare and ask why you were denied and have your surgeon’s office change what was wrong and re-fax it in to tricare and usually you will be approved if what was wrong was changed and it fit tricare’s conditions.

7. Seventh: After you get your approval your doctor’s office should get notification and so should you, either through the mail, a phone call, or you tricare region’s website. If you find out off the tricare’s website you most likely found out before your doctor’s office, I would suggest you call your doctor’s office and tell them so you can schedule your surgery. If you are anything like me when I get my letter of approval or see that I’m approved online I will first jump for joy and second call my doctors office to schedule my surgery, lol.

I’m probably leaving something’s out but this is an overview of what you will have to do in trying to get approved for the Lapband. I hope this helps some of you just starting this process. I’ve looked high and low and it is really hard to find a “one stop” list of “how to” on the lapband process with tricare. I will say again that some procedures are a little different according to what region you’re in with tricare, if you have a base hospital that does Lapband there, and if you have tricare standard instead of tricare prime. But overall the process is kind of the same and will at least give you an overall look at what you have in store. I’m by far not an expert on this but I’ve read and lerked around these and other forums to get informed on the subject. I’m still on step number 4(blood work)/6 but I’m just a little step closer to my goal. I’ve been dreaming of having this tool to help me change my life I’m hoping this is it for me! I’ll keep yall updated on my progress, and I hope this helps anyone considering this surgery. Much love for you guys, wish me luck!!! :smile:

Edited July 19, 2009 by chrystinaw

[babyka16 0]

OMG! thanks for all the info there. I have tricare prime and I'm also in the triwest area too (southern Arizona) i went in to see my PCM on the 16th of this month and he said that I'm good for it!!! WOOHOOO!!! so Ive been checking my tricare stuff on line and sure thing a few hours ago found out that i got approved to see a surgeon! So I'm going to call first thing Monday morning to set up an appt! ( seeing how its Saturday and they are only open from Monday to Friday) I'm hoping the surgeon agrees with my PCM and says that I'm in the green to have the surgery!?? i hope he does and have my fingers crossed. So all the info you just gave out really helped me. So I'm going to ask allot of Q's and ask right over the phone Monday morning if there is anything i need to do or help to get things going faster!!!!! right now I'm 260 pounds 5'5 and about 43 MBI i don't have anything bad going on with my body just fat so i know that i qualify with the tricare standards. anyway thanks again so much and i wish the best for you

Karen

[Tina254 0]

You are welcome babyka16, I'm glad that helped you...with your weight and height it looks like you qualify for the 200% or more qualification for tricare so I don't think you will have a problem.

According to the MetLife chart you are ideal weight for Medium frame is suppose to be 127-141 that means to qualify for 200% or more over you ideal weight you have to be between 254-282, so you being at 260 puts you right in the middle, if you are small frame then thats even better!

I'm in the same spot you are I don't have any co-morbids but I qualify for the 200% or more condition. I'm 277lbs at 5'5.

Well I hope all goes well for you, let me know how everything goes at your frist consult! Good luck! :smile:

Edited July 19, 2009 by chrystinaw

[babyka16 0]

same here. i hope things go well for you. I'm glad to have found someone that is in the same (kinda) boat that I'm in. sounds like we will be really close to having our surgeries ( if mine goes through) together!! cant wait for Monday. hope you get some answers Monday too!

Karen

[Tina254 0]

Thanks! :smile: lol, since I started this process I've hated saturday and sunday when it came to this Lap band. Everything is closed and I always have to wait until Monday to find out answers!

I'm hoping for a beginning of August date for my surgery, if all goes well, I'll get my wish, lol.

I'll keep updateing you on my progress. I'm am also glad I found someone in the same boat, I've noticed sometimes its kind of hard to find someone.

[babyka16 0]

Same here!!

[mjm2009 0]

Thank you so much for posting the information on Tricare. I am in Texas and have Tricare Prime through Humana. It all seems so vague as so the process, so I really appreciate your step by step info! Good luck on your journey.

I am waiting for my referral to come back and it looks like (according to my nurse) I will be having the surgery at Fort Hood, Darnall Army Medical Center. I guess this is where they are sending the Tricare people in this area. My nurse had Lap Band surgery in May there, and had great things to say, so I am pumped and very impatient!

[brookelynne 0]

Hi Christina- Good luck! I am being banded on August 7- a day before my b-day.

My DH and I are hoping to start a family once I get down to about 180-200 lbs. It's a big part of why I am doing this, also, for myself of course :-)

Good luck!

[Tina254 0]

mjm2009 wrote: Thank you so much for posting the information on Tricare. I am in Texas and have Tricare Prime through Humana. It all seems so vague as so the process, so I really appreciate your step by step info! Good luck on your journey.

Hey mjm2009, I'm glad you found the info to help you along the process. I used to leave in Texas and Fort Hood is my dad's last duty station he retired Army after 22 years. Now I'm married to an Air Force man, lol. I hope your process with Darrnell goes smoothly...keep me updated.

brookelynne wrote: Hi Christina- Good luck! I am being banded on August 7- a day before my b-day.

Hey brookelynne, Congrats on getting your date for surgery, I only hope Tricare approves me soon. I can't wait to start TTC Keep me updated on your progress after the surgery!

Edited July 20, 2009 by chrystinaw