SqueakyWheel&Ethyl

China mama your plate is full! This is the advice I have: When you call your ins co tomorrow, ask for "the Medical Director responsible for the approval of your procedure." THAT is where the buck stops. You may only be allowed contact with a nurse in that office, but that's where you need to be. Tell her that you understand you have met all of their criteria and need to understand why there are more delays. Give them the chance to explain their stall tactics. Then, ask, "if you were me, what would YOU do to get this resolved ASAP?" Keep putting it in their lap. Offer to send it Fed Ex for next day delivery. If they say, USPS only, ask them to justify the logic behind that. Remind them that all these delays are only increasing the risk of an emergent situation and it is in everyone's best interest to resolve this and move on. I would be on the phone calling, leaving messages, etc EVERY SINGLE DAY until you are satisfied. SQUEAKY WHEEL GETS THE GREASE. Good luck!

That had not even crossed my mind! Thanks!

I love your signature quote. Very appropriate! I'm not in Canada. I don't even know what PCOS is. I do have Hashimotos (hypothyroidism). I can share my experience with you and answer a few of your questions. I have two 4 pound handheld weights that I use while sitting and resting. I do arm curls and try different angles of lifting and lowering to target different areas of my arms and shoulders. I was told even if I am too weak to walk, I can do arm exercises while I relax in front of the TV. I also flex and extend my legs and raise and lower them. You can feel it in your abs. Even if you only do 5 of each, that's 5 more than you would do otherwise. I, too, am blogging about my journey. Feel free to read it. Good luck!

Call the ins. co. Ask for the Medical Director's office responsible for approving procedures. It's possible they NEVER EVER cover this under any circumstances. Or, they cover it based on specific criteria. Find out which one applies here. Do they cover if the patient is over 100lbs overweight? Or if they have Diabetes and other conditions? They won't volunteer this info. You have to press them for it. If there are SOME cases they would approve (like listed above), then your next Quest is to see if you qualify based on their criteria. If you do, then you need to request a list of EVERYTHING expected to be done to garner approval. Such as: Nutritional Counseling Psychiatric Evaluation Lab work Keep a 6 month food journal Etc. Keep a journal including every phone call or email, etc. WHO said WHAT and date/time. Check off each of their criteria as you accomplish it. Get on a first-name basis with whoever your point of contact is with your insurance company's Medical Director's office. Check in with them regularly and ask, 'what else will you need from me?' If they absolutely do not cover under any circumstance, then it's a closed subject. But, they many times WILL cover under certain criteria, BUT they don't want their customers to know it. That's why you must press for the info. Good luck!

Sorry, just saw this. I have three pills I must take daily. Two of them, twice daily. They are small, and I take them one at a time, spacing them about 2-3 minutes apart. NO PROBLEM.

You look GREAT!

I did that. Then I said, has anything else worked for the past 30 years? No. Have you done adequate research on this subject? Yes. Do your physicians support this decision? Yes. Then, trust yourself. The person who brought you this far obviously has done her homework. Trust her. I made peace that way and now I want to hug her for bringing me to this. I have a new birthday. April 17th! Thanks, PBCN

Not trying to argue this.... I totally agree, if they absolutely do NOT cover under any circumstances then its done. My advice is based on the insurance companies that do cover SOME cases, but don't want their customers to know it. Which is pretty common from what I've learned from my own research and my surgeon's insurance specialist. I think it's unethical to say "no" when asked, when they are aware that SOME cases would be approved under THEIR guidelines.

Quote from the movie, 'A League of Their Own': "It's supposed to be hard. If it wasn't hard, everyone would do it. The hard is what makes it great." Day 6 Post-Surgery for me. It's worth it.

I hate nausea and throwing up. If you do, too, you'll take tiny nibbles and gradually take little bit bigger bites until your body says, EH. Your body will tell you. I don't think the pouch can stretch that much, unless maybe if you deliberately try to force the issue, but I've never heard of anyone doing that.

I'm not saying they ALL have to approve you. On the first call I made, mine said they don't cover it. Case closed. But when I pressed further, it turns out they DO cover it if: 1. 100+ lbs. overweight, OR 2. Less than 100 lbs. overweight, but have at least two medical conditions that will be improved or eliminated (in my case, Diabetes and PBC/NASH). If they had said it doesn't matter how sick you are or how heavy you are, we NEVER cover it, then, I would completely agree with you. Once they admit they DO cover it under certain circumstances, and the patient meets the criteria, AND the patient fulfills all the terms according to don't you - in your profession - believe they SHOULD honor the terms THEY set?

that sounds good!

NEVER NEVER NEVER let anyone with your insurance company sense that you think denial is even an option to consider. If they DONT APPROVE, you call the insurance company and ask for the Medical Director in charge of your procedure approval. You'll probably get a nurse who works with the MD. Ask them what is needed to get this through. Present it like, "I understand your rules for approval are 1. xxxx. I did that. 2. xxx. I did that too. ..." Confirm they see the docs to support each line item. Find out EXACTLY what is missing and tell them you'll make sure it is in their hands by xxxx date. When you are playing by THEIR RULES and you meet each task as required, they HAVE to approve. Keep that in mind with every contact you make with them. And, try to keep it in a business tone, non-emotional. If they sense that you already KNOW you are going to get the approval, they know you aren't messing around, you'll be surprised how quickly you'll get your approval just to get you off their backs.

My ins co said, "where's your food journal for the last six months?" I worked all night and turned it in the next day. Got approved 24 hours later. DON'T GIVE UP!

Let go of that fear. You will lose. I don't know ANYONE who has failed.

Centrum Chewables are bright colored round balls with a thin candy shell that tastes fruity and good!

