How did you bring it up?

[butterflycheri 0]

This is my first post here. I'm 29, 5'1" (and 3/4"!) and weigh about 230 pounds. My husband is in the US Army and we're currently stationed in Germany.

I've been researching the Lap-Band® since July, when my PCM told me that I have type 2 diabetes and at the same appointment suggested that I consider a band.

Since then, we've moved overseas and I have a new PCM. I have an appointment next Monday for another reason and I want to ask her for a referral so that I can go through with this procedure.

I'm a bit concerned about bringing it up at another appointment, but it's not as though I'm going to make an appointment with my PCM solely to discuss weight loss.

I'm pretty sure Tricare Prime only covers Lap-Band® and RNY at this point, but I've also been exploring the option of VSG. I'm still uncomfortable with aspects of both surgeries.

I don't think I'd have an issue qualifying, as I'm overweight by 100 pounds (I actually think I'm just barely 200% over if they say I'm 5'1" instead of 5'2") and I have type 2 diabetes.

How did you bring this up to your PCM? I've seen a nutritionist three times in six years and in that same time I've tried WW (twice), Nutrisystem, Medifast, pills, etc. and haven't ever lost more than 30 pounds on any diet or program.

My issue is that no matter how much I exercise and count calories I never, ever feel full or satisfied, so it's a constant struggle to stay between 800-1200 calories...and I always lose the struggle right around the 90 day mark. Then, I rebound and I always tack on an extra 5-10 pounds to my starting weight.

In any case, I just wanted to ask how everyone else (especially folks with Tricare) brought this up to their physician. I expect to meet with some resistance - after all, every doctor I've seen for most of my life has told me that it's all about calories in vs. calories burned and if I'd just exercise some willpower I'd lose weight. Well, it hasn't been that simple in the past 14 years I've been overweight, so I think it's time to try something else.

I appreciate any advice or comments.

~Cheri

[turtlewoman 0]

I didn't have any trouble discussing the options with my physician. After all, she can see from me and my weight that I NEED to lose a bunch of weight. She also knows that I have COPD, sleep apnea, hypertension and bad knees! She was SUPER supportive when I did bring it up. An employee of hers had the LB, too, so that made it much easier. If you are worried about bringing it up to your PCP maybe you should think about going someplace else if that's an option. And, why not make a special appointment to talk about your weight? Be proactive and let him/her know that you are very serious. This is your life, not theirs for gosh sakes!

Good luck and post what happens.

[adagray 1]

I can't remember if I made a separate appointment to talk to my PCP about this or brought it up in another appointment. I know I was a little nervous to bring it up, though. I just forced myself to say those words. You can even plan ahead the exact one or two sentences you will say to start the conversation such as 'I've been looking into getting lapband surgery and am wondering if you can recommend a surgeon.' Honestly, I think my PCP was happy/relieved that I brought this up w/her. I think doctors are in a difficult position when it comes to broaching the subject of weight w/their patients. They know it is a problem, but they risk offending their patients if they are too pushy about it. My conversation went very well w/my doctor. She calculated my BMI and told me she thought it was a good option for me. I don't think she has any other patients who have had WLS, but she seems genuinely excited to see how it works out for me. Of course, if your PCP is not supportive, you can always find one who is. In my opinion, a doctor who would not be in favor of it for someone who is morbidly obese, is behind-the-times and not well educated about it. Most doctors should know by now that it is extremely unlikely (like 3% chance) that you can take the weight off and keep it off w/diet and exercise alone once you've already become morbidly obese. Those are really crappy odds.

Edited December 9, 2009 by adagray

[arthukd 1]

I never discussed it with my primary care physican. I attended a seminar, realized insurance would not pay for it and waited two years until I could afford to pay for it myself. I made an appointment w/ the same surgeon my sister used and scheduled a surgery date at my first appointment. It is all moving kind of quickly, but since I have my sister to discuss things with I feel much better about it.

Good luck tallking to your doc. I am sure he/she would be supportive and give you very good advice. I just never did b/c I didn't see it as a necessary step, like you I didn't feel like I needed to make an appointment just to talk about my weight and on reguarley scheduled visits I didn't think I would be having the surgery so I never brought it up. (I have a roommate now and I am using the money I am saving to finance the surgery)

[Yvette1026 0]

Just tell them, I'm considering the lap-band these are the reasons why and I would like a referral. They'll send you.

My friend has tri-care and she was qualified easily and had the surgery done in no time. She actually had to pack on 20lbs for the surgery, but because she has type 2 she was given the referral, got to the LB doctor and was told she needed to gain 20lbs for it. She did and received it and now she's about 6 months post op. She's only lost 40lbs but that's because of how she eats and she doesn't stay up on her fills. If it's possible, she will be the first person to actually GAIN weight with the LB lol.

[ParrotheadCathy 0]

I knew I had a doctor's appointment coming up (as a Type 2 diabetic, you need quarterly blood tests) and I felt I'd completed my research. Add to that, I knew that my doctor would ALWAYS say something like "if you'd lose some weight, your health problems would probably go away"...

So, when he'd finished up the stuff I came for, I said "I want to talk to you about something". He sat down and gave me his full attention. So I told him, I'd done my research and felt that lap band might be the thing I needed to pursue. He told me everything he knew about it (which was considerable) and gave me the names of a couple of bariatric surgeons. He pointed out that my insurance might not cover it and that if it didn't and I needed pre-op testing, to call him and he would make all the referrals so that my insurance would at least cover all that expense.

Another doctor in the military system has already mentioned it to you, and it may be noted in your file. Just go to your appointment and at the end, say that Dr. So-and-So had discussed lap band with you at your last doctor visit and that you've done a lot of research and you believe that this is something you want/need to pursue and ask for the necessary referral.

Good Luck!

[kagead 0]

Lots of great advice here. You could also say, "I had some conversations about Lap Band surgery with my previous Dr. and I'm ready to pursue it now."

Best of luck to you!

kagead

[Luv2Lose 0]

I just went through this with my dr. She didn't think that I needed weight lose surgery. She told me to give it another 6 months. She weighed maybe 100 pounds soaking wet and had just given birth two months prior to twins. I am 6 months out of having my second daughter and was back at my pre pregnancy weight too. I just happen to be over weight before and after pregnancy. We are tricare prime as well. I went to a follow up appointment about my blood pressure. I waited until we discussed what the dr had to say about my blood pressure, took a breath and said I would like a referal to a bariatric surgeon. The dr said ok, not sure if you will qualify and I don't think you need to resort to weight lose surgery but I have no problem submitting the referal for you as it is yor life and your body.

[butterflycheri 0]

Thanks, everyone for posting replies with advice.

It turns out my doctor was very reluctant to talk about WLS until I mentioned the band instead of RNY. She's opposed to RNY for her patients with a BMI under 50, apparently.

I was told that for Tricare Prime Overseas, they've started referring everyone to a nurse practioner in one area (here it's Heidelberg) and you have to see her for a referral. She said there were issues with patients meeting the criteria for WLS and they decided to have one person handle all of the cases in her area.

So, I will have to talk to her and get an appointment, then do the three part process - nutritionist, metabolic testing and a fitness class.

To be honest, I want WLS and I'm glad my insurance will cover this (I don't expect to be turned down) but I'm starting to lean away from the band and towards VSG.

In any case, thanks again. I just brought it up when she mentioned my diabetes. It was painless.

~Cheri