The Decision, and The Call

OK, so if you're a Weight Loss Surgery person, you know what "The Call" is and can skip the next paragraph.  If not, here you go.

I got two days of The Call.  The first one was yesterday, 1/30/2012, about 6 months after I went to my first information session about baritric surgery.  It was my patient care coordinator, Diane, from hospital C calling to tell me that my insurance company had finally pre-approved my surgery!  This is the call I've been waiting for - I finished my 90 days of multidisciplinary supervised dieting a month ago, and needed them to review all the documentation and say "Yes, she's compliant and fulfilled our requirements for pre-approval".  The second part happened today, 1/31/2012 about 15 minutes ago.  Sabrina, the scheduler called and said that they actually have an opening in the surgical schedule for Feb. 16th! 

So now that I have a surgery date, I'll call Feb. 16th my new Valentine's Day.  The one where I and my whole family say "You are worth this, we love you and want you to live a long healthy life".  I'll be honest, when I got the call about the insurance company approving me I broke down and cried.  In my car in the parking lot of the grocery store.  Several times.  It took me until my fourth phone call to family to stop crying each time I told them.  So the scheduler was supposed to call me in the next couple days, but they needed to make sure I understood that I would need to pay the $350 program fee and the $3000 deposit (because my insurance caps it's bariatric benefits below the cost of the operation) when I come in for pre-admission testing.  OK, I've been preparing for that.

I was so overwhelmed, I almost got in a car accident on the way home.  By the time it was dinner, I think I felt like a kid at the end of Christmas day.  Dazed, so happy to have gotten just what I wanted, but exhausted from the emotions of it all.

The scheduler called today, and I'm going in for blood work, EKG and counseling with the inpatient care doctor and nutritionist all day on Thursday.  Deal!  Can I pay the program fee and deposit in just two days?  If they take credit cards, I can!  (The answer was yes). 

So now things are clipping right along, and I'm going to be working like crazy to get everything prepared.  Coverage for the kids (my husband and mom will be helping), grocery shopping for them ahead of time - grocery shopping for my liquid diet post-op (noting NOT to overbuy - especially on things like broth, thank you guys for your blogs), and cleaning the house so my mom doesn't put EVERYTHING away where I can't find it when she comes to help.  Pre-op pictures - check.  The list is a living, evolving thing.  Suggestions are welcome!

I'm so excited!  And everyone I know is so excited for me.  I am blessed. 

Bariatric Betty says "What are we doing to our kids?"

Those of you who have read my blog before know that my children are a large part of the reason that I want to have this surgery.  I don't want them to grow up without a mom, or with a blind mom, or with a disabled mom if there is anything I can do to help it.  Being morbidly obese (actually now just "obese" with the pre-op diet) and diabetic means that those conditions are in my future - it's just a matter of when. 

It's also because I don't want my kids feeling like they have to defend or protect me.  When I hear that my kids have heard someone call me fat, or laugh at me, it breaks my heart.  It's never fun to be insulted or the butt of someone's joke.  But the big thing is that kids aren't supposed to defend and protect their parents - their suppposed to be protected and defended BY us. 

Then there's the fact that I want my children to be healthier than I am.  Having parents that always struggled with their weight and body issues, I want to be a good example.  I don't want to just say "go outside, play some basketball/ soccer/ run around.." - I want them to see me DOING that stuff.  To know that I will have the energy to join them and inspire them to be more active.  To see me eating healthy, and have healthy food for them to eat as well.  To know that a great way to have one-on-one time with me is to go biking, or swimming, etc. - not just cuddling up on the couch. 

