crosswind

Susanne, I haven't been sleeved yet. And I think what I was trying to express wasn't whether the "surgeon was right or wrong" -- really how would I know? I'm not a surgeon. What I am trying to say is that it seems like the American healthcare system is really fuqed. And when I say that I mean the whole attitude we've become accustomed to -- wait six months for this evaluation. Wait another four weeks for that approval. The doctor makes his pronouncements about these things and as consumers we really aren't free to argue; even though I have to tell you in that situation I might. The way I came to my decision about whether I would have surgery in the country ( knowing I sure as Christmas was not going to get covered for this even if I waited til Hell froze over) or out of the country finally had to do with how long I was going to have to wait and how much crap I have to put up with just to get to the freakin *point*. In my *opinion* making people dance on the head of a pin to prove to a doctor they deserve surgery is pointless since the *actual surgery* and post-op is such a massive pain. I truly doubt anyone considering this surgery does not know that their lives are riding on that fork. If you are suicidal or stupid, you are going to go home from the hospital and order a pizza. Otherwise there has to be a clue included somewhere in the fact that your stomach is gone. What I've gleaned from my research is that the huge variation in pre-op instructions has to do entirely with what is comfortable for the surgeon. There seem to be unique instructions and methods with every guy. If there was an industry or medical standard regarding these things, both you and I would know about it. So what I was trying to say -- respectfully, Susanne -- was that it's possible to separate these issues out without feeling like you ruined your life by eating a cookie. *After* the surgery that might be true for a while. But forever before, with surgeons who insist people have to lose fifty pounds before they can even * get* to the "pre-op diet", and insurance companies denying these procedures at the last minute for some "actuarial" reason -- the way all this goes it seems like you might just die of natural causes or *stress* before you lose pound one. That's all, just my 2

. Hi Susanne: Not being able to keep our hands out of the cookie jar is the reason everyone here is shelling out ten to twenty to thirty times that to get their stomachs permanently altered. If it were that simple, no one would need this surgery at all. At the hospital I'll be getting a chest x-ray and I'll also be put under life-threatening anesthesia, endure the risk of severe pain and complication, need Vitamin supplements and carry scars for the rest of my life not to mention figure out a way to do without any food at all for ten plus days. All because of that cookie jar. That said, there are some really excellent reasons to comply with a lowcarb diet prior to surgery. Lowcarb not only depletes the liver of glycogen, it also depletes the rest of your tissues making it far less likely that lymph-related complications will arise. Less Water means less pressure on your heart and circulation which is a good thing when you're undergoing anesthesia. Also people who are carb-laden are in "sugar-burning" mode -- in a surgery like this a ketotic state is optimal since blood sugar is less likely to undergo life-threatening drops. Once you get into a ketotic state, you get anorectic because you don't have insulin and blood sugar driving you to eat. When a person comes out of surgery with most of their stomach removed, it's pretty likely that without that they'll come out starving and weak since fat metabolism hasn't kicked in. But...again...another way to check to see if a person is in ketosis for surgery is to ask them to pee in a cup.

Wonderful. I hope I feel the same way.

I just got off the phone with the patient coordinator at Dr. Aceves office where I have my surgery scheduled for Monday. I was worried because I haven't really been checked out thoroughly by a doctor in a couple years. She told me not to worry -- she said, look, you're in a hospital, if there's anything wrong we'll work on it so you can have a safe surgery. It seems like in the states the whole system really wants to make all this is as hard as possible. It's one of the reasons I decided to go to Mexico despite the risks. I had second thoughts a couple days ago and called the surgeon I was going to originally go with, and asked them if I decided to go with them and their BLIS insurance how long it would take before I actually ended up on the table. She said three months to a year. I thought, that's three to 12 months of my life gone for some piece of paper to get somewhere else, for me to answer correctly on all the forms, for me to drive to the office and 'consult" with yet another bariatric professional, and for me to get all kinds of lectures about how I live my life. Now I don't know for absolute sure if I've made the right decision but I do know that if I were you I would not be ashamed, I would be annoyed. It's not *you* who's got the problem, it's them, and I'll tell you what it is - your surgeon is afraid to do that surgery unless he is absolutely certain your liver is perfect. But one way to find that out, since you're actually *in the building* -- would be to order a catscan or an ultrasound to see how big it really is. It would take 45 minutes, tops. Your liver and it's rumored massiveness was sitting *right there* on the chair, in the hospital. There are actually much more scientific ways to find out if a liver is enlarged besides asking the patient if they ate a cracker that week. You need to lose that weight and stick to your lowcarb diet to get the doctor to actually operate on you. It's his concern about his own skills that are up for review here, not your worthiness. So just do it so he feels better and you can actually get your sleeve. But don't feel bad about it -- you're actually making allowances for his insecurity. If my doctor told me he would feel better if I walked around wearing a pink hat and purchased a parrot before surgery, I'd do it.

