Stress Test, INS prereq's

[Poodles 0]

I keep reading that some insurance requires psyche exams, sometimes sleep apnea tests, and sometimes a stress test. Would like to know exactly what tests are required before surgery. Is it different for each person?

Also, I had a nuclear stress test two years ago. Do you think that would work? Or do the tests have to be recent?

And about Dr reports on diets, what are the requirements? I was put on a low carb diet after I was released from the hospital for chest pain (Atkins same time as the stress test). My OBGYN put me on it for my PCOS/HBP/insulin factors. He may have it in my chart. Went from 320 to 285. I have tons of proof of using the product (receipts), but no official Dr visits for weight loss. I was also on Phen-Phen 8 years ago, and could probably get the records. Info too old?

Just don't know what kind of stuff I will need, or if I need to start now.

[MelissaE1979 0]

Poodles,

I posted a question a couple of days ago about the nuclear stress test. It has me a little freaked out...what's it like? I'd prefer my stress to be induced via treadmill than chemical, but I guess I don't have a choice. If I gather correctly, it's some sort of adrenaline injected. I'm worried of feeling a little panicky.

With the other test, my drs office says the psych exam is good for a year, but the others are 6 months, and some of the blood test and ekg has to be within 2 weeks.

[Poodles 0]

The nuclear stress test is no big deal. They shoot you up with green juice (joke) and they take some pictures of your heart. If I remember correctly, they take pictures of your heart. Then they put you on a treadmill and take pictures of your heart again after exercise. The "green juice" just makes everything show up better. I drove myself to the office and everything. It seemed to take forever, but was only around 2 hours. I had two doctors review mine, and everything was fine. My EKG was fine, and they could not figure out why my BP shot up so high and I had chest pains. New Meds and a few days rest and I was back at work.

Now the nuclear stress test itself required no follow up. Guess it just depends on your results as to what they do after.

[Alexandra 55]

Poodles, every person's pre-op routine is going to be different based on their personal health situation. Doctors have a general list of pre-requisite tests they like to have done, which varies from doctor to doctor, and insurance carriers may also have some requirements. But all of those "general" rules are subject to change based on your particular medical needs.

My insurer wanted a diet history and a record of a 6-month physician-supervised attempt at weight control. I had been seeing doctors over the last five years, through two pregnancies and so on, so there were lots of notes from my PCP and my OB-GYN about my weight and our concern about it. By the time I went to get approval for WLS, all those notes added up to way more than 6 months' worth.

We can't tell you what will or will not work in your situation. But more information is always better than less, so gather your notes together.

[Poodles 0]

So does it have to be six months straight? If so I need to start back now. If it can be three/four times a year, or once/twice a year with my OBGYN then I am good for the past 10+ years.

[GeezerSue 7]

I just had the adenosine nuclear stress test, which is like having a heart attack, I'm told. there is no treadmill involved. It was time consuming, and--as promised--the last part was pretty much like having an elephant land on your chest while your veins all try to explode. BUT...it doesn't last long.

HOWEVER, THE sleep APNEA TEST IS CRITICAL!!! This is meant to educate, not terrify. While this patient had RnY, the outcome could have been the same with ANY SURGERY.

http://www.obesityhelp.com/morbidobesity/information/showcomplarticle.php?ID=1033479097

[Alexandra 55]

So does it have to be six months straight? If so I need to start back now. If it can be three/four times a year, or once/twice a year with my OBGYN then I am good for the past 10+ years.

We can't predict what your insurer will accept, of course. If your doctors' notes show discussion about your weight, possibly that they've given you a diet to follow, talked about exercise and so on, some of that time may indeed count.

Sue, I'm not trying to minimize the importance of sleep apnea being correctly diagnosed, but not everyone needs the testing. The woman in the profile you linked to above had clear symptoms prior to surgery:

During those last two years, she constantly felt drained and tired and had no energy. She continuously fell asleep during the day while at work and while she was driving. She rarely felt rested when she woke up in the morning. She would wake up at night sometimes gasping for breath with her heart pounding. She had to sleep sitting up in a recliner because she got to the point that she couldn't breathe lying down. Also, she frequently had terrible headaches when she woke up in the morning.

No one ever suggested a sleep apnea test to me, because I had no reason to suspect I had the condition. It doesn't make sense to conduct this expensive testing for every person if there's no evidence of apnea.

[GeezerSue 7]

No one ever suggested a sleep apnea test to me, because I had no reason to suspect I had the condition. It doesn't make sense to conduct this expensive testing for every person if there's no evidence of apnea.

Maybe not...but when I told my husband's cardiologist that I was sure I didn't have sleep apnea because I had no symptoms, he told me he didn't have any patients with (what he guessed was) my BMI, (it was about 50 at the time) who DIDN'T have sleep apnea.

I don't know. Maybe he said it to scare me into scheduling the test. (His partner was my pulmonologist and he had been recommending it and I had been fighting it for months.) But I had the test and it was positive, and while I was SURE I didn't have sleep apnea, turns out it was severe. And earlier this year I went to the VA and ended up seeing one of those "just passing through between real gigs" doctors who decided to spend some time on the west coast and get paid in the process. He, too, was a cardiologist and, of all the stuff I've got going on with my out-of-shape-ness, THAT was the one issue he decided to discuss with me...for about forty minutes. He didn't go off on diet and exercise and my weight. He spent most of forty minutes on sleep apnea...which is a REALLY long visit at the VA. He got me back up to the sleep clinic and retested in record time, and I'm back (with my weight regain) in one of those stupid Bi-PAP machines.

Anyone--fat or thin--can have sleep apnea. But I know that I've read that a higher percentage of people with more severe sleep apnea are heavier people.

