There are a lot of decision to be made when considering bariatric surgery! I will tell anyone who is thinking about it and has not yet decided that this is NOT for everyone! It isn't a "quick fix". It isn't easy. It IS often unpleasant; or better said, some of the side effects of surgery are unpleasant. If you are not committed to changing your habits then you shouldn't go any further.
However, if you have given thoughtful and serious consideration to your decision and know it is for you then you will be learning a lot about what choices you have.
If you are one of the lucky ones, like I was; your insurance company will pay for the proceedure provided you meet certain health/weight criteria. Years ago; the rule of thumb for any bariatric procedure was that you had to be at least 100lbs overweight! Baby...lets face it...once you are "at least" a hundred pounds overweight it's probably closer to 150 and you are living a nightmare existence trapped inside a body that is literally dying under all that pressure. For some strange reason, that was the magic number doctors and insurance companies used to decide FOR you whether or not you needed surgical intervention.
Then we started hearing buzz words like "co-morbidity factors" or just "co-morbidity". Yes, it means exactly what is sounds like! We all understand the word morbidity. It's a factor or issue that COULD have a morbid outcome. In terms of your health; simply said, that means it could kill you! In relation to obesity which is in itself a morbidity factor, we have all these other health problems that arise as a result of being overweight. Cheif among them are diabetes, hypertention, congestive heart failure, asthma/respiratory distress, sleep apnea, osteoarthritis, gerd, hiatal hernia, non-alcoholic fatty liver disease, arteriosclerosis (hardening of the arteries) and many other conditions both minor and severe. Limited mobility makes exercise an unatainable ideal for many morbidly obese people.
FINALLY...after 20 years, doctors and insurance companies have begun to realize that you don't have to be 100 lbs overweight to be at risk for obesity related illness. This is where the co-morbidity factors come in. The guideline was just recently changed. NOW, if you are 35% (instead of 40) bmi with at least three or four co-morbidity factors...you ARE a candidate for bariatric surgery. This is where I found myself; 38% BMI with hypertention, sleep apnea, hialatal hernia, chronic heartburn, osteoarthritis and fatty liver.
Since my insurance is Humana Military (Tricare), they follow the same standards and guidelines as Medicare, medicaid or any other government sponsored insurance. I knew they recognized the 35% rule. But, just to cover the bases and because I didn't want to get my hopes all up only to be told that they would not pay for it; I called Tricare FIRST and spoke with a representative. She explained to me that they would need a letter of medical necessity from my primary physician, several pre-op tests, a psych eval, the surgeon must be willing to accept Tricare of course and be willing to jump through all the hoops to aquire pre-authorization and then of course, the final authorization! PHEW!!!! It is a LOT. This does NOT happen overnight. Generally you can expect to be dotting i's and crossing t's for 5-6 months from the time you find a surgeon till the date of your surgery.
Which leads me into the next critical decision...your surgeon. Please, please, PLEASE...DO YOUR HOMEWORK! There are just as many quacks performing bariatric surgeries as there are in any other medical/surgical field. If you get one...YOU COULD DIE!
I scoured the internet for surgeons from Pensacola to Miami and much to my delight discovered Dr. Thomas Bass and the wonderful support staff at Gulfcoast Bariatrics with offices in Fort Myers and Naples. They are a bariatric center of excellence and Dr. Bass himself is a caring, concerned and thoughtful physician. He sat down with me on my consultation visit and we just talked about how my weight was affecting my life and my health. He listened carefully. I was an emotional wreck; crying and distraught because I felts SO hopeless and out of control. I just felt like, if they turn me down; there's nothing else...nowhere else to go, no more diets to try. I'm going to DIE from being fat!
Dr. Bass reviewed everything I had told him and then he said the words that changed my life. "I do think you would benefit from weight loss surgery. You are definately a candidate." I wanted to jump up and down with joy! For me it was validation. I know this sounds weird but if you are a fat person you are going to understand this. Your family and friends may say you need to lose weight for your health or they may elude to the fact that you need to lose weight but they DON'T understand how it feels to be the carrying that weight around like an albatross around your neck. When you have that once piece of birthday cake at your cousin's party (no bigger than anyone else's piece)...I'm willing to bet that you are looking around the room at all your skinny relatives and feeling guilty for eating your piece of birthday cake. They may even say things like, "well yeah honey, you are a little plump but we love you just the way you are." You've got a mirror....50 lbs of BUTT ain't just a little plump! So well meaning as they may be, sometimes in an effort not to hurt our feelings, friends and relations downplay our weight.