Thanks Becca. I was wondering, do you feel -- can you tell your stomach is smaller now? Do you feel that it's smaller inside your body or does it just feel like a normal stomach after a while?

My sleeve is scheduled in Mexicali with Dr. Aceves and I'm starting to er, rethink this. Am I crazy? It's so much money. What if something happens? I have no insurance. I have a little insurance but...oh boy oh boy what a huge step to take.... For a while I was retreating back to the lap band but there seem to be a lot of long term complications with it there aren't with the sleeve. I have tried every diet and gained all the weight back, gotten depressed and gotten back on the trail again to lose over a hundred pounds twice, but it never lasts. I'm just under 40 BMI now....I don't think I can ever in any scenario see a time when insurance would ever cover this for me. I don't even like food very much. I just want to be normal. Go to work, eat what I want, stop when I've had enough and not be fat. I feel like I'm at the end of the trail, it's this or nothing, Now or never. I just hope it works out.

. Hi Rosie: Yeah I've got my eye out for you guys. My mother died of pancreatic cancer when she was 79. She was diagnosed when she was 75 and there was a conversation at some point whether surgery was "worth it" since she was over some number, seventy I think. My mother said excuse me? It's worth it.

http://www.ncbi.nlm.nih.gov/pubmed/21298508

This is another study on pubmed from JAMA, comparing bariatric surgery procedures and their complication rates to get a handle on what made things go wrong, if they did. Total complication rate for all surgeries was 1.6 percent. Sleeve surgeries alone had a serious complication rate of 2.2 %; mortality rate for sleeve surgeries was exactly zero. The study said that complications were inversely proportional to how many surgeries the hospital handled, and how many surgeries the surgeon had performed. COE status was irrelevant. http://www.ncbi.nlm....pubmed/20664044

I was running a scan over on pubmed and found this abstract of a study comparing bariatric surgery outcomes in people over 65 compared to younger people. Turns out some of the variables were even better. http://www.ncbi.nlm.nih.gov/pubmed/20870182

OH, I got my last post about this backwards. It's BCBS that's two years and UHC that's five. Sorry. Long time either way.

Thanks for posting this. When I talked to a customer service rep he said it depended how the claim was written. Most doctors won't refer to the surgery if you mention it migt be a bad idea, and a barium swallow won't raise much suspicion since it's used for all kinds of diagnostic reasons. Basically if he orders it, it's going to go through.

Hi Heidi: Blue Cross told me five years, United Healthcare told me two. I realized I had a COBRA policy I can opt into but the price is unbelievable: they quoted me 1,322.00 a month to stay insured, and it's Anthem so I'm not sure if they would cover anything that happened anyway. What I'm thinking is I'll just cross my fingers and pay COBRA for a couple months, and then go out looking for cheaper insurance. I remember Aetna told me that you had to wait six weeks before applying after a major surgery or pre-existing diagnosis and they would look at applications on a case-by-case basis. I don't qualify for HIPAA or CHIP because I have COBRA; if I have a valid offer I don't qualify until it's exhausted. But basically I think what's going to happen is as soon as I'm sure I'm not going to have complications, I'll drop insurance and go bare. I am *quite confident* that barring any complications I am going to be a lot healthier after this surgery. Most routine stuff -- cold, bladder infection, etc, is cheaper out of pocket anyway. Most health conditions in middle age are related to diet: diabetes, heart problems, cancer -- all of it is either entire or somewhat related to that so the likelihood of my having a heart attack or something *after* this surgery is kind of small. This is clearly the biggest risk self-pay patients face but later on I wonder who else will be stuck between a rock and a hard place, unisurable because of their sugery they got while on another carrier. I spent some time following links from an initial link that promised to have "gastric bypass insurance." All I got back was a quote screen where I could leave a name and number for agents, to call: most of them were BCBS, Aetna, etc. Not sure what they're up to there. If you're not insurable over 40 and you're not insurable after bypass, it seems what insurance companies want us to do is diet and exercise so we never bother them with any kind of bill at all.

BTW this puts me undoubtedly under 40 BMI. Thank goodness I'm self-pay.