I was first screened with a pulse-ox and I kept an overnight journal...maybe that's a cheaper way to go. People who don't repeatedly desat during the night might not need more expensive testing. (Because no one who doesn't need that goo in their hair should have to go through that...ugh.)

[Alexandra 55]

Maybe not...but when I told my husband's cardiologist that I was sure I didn't have sleep apnea because I had no symptoms, he told me he didn't have any patients with (what he guessed was) my BMI, (it was about 50 at the time) who DIDN'T have sleep apnea.

I don't know. Maybe he said it to scare me into scheduling the test. (His partner was my pulmonologist and he had been recommending it and I had been fighting it for months.) But I had the test and it was positive, and while I was SURE I didn't have sleep apnea, turns out it was severe.

I assume you had a pulmonologist because you were having some lung issues, right? That would be reason enough to accede to his suggestion that testing be done. No question!

Anyone--fat or thin--can have sleep apnea. But I know that I've read that a higher percentage of people with more severe sleep apnea are heavier people.

In total agreement on this point. But it does not follow that all heavy people suffer from the condition.

I was first screened with a pulse-ox and I kept an overnight journal...maybe that's a cheaper way to go. People who don't repeatedly desat during the night might not need more expensive testing. (Because no one who doesn't need that goo in their hair should have to go through that...ugh.)

I don't know what "desat" means, but if there's a less extensive way to screen for sleep apnea I'd be all for it for anyone seeking WLS. Correct me if I'm wrong, but doesn't a definitive diagnosis actually require a night at a sleep center? The cost of that must be exhorbitant and it seems like extreme overkill if there are absolutely no symptoms.

[GeezerSue 7]

I don't know what "desat" means, but if there's a less extensive way to screen for sleep apnea I'd be all for it for anyone seeking WLS. Correct me if I'm wrong, but doesn't a definitive diagnosis actually require a night at a sleep center? The cost of that must be exhorbitant and it seems like extreme overkill if there are absolutely no symptoms.

Alexandra, my dear, you are NEVER wrong. And if you are, you're never wrong here. "Desat" refers to oxygen desaturation. You wear that little pulse-ox thingy on your finger while you sleep and the machine records and prints your O2 levels. I think that would be a very reasonable primary screening thing. People whose O2 levels never drop to below 92% or some other figure could be sent on their merry way. Let's work on legislation or something.

The testing is not only expensive AND an overnight excursion, but the crap they use to glue the electrodes to your scalp ought to be illegal. And the VA pretty much just SANDS them off your skin, with alcohol-soaked emery paper or something.

[Alexandra 55]

You wear that little pulse-ox thingy on your finger while you sleep and the machine records and prints your O2 levels. I think that would be a very reasonable primary screening thing. People whose O2 levels never drop to below 92% or some other figure could be sent on their merry way. Let's work on legislation or something.

LOL! Except for the working-on-legislation part, I'm on board.

The testing is not only expensive AND an overnight excursion, but the crap they use to glue the electrodes to your scalp ought to be illegal. And the VA pretty much just SANDS them off your skin, with alcohol-soaked emery paper or something.

Sounds charming.

I've always wondered how sleep centers get any accurate diagnoses. I, for one, would never be able to actually sleep in those conditions.

[Poodles 0]

Well according to my OB/GYN I have three years of documentation and he will write me a letter of recommendation for the approval. I think that is good news! Hopefully, it will work! As for the sleep test, he did not know.

Called my insurance company and they said I need a psych test, a nutrition consultation, and 12 months of documentation. Guess my next step is to find out if I am psycho....

[Poodles 0]

I am officially SANE. I have documented proof. No one can call me crazy anymore. I have officially completed all of the tests to be "medically cleared". Had my labs drawn, psych eval, nutritionist consult, and stress test done on Wednesday. sleep study last weekend.

The psych test has come in and I don't have to worry about a padded room or straight jacket. Now to wait for the other results and on insurance.

They said all test results should be in by the end of next week and then they will send it to lapband solutions to put together for insurance. Wonder how long it will take to be approved/denied? Anyone have an educated guess???

[Beverly 0]

Hello everyone. I've been reading this site for about a month now. I have learned alot from it plus searching other sites. I was wondering if any of you had your banding done in Goshen, IN at the Goshen Bariatric Center. I had contacted them and went to a seminar. Then I made up my mind this was the safest way for me to go. I had talked to my PCP and he said this way was much more safe and not so avasive. My first appt. was with a nurse who took my height, weight and BMI to see if I qualified for the band. She took all the information down and said with appproval I would be looking at around the first of the year for surgery. I go Nov. 1st and see the surgeon, nutritist and the exercise trainer. I will probably have to have a mental evaluation too. I just want to feel better and have a healthier life. They have ask me to keep a food log and a daily journal and bring it my next visit. And fill out the questionare for the surgeon. I truly do feel this is the safe way for me to go, Yes I know any surgery can have complications. Right now I'm fighting the weight, high blood pressure, thyroid problems, ulcers on my legs, knee and ankle pain. And my sugar is 115 right now . Which I don't think is bad but Dr.'s like to see double digits. I work a full time job and apart time one. (my husband had a kidney transplant 1996 doing well). My insurance is BCBS of Illionis. They will cover the WLS. But they do have guidelines. I am willing to wait it out and do what they say to get this done. I feel that I'm taking a worth while step to a healthier me. I deserve to to this for myself. I've taken care of eveyone else for a long time it is my turn now. I feel good about this.

Thanks for letting me share this.

Waiting to get approved:

Age: 49

Weight: 281.5

Height: 5.5

BMI: 46.1

[banded_for_life 2]

(Pointing at Poodles behind my hand and mouthing...She's Crazy!!!!) :-)