My family was loving but not at all supportive of my decision to have surgery. My mother and my husband were especially apprehensive. My adult daughters were scared of the procedure but were more understanding of my desire to do it. My best friend was afraid for me but she said, "you have to do what you think is right for you."
I began the pre-surgical screening process immediately; attending a support group and a mandatory orientation meeting where we watched a film that thoroughly explained each type of procedure that was available and how to know which one to chose. I went to my primary and told her that I was going to have bariatric surgery and that my insurance company required her to document that I was on a medically supervised weight loss regimen for the next three months. At the end of which; if I had not lost any significant amount of weight she could write her recommendation that I go ahead with surgery. Which is exactly what happened.
I had an upper GI to check for any blockages in the pipes! They went down my throat with a scope and yep...I had a big ole hernia sitting right at the base of my esophygus. But there was something unexpected; some strange allergy condition in the esophygus that made it very narrow and the "walls" somewhat thick. No wonder I always got food stuck in the pipe! They stretched it (since the opening was about the size of a number 2 pencil). But the most important discovery that came from this procedure was that it changed the type of bariatric surgery I thought I was going to have. I had originally planned to do a lap band but was now NOT a candidate for this particular surgery.
I went back to Dr. Bass who then said, well okay...so we do a sleeve gastrectomy. That is a procedure in which a part of the stomach is removed, leaving you with a stomach roughly the size of a banana but not redirecting or any cutting of the small intestine. Again, we went through all the hoops and then I get a call from the lady who handles all Dr. Bass's insurance approvals. Tricare says NOPE...we don't pay for the sleeve gastrectomy because it is "experimental". It isn't. But because it is the "new and improved" version of the gastric bypass they still consider it such. Dr. Bass even spoke with them explaining that he thought I would benefit from the less invasive sleeve gastrectomy (due to some pre existing gastrointestinal issues) but they would not budge.
I was so upset. I cried for days. I'd been prepared to go through with first one, then another and now...my only option was a full on gastric by-pass. The granddaddy of them all; the Roux-en-Y Anastomosis which is of course a very invasive procedure. It not only affects consumption of food, it also affects the absorption of the nutrients from that food. You will need vitamins for the rest of your life. I took a few weeks off to think it over. Then my aunt Marianne (Auntie M as she is affectionately known between the cousins) came down for a visit. She has been in the medical field for 30 years and she said..."girl, you need to do this... you are going to feel SO much better."
At this point I was three months into the screening process and during this time; my husband of 7 years found his high school girlfriend on classmates and two weeks later...he was GONE! We'd never had a serious argument in all our time together. It was so abrupt and cruel and really had thrown me into a tail spin. I knew that I had to get past that if I was going to get through the psych eval for my surgery. My heart was shredded but I met with the psychiatrist and she was able to see that I was basically a stable person (no comment from the peanut gallery) and that I was capable of compartmentalizing my surgery and the issue of my cheating, lying spouse! Not an easy thing to do when your heart is broken!
Finally, nearing the end of the physcal year for my insurance company and capped out on my copay...if they could just pull this off before Oct 1, 2011...it would not cost me ONE RED CENT! We got the last two pieces of the puzzle in place the last week of September...the sign off from my primary and the results of the psych eval. Carol at Dr. Bass's office rode Tricare like a mechanical bull to get that final authorization in time. It was faxed to her that same day and she called me to give me the news. I cried with relief. I was on the surgical schedule for September 26th...just FOUR DAYS short of the cut off for the current year on my insurance!
This is where I will stop for tonight. I want to explain each of the bariatric procedures in depth in the next few posts but I needed to lead up to that. Plus, I want everyone to get a real picture of what is involved in this decision so it might help someone else.
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