I was supposed to start the pre-op diet ten days before surgery but I started a little early. I'm on my third day and I lost five pounds -- low carb, low fat, high protein for Dr. Aceves.

No one knows I'm doing this. It's funny, even though I don't qualify for regular insurance and even though I'm clearly obese no one would suspect that I, the quietly growing mushroom in the corner, would one day get on a flight to Mexico to have my stomach cut out. Maybe this is common for wealthy or extremely confident people. I read all the time about movie stars and other sparkly people jetting off to Rome or Cancun -- or what is it these days? Cabo San Lucas with only a bikini and a couple of syringes in a Prada bag but for me this is one gutsy, desperate, expensive, slightly terrifying thing I'm doing. I am not a good flyer. I am a bad flyer. When I get on an airplane I instantly begin to calculate the strength and the agility of the people around me to gauge whether they would be saveable or not if we rocketed into the ocean and it was up to me to get their infirm asses up to the surface and home to their yorkie, Funyons. I usually drink a lot on a flight but this will not be allowed eleven days from now because, as I mentioned, I will be having my stomach cut out the next day. I was just reading an article in the New York Times about the search for an incisionless solution to obesity. They're not having much luck. The fact is that even though twenty percent of people in the US would qualify for surgery, a number that's growing each year, no one's got much more of an answer than to cut your stomach out. I used to think there was some kind of special thing I was not personally doing and once I discovered it I would find myself in an instant size eight, but now I don't think so. I think consumer culture is trying to kill us. The problem is that as food gets cheaper to produce and there are more people on the planet, the quality of it all tanks. There are these places in the US called food deserts where you can't find a leaf of lettuce to save your life but Little Debbie, Hostess and Aunt Jemina are smiling from every shelf like spokesmodels for the apocalypse. I'm five ten and I weigh about 280. Seven years ago I went on the Atkins diet and lost all the weight: I zipped around in teen section jeans from Target and fell in love with a guy who didn't understand what it was taking me, what it had taken me to get to that point. He was a food nazi and a semi-vegetarian and he kept telling me everything I did was "unhealthy". I would work out an hour and a half a day, he told me I wasn't doing enough cardio. He would actually get redfaced over this stuff. His thing was, he was born naturally thin and he really paid very little attention to what he was supposed to be doing or eating, because being naturally thin, he was naturally healthy. I had to work at it. So he would go to work and graze from the Estrogen Bar set out by the office ladies and then come home and want to go out to eat. He loved restaurants.I would have to diet like crazy to keep up with this, and it finally got to the point where I would go off by myself, binge for a couple weeks, then spend the next couple weeks starving myself, and then reappear again, thin as ever. By the time we broke up I weighed about 240, up from a very happy 150 when we first met. During the breakup process, I put on forty more pounds. It was easy, it was instanteous. So for a while I gave up on the whole thing. I mean, how much heartbreak do you need to pack into an issue before you just check out and go for the pasta? I just kept buying bigger and bigger clothes. I didn't care, no one was ever going to love me again and I was now over 40. If I lived in the old country I could put on black robes and a veil and make everybody in the village dumplings every day. And then I realized something kind of odd. The reason we really broke up was because I was too fat for him already, when we met. I wasn't perfect then. I was a blank, doofus of an in-love slate to be improved upon, screamed and tantrummed at and *nothing* in the world would ever make me loveable enough for him. You really have to ask yourself in these moments if you want to live or die, because I had been almost intentionally, systematically destroying myself for a couple of years. But I didn't have the heart for another diet. Atkins wasn't working the way it had for one thing and my life and my body had changed in the past seven years. I had started smoking again. Seven years ago people were saying my god you're so thin how are you doing this you look like a different person just beautiful where is the rest of you? I'm ashamed I'm all the way back where I was then. I don't like to go out where people can see me and compare my old self to my new self. I hate the whole thing. For a while I just decided to be fat. I would walk around asking myself, am I loveable this way? Am I really disqualified from society because of a hundred pounds? It's still a good question, right? Then for a while I tried to do a Geneen Roth thing and "just eat normally". The problem is, for me, eating normally means I gain forty pounds in six months. It would take a year to get back there if I got there at all. I need help, that's just all there is to it. I am not going to count, measure, starve, obsess, and do all that, live on the edge of anxiety all the time worried that I'll somehow destroy my life if i have a piece of cake, only to gain it *all* back anyway in a moment of weakness. There has to be a better way. I really hope this is the way. I'm so sick of this now. It's enough already.