My kids are overweight.  Not obese, but overweight.  One of them was in great shape until about 1 1/2 years ago, when we moved.  He is a black belt in Tai Kwon Do and was incredibly active.  No matter what he ate - he burned it off.  Now that he's just moderately active, it has started to accumulate.  My other son has always been heavy, in addition to have developmental delays and low tone.  We have always gotten them into community sports, and started taking them to the gym twice a week 5 months ago - and it's making a difference.  My husband has taken the brunt of that - he committed to getting them there no matter what - and it's rare that they miss a Tuesday or Thursday.  Their clothes fit differently, and the scale shows that they've leveled off.  Our pediatrician said that he would like them to be active and work on "stretching" their bodies out - getting taller without gaining much, not putting them on a diet.  But we have cut change their preference to graze to having defined snacks, and my personal battlefront has been serving size.  My 8 year old now knows serving sizes of many of his favorite snack foods.  He double checks the amount of Cheerios or pretzels he puts in a bowl with me.  He knows that he can have 5 crackers with his cheese.  It's still hard though - because there are times he just WHINES about wanting to eat more.  I usually don't give in.  He still gets treats - just not everyday, and when he does get them, they replace a snack.  That's important I think, because I want him to learn moderation.  I don't want him to end up like me. 

So this morning while I was working out I watched Toddlers & Tiaras.  It's easy to feel morally superior and snarky when you watch an editted "reality" show like that.  Usually when I watch it I cheer for the underdogs and girls who actually seem nice, and hope everyone else finds a good therapist some day.  Today, my heart hurt as I watched.  A big thrust of the episode was about the girls' weight.  As the pagent director put it "girls who aren't really pretty or are a little chubby should just find another hobby".  OK, I think all of the girls there should find another hobby, and a small percentage actually enjoy what they're doing, but it was the overall message she was giving that blew me away. 

The girls she was talking about were under 10.  Most were 4-7.  Choosing a girl as "most beautiful" from a group is one issue.  Telling girls that young that they are not pretty enough or too heavy to even be IN the competition appalls me.  Most of the pagent directors in other episodes talk about "building up girls' self  confidence" and "being proud of yourself".  This director from Arkansas held up no such illusion.  "These girls should look like Barbie". 

If I was a reporter, I would now insert several links to studies that show how young girls body images are damaged by dolls like Barbie, or reference other articles about how a woman actually built "like Barbie" would be incredibly unhealthy, almost grotesque to look at, or at women who have had dozens of plastic surgeries to approximate that "Barbie" look.  But I'm just an opinionated mom, not a reporter, and you can look those things up if you haven't heard of them.  And I think that if I had a girl I would let her have Barbies, I would just also make sure to point out how weird their proportions are, and make sure she had other dolls as well. 

Perhaps even harder was listening to moms who put their daughters on diets.  At 5 and 7 years old.  These children were not overweight, let alone obese, but they were going to "eat lots of salads" so they would look better in their beautywear.  One mom who was hyper about it, ended up having her daughter's beautywear dress be TOO LOOSE because she had lost more weight than she thought.  Think about that.  A 7 year old who probably weighed 60-70 pounds to start lost about 10 pounds to prepare for a pagent.  And then the judges ended up deducting points because her dress was too loose.  Or the 10 year old girl who won the Ultimate Grand Supreme (translation: the biggest prize) who stood in front of a mirror, probably weighing 65 pounds in this beautiful dress and said to herself "This dress makes me look big". 

The United States has a big problem with obesity.  And the kids are starting to catch up with the grown-ups.  The government just finally changed the school lunch programs to say our kids have to be offered a fruit AND a vegetable at each meal.  However, they also caved to lobbyists and said that pizza can continue to be counted as a vegetable.  Read that last line again, I'll wait.

I heard about a contest that Disney is running where you submit pictures to show changes your family is making to try to improve their health.  LOVE IT.  Way to go, Disney!  The grand prize winners get all expense paid trips for 4 to their new Hawaiian resort.  I told my kids that I'm bringing my camera to the gym tonight to take pictures to show how well they're doing and submit it for the contest.  I'm telling you about it because I would love for everybody in the world to know about it.  Tell your friends, tell your neighbors.  Because even if it increases the number of entries ten fold and decreases our chances of winning, it increases our children's chance at healthy lives.  And they deserve that.

Bariatric Betty plays Beat the Clock

My husband used to feel like he had an ulcer every Sunday night when he heard the stopwatch clicking on "60 Minutes".  That's when he decided he should probably look at changing jobs and went from being a pharmacist to an IT guy.  Now I hear an imaginary clock ticking, and it's keeping track of how long it's been since my packet was submitted to the insurance company for pre-approval for RNY surgery. 