By the way I don't mind sugar free and I basically eat sugar free everything. Except normally maybe in this case, when I've just had major surgery.

Right. It just seems like, for a shorter period of time, a little sugar might help. Later when your first priority is protein it makes sense to cut carbs since the belly won't hold much food. But in the beginning for the sake of calories?

I've been noting that the post-op diet is all low-carb and sugar free. It would make more sense to me that in the post-op period with very few calories allowed anyway that sugar would be allowed. Real fruit juices, non-sugar free koolaid and etcetera. Does anyone know why only sugar free things are recommended?

Is there anything i can buy at the supermarket that would work as a clear Protein drink? Is milk okay?

So here is what I found out about getting insured after the VSG. If you are a self-pay patient because you can not get approved by your regular carrier, or because you have no insurance at this time ( possibly because your BMI is too high) -- then your next option is federal or state PCIP insurance. I am posting this here because even if you have health insurance now, there might come a time later when you lose your job or want to apply for private individual insurance and are denied because the VSG makes you UNINSURABLE. According to the rep at BCBS the surgery needs to be two years old with no complcations in order for them to write a policy. According to AETNA, you may not apply for six weeks after surgery and if complications arise, you are considered uninsurable. According to United Healthcare, you may not have had any bariatric surgery for five years, with no complications. So in the case that you are truly SOL, Obama's Affordable Insurance Act created an opt-in program for all states to provide low-premium affordable health insurance. Information about that is here: http://www.healthcare.gov/law/provisions/preexisting/index.html You can apply immediately and electronically at this link if your state participates in the federal coverage enacted by this law: https://www.pcip.gov/Apply.html There is no waiting period. If your state does not participate in federal PCIP hen they have created their own affordable healthcare state option. Information about your state's PCIP can be found at the top link.

Uh, good question.

I just talked to my insurance rep about approval on a policy after the fact of VSG. She told me that, first of all, if my BMI was over 40 that I was uninsurable. I am *right* at the line, just under 40, so the underwriters told her that I might not be approved anyway because I may be considered too close to the line. FACT 1: IF YOUR BMI IS OVER 40, YOU ARE POTENTIALLY UNINSURABLE BY MAINSTREAM CARRIERS She also told me that if I had already had VSG and I was applying for a policy and did not disclose it at time of application, on discovery the policy would be rescinded. FACT 2: IF YOU LIE TO PROSPECTIVE HEALTH INSURANCE CARRIERS, IF THEY FIND OUT THEY'LL CANCEL YOUR POLICY IMMEDIATELY. She also said that if I was 'contemplating bariatric surgery" at the time and I did not disclose that, my policy would be rescinded upon discovery. However she also said that if t I was contemplating the surgery beforehand and I did disclose it, and they wrote the policy for coverage, later discovery would *not* mean it was rescinded. FACT 3: IF YOU ARE CONTEMPLATING SURGERY AT THE TIME YOU APPLY FOR REGULAR HEALTH INSURANCE AND YOU TELL THEM THIS, LATER DISCOVERY OF YOUR SURGERY WILL NOT RESULT IN POLICY CANCELLATION. Blue Cross Blue Shield, according to her, will not insure people who have had any bariatric procedure within the past two years. And finally: she quizzed me very carefully once I had asked her about this and she talked to the underwriters about whether or not my weight was accurate. Because I had asked about this, the underwriters were dubious that I was telling the truth about my BMI, because as far as they knew bariatric surgery is never performed on anyone who has a BMI under 40. They thought that because I was trying to get a clear answer about this I might actually be over 40 and lied on my application for general health insurance. I told her yes, it was accurate, and that in insurance scenarios you can't often get approved under 40 but as a self-pay patient being over 40 is not a hard and fast rule. The underwriters apparently did not know this and so she asked me several times if I was perhaps fabricating my weight for insurance purposes. Anyway, interesting conversation. Take what you need.

. Hi just an update from my research. I talked to United Healthcare today and asked them what would happen if I got a vertical sleeve and then applied for a policy. They told me any prior bariatric surgery makes me uninsurable and they will not write a new policy. I asked her what people do when they have uninsurable conditions, and she said people look at "other options" -- their employer (?), a COBRA policy, or for high risk policy insurance. !

Eh, they need ten years of history before they make a final determination. There's that for the lap band but not for the sleeve. But personally after reading all the "nonfatal' problems there are with the band I'd rather just sleeve and be done. Why would I want an "adjustable" stomach?