My patient care coordinator at Hospital C, Diane, said it we would hopefully hear back in less than two weeks.  That was 12 days ago.  I checked in with her last Friday and she said she hadn't heard anything yet but she would follow-up this week.  Yesterday was a holiday, so today I sent her an email and asked if would be an obnoxiously bad idea to call my insurance company myself to see if it had been determined yet.  She said she had planned to call them tomorrow, but would happily call them today.

So I got a call from her ......

And she said "They haven't scanned in your packet yet." 

Huh?  Apparently, the packet they submitted hasn't even been scanned into their system from the fax yet.  Then it has to be assigned to a nurse for review.  Then they make a decision.  Aetna said that they will move it up to being scanned ASAP since she called, and that a nurse reviewer should have it by Thursday (that would be the two weeks mark - but instead of having an answer, it will probably JUST be started to be reviewed).  So, before I could ask, Diane offered to call them on Thursday to make sure it has been assigned and see if she can get any other info (like when we could expect a decision).  I love Diane.

Did you know that people in Canada can wait for YEARS on the waiting list to get their bariatric surgery?  Painful, but true.  Of course, they spend that time KNOWING that they WILL get the surgery.  I've been waiting for 117 days so far just to see if I will qualify, dieting the whole time and trying to stay motivated while knowing that the insurance company may say "No".

It's a win-win for the insurance company if they cover it - their policy limits them to $15,000 max for life for bariatric surgery.  Just considering the cost of my medications and supplied for diabetes, they would make that back and not have to worry about hospital expenses for co-morbidity treatments.  But that's logic, not insurance policy.  If I'm denied, I will appeal. 

I heard an interesting fact from a Weight Loss Surgery vet who works for a different insurance company (not to be named).  She said that 9 out of 10 of their appeals get approved.  Right.  That leads me to wonder - if they are going to approve 9 out of 10 appeals in their company, shouldn't they just ask a couple questions and skip the denial process?  I would guess the answer is no because delays in approvals push costs further down the fiscal year, and because most people will never appeal - so that means no immediate costs. 

I understand the commercial model appeal of that concept.  It's like Old Navy giving out coupons for $10 off a $20 or more purchase a month from now.  They're betting 1) most of the people they give out the coupons for will lose the coupons or forget about them and 2) You will spend more money on the return trip since the you will be thinking "Hey, I'm going to get $10 free". 

Here lies my issue.  My health is not an Old Navy t-shirt.  My surgery is not something that can go on the clearance rack.  And unlike a trendy plaid skirt, my obesity will not go out of style - it will kill me. 

So I'm waiting, again.  Feels like I'm starting over the two week estimate again, and the last 12 days have already caused a lot of insomnia and stress.  I'm going to try to think positive.  I'm trying to work out more again, thinking "Any pounds I lose now are less that I will have to lose after surgery".  And they had better approve my surgery, because they don't want to have to deal with me during an appeal process.  I keep excellent documentation and WILL wear them down.  Think I sound determined?  You haven't even MET the stubborn side of me yet.

The Decision 2012 - Bariatric Betty waits for Pre-Approval

OK, the "decision" in my case will not be broadcast on network TV, and it also won't give any city an inferiority complex.  The decision is whether or not my insurance company will pre-approve me for Roux-n-Y gastric bypass.  Before submitting for pre-approval I had to be on a 90 day multi-disciplinary medically supervised diet.  I met with the Physician's Assistant monitoring me 4 times, met with a nutritionist 3 times, met with a psychologist twice and had one telephone consult, took the MMPI to see if I was of sound mind, and worked with a trainer over the 90 days.

Yesterday my wonderful P.A. Drew called to say the the packet of consults, diet and exercise logs, and his recommendation were ready for me to pick up, and this morning I took them to Hospital C where my Patient Care Coordinator Diane reviewed them and combined them with all of their notes and medical histories.  She
is submitting them today, and says we should here back in less than two weeks.  She said it looked great, and was especially pleased with my exercise.  She said that exercise before and after surgery are two great predictors on the success of patients, and that if I keep it up I will be so pleased with my results.  She said a lot of patients say "well, I walk" when they are asked about exercise, but that they need to push themselves.  Many of them may not have been able to walk before, so walking is an appropriate first step.  But adding in more vigorous cardio, strength training (not my favorite), and changing up our routine will make a big impact. 

So I made it through the holidays on my diet, eating some cookies I won't be able to have anymore, but staying within my pre-op diet calories.  I had a really hard time exercising.  Partly be was EXHAUSTING.  Partially because I spent a lot of time cleaning up after them and getting ready for guests.  I guess that counts as some exercise (as does walking the dog) but you know what I mean.  Anyway, the boys are back in school as of yesterday and I've been on the elliptical again for the past 3 days.  Feel SO much better.

So I'm thinking about coming "out of the closet" about bariatric surgery with more people after I get approved.  I just posted a rant on a friend's wall on Facebook to an ignorant (ex)friend of hers who was saying that weight loss surgery kills too many people, that people just need to exercise and shut their mouths.  Augh!  I realized that now someone can go to my wall and click on the post intro and see that I know A LOT of statistics about bariatric surgery and put 2 and 2 together.  If they care that much what I write on other people's walls, I guess they'll know. 

Not that I have strong opinions about anything :)

I guess what make me think I might be ready to "come out" about having surgery (after I actually know I'm going to have it) is because all it will take is one uneducated person saying something like Dee in real life, and everybody will know because of how I respond.  Besides, I think I will be proud to be a good example or how baritric surgery will help.  I'll probably treat it like I treat talking about taking meds for my depression - I won't bring it up with random strangers (which I guess I don't think of my readers as), I won't have a problem talking about it/ defending it.

Waiting is hard.... but at least it shouldn't be for another 90 days.

Yes, Bariatric Betty, there is a Santa Claus...

***If you missed my last post, I found out yesterday that my primary care doctor didn't have a record of my weight in 2008 or 2009 because I had started declining being weighed.  Just because I was too proud to let other people see how much I weighed, I might not be able to satisfy my insurance company's requirements to be approved for the surgery.

First of all I must thank you for all of your thoughts and prayers.  They worked, and I got the information I needed today.  My husband had the wonderful idea of my trying to reach my old OB/Gyn to see if they had a weight for me in 2009.  I have been trying to reach them all day.  The nurses have been tied up (there must be a lot of pregnant women in labor today is all I can figure!) because I have been on hold for over 20 minutes twice before hanging up.  Both the medical record persons line and administrator's line went straight to voicemail.  On the latter's voicemail I started begging for them to just call me and tell me if they could just let me know if I had let them weigh me when I came in for my annual pap smear. 

Five minutes ago, the medical record person called me back and said I did indeed get weighed in December of 2009 - and (Thank you, God) my weight put me in at a BMI over 40.  She's faxing the info to Hospital C today.  All of the sudden, I feel like a boulder has been lifted off my shoulders.  I will be saying extra prayers of thanks tonight, and that includes to all of you who have been so supportive in your words, thoughts, and prayers. 

Great lesson learned - being too proud will cost you.  Maybe not now, but eventually.  Be honest with yourself and others, and take what's coming, it's the only way you will keep moving forward.

Bariatric Betty's pride goes before a fall...

So, today I reached my 90th day of supervised dieting.  Hurray!  I've lost almost 20 pounds and I'm very proud of myself.  I emailed my patient care coordinator at Hospital C to make sure she had received the records she needed from my primary care doctor from 2008 and 2009.  She wrote back and said she received a packet, but it only had records from 1998-2004.  This was a big problem, because I need multiple years of weight history showing my morbid obesity for insurance pre-approval of partial payment of my bariatric surgery. 

So I got ticked that my past doctor's office could have screwed up my request so badly.  I wrote out specifically what I needed on the record release request.  I calmed down enough to call them and explained that there seemed to have been a mistake.  The woman at first agreed and then pulled my file.  Turns out there was no mistake, except my own.

I remembered going through a phase where I declined to get weighed because I was so embarassed with my weight.  Apparently, that phase was from 2004-2009, because all of of my visits during then don't have weight recorded.  So now because I was too embarrassed back then I might not have enough documentation to be approved my my insurance company.  I have data from my doctors from 2011, late 2010, and then 2004 and earlier. 

This afternoon I was able to get a copy of my record sent electronically from my old weight watcher's location in Central Ohio.  That gave me a starting weight in 1/2008 and an ending weight in 11/2008.  During that entire 10 months I lost just over 20 pounds.  Versus the last 90 days when I've lost just under 20.  I hope my earnest trying helps.  But now I'm really worried that since we don't have data from 2009, I may have shot myself in my foot.  What if my reluctance to face my weight in 2009 results in my not being approved for surgery?

There's nothing to do about it, but pray and wait.  My P.A. that is coordinating my multidisciplenary diet will be writing up his summary and putting together the packet next week.  Then the hospital will submit and we will wait.  And pray.  And try to remember that things will happen the way they should, even if I don't get approved. 

So here's my advice of the day.  Don't decline to be weighed, or have tests done.  Because you can't predit what will be needed in the future.  I never thought I would be looking at having this surgery, and now look what happened.  Pass it on. 

Day 75 and Bariatric Betty has a bumpy ride

So today I've been on my medically monitored diet for 75 days.  Depending on whose scale you're using, I've lost between 13.5 - 19 pounds.  When I met with Drew, the P.A. supervising my diet, he was pleased to see that I had lost 6 pounds in just the last four weeks.  Plus, he was really excited about my latest test results.  My Hemaglobin A1C has gone from 6.8 (really good for a diabetic) to 6.4 (GREAT for a diabetic) in the last three months and my insulin doses have been cut in half.  Then, he said - the next step is that you're going to go off your Novolog (insulin I take with my meals) altogether ."  I'm already down to 3 units with meals.  The next comment was "6.4, that's barely diabetic."  Ouch.  I said I was lucky that my insurance company wasn't making me diet for 6 months, or I might have a hard time qualifying.  He said "Well, for now you're still on three medications, and still diabetic..."  Whew.  No more labs before my case is submitted to the insurance company, and I will consider my self lucky.

A couple of days ago I got an email from my trainer.  She's left her job, and is no longer working as a trainer, but following her other love - photography.  As much as I'd like to be happy for her, she hasn't written up a summary of our work together, so I'm scrambling to print emails that I hadn't deleted yet and a couple comments she made while following my training on myfitnesspal.com.  My three month diet only satisfies the insurance company requirements if there is documentation of consults (at least three), behavioral modification sessions, nutritionist sessions (at least three), psych eval, and working with a trainer.  It specifically says "work with trainer may not be entirely remote (i.e. - online)".  And what I have proof of is from online.  My PA says that he talked to her before she left and is aware that we met in person once, and that he will write it up.  Just to be sure I'm covered, though, I'm meeting with another trainer this Friday.  He works at the same gym - I asked if he had access to her stuff or if I should bring copies of the program she designed.  He said "Oh, please bring it" - just like I thought, she left nothing....  

Oh, and if for some reason the insurance company doesn't think I've satisfied their requirements, I can continue to diet and have consults for three more months - but at that point I probably won't qualify because my diabetes would probably be diet controlled and have a BMI under 40. 

On a totally different note, I feel very blessed today.  Yesterday my father in law called.  He had gone to his doctor about pain in one leg and was sent to the hospital to get an ultrasound immediately, because the doctor suspected a blood clot.  He's 87 and in marvelous health for his age - very active and health conscious.  We just lost my mother in law this summer, and the thought of the chance of losing him so soon after was just crushing.  I sent a message out to my friends on facebook asking for prayers and was touched by how many responded so quickly.  Two hours later we found out that the ultrasound showed it WASN'T a blood clot after all!  So he still has to find out why it hurts, and we're a little worried about that - but the chance of a stroke has been pushed far down the list and we're so grateful for that. 

I have to remind myself each day; I have great faith in God.  I believe that God will see me through my journey in the best way.  I think that will include weight loss surgery, but maybe God knows something better.  I will keep reminding myself of this while I go through the last couple weeks of my supervised diet and the weeks waiting for the insurance company to make their decision.