My surgery was the 17th, too. Thanks for asking this question. I LOVE hummus and can't wait to get some! Looking forward to the minced white fish, too. That's in the Purée stage just around the corner!!!

Day 5 - Sunday, April 21st. I didn't sleep peacefully. Lately, I've been sleeping propped up on several pillows and it still feels foreign. I can't shake this headache. I think it's caffeine-withdrawal, but it could be aggravated by the residual general anesthesia administered during surgery. I have a history of not tolerating anesthesia well over weeks and even months after it was administered. My liver doesn't process toxins as well as the average person. It just takes longer to dissipate. I think I did too much Saturday. I felt like a rock star and wanted to do a lot. Going shopping was probably premature. I woke up Sunday feeling like I was hit by a bus.... Figuratively speaking, only. So, Sunday was much quieter. I SHOULD have napped, but, my mind was constantly going. I take care of my younger sister with severe CP, normally. She lives with me. We finished a 64 day hospitalization just a month before my surgery. I say "we" because I stayed with her. Pneumonia and a host of other life-threatening illnesses almost took her from me, but she recovered. She got her first tracheotomy and came home with a ventilator (life support). I have aides lined up to take care of her during the day and evening for two weeks while I recover from my VS. my husband does night duty. But, yesterday, there was a few hours that my sis and I only had each other to care for us. Not much needed to be done, but I needed to stay awake for her sake, so I never rested like I should have. Also, I think I hurt myself. I shredded up 1/2 of a slice of (2% milk) cheese and put it in a mug with my hot tomato soup. I'm suspicious that's why I have this continual burning sensation in my sternum even today. I'm doing mostly clear fluids today. I'll do my best to get my protein in, but I'm going to be conservative about everything today. My surgeon changed me from Nexium to Pepcid. I'm not sure that was best for me. Sunday night, I couldn't relax enough to get comfortable and fall asleep. I finally took an Ultram about midnight, hoping it would help me rest. It did. But today, Monday, I feel very drugged and sluggish. I think I'll put the pain pills away and just ask my husband to massage me till I fall asleep if I have another night like that. The physical pain is almost completely gone. Just a few tender places on my tummy. I'm looking forward to getting back to work, but I need to get that pain pill out of my system first. I can't think clearly today. I never like feeling drugged or drunk. This, too, shall pass. Am I sorry I had the surgery? Not at all! These quirks are to be expected and will pass. I'm really looking forward to how much better I will feel by my 52nd birthday in August. I consider April 17th my other birthday and will celebrate it every year.

Oh, I agree with cbd that you get more with honey than with vinegar (my grandma used to say), however, I have also experienced being LIED to by the insurance company repeatedly in the beginning of this quest. When I got them to FINALLY admit that - under certain circumstances they will cover it, I asked for a printed out list of guidelines to follow. For example, 100+ lbs overweight 80+ lbs overweight with 2 or more qualifying medical conditions that will improve or be eliminated through this surgery And then the rules I must follow to get it all approved, such as, 6 months Nutritional Counseling Maintain a food journal Psych Evaluation by a Psychiatrist, etc ..... They refused to give me anything in writing to use as a checklist to make sure I did everything ACCORDING TO THEIR RULES. It's at this point that being nice, saying ma'am, and thank you are NOT enough. They have been trained to NOT be cooperative with the 'nice' people. They figure if they resist enough, the nice ones will give up and stop calling. I documented every call, email, etc. After 2 months, I called again, and was told they had no record I had ever contacted them on this subject - EVER. When I sent my DETAILED documentation of every contact made, including their name, date, and time of contact, they FINALLY started cooperating with me. If you can get there with kindness, GREAT! But, make it clear that they shouldn't confuse a kindness with weakness. Good luck!

Thinking about you today!

I'm excited for you! Good luck!

My primary insurance resisted for a LONG time. Honey, do what I did. Take that bull by the balls. Call the Insurance Company and ask for either the Medical Director or their Nurse. These are the actual people who rubber stamp the approval. Don't hang up til you get them. If you hit a brick wall, tell them you expect a call back by 5 pm today or you will be contacting both your Congressman and the local news media outlet. When you get the MD or their Nurse on the phone, tell them what you need done. Tell them, "i believe i have been patient enough waiting for your company to do your job on my surgical request. my secondary approved it long ago. In a perfect world, I would be able to schedule surgery as soon as I hang up this phone. But I know this isn't a perfect world. So, YOU tell ME when the authorization will be approved. I NEED this surgery no later than May XX." Pick the date that works best for you. Don't say 'approved or denied.'. In your brain, denial IS NOT an option. Lay it out. Remind them of what THEIR rules are for approval. Go over each rule step-by-step confirming you have completed each task. Then, hold their feet to the fire on getting the approval in the next 24 hours. It's quite simple. Its THEIR game. And, if YOU have played it by THEIR RULES, you WILL WIN because they HAVE to play by their rules, too. Everyone where I work told me our insurance doesn't cover it. I got approval (cuz I can be a bit of a b***h... With documentation to support my bitchiness.) and had my surgery last Wednesday. Don't be discouraged if you find you have to do Nutritional Counseling for 6 months or a year. Even if your husband is not there to help with the kids, YOU can line up the support you need. I am the caregiver to my severely disabled sister who is at home with me on life-support. If I can line up people to take care of her for a couple of weeks, ANYONE can. You just have to find the burning desire in your heart to demand doing something FOR YOU. In the long run, it's for them too. And, I believe your husband can still play a big role in the support you need even from halfway around the world. ((HUGS)) to you. Please stay in touch. I am here to help you find the words you need.

Starting this blog with the day before surgery. No food or water after midnight Tuesday, 16th. I took a mild laxative early on the 16th, too, thinking a flush would make this easier on me. I followed hospital instructions. Change the sheets. Check. Shower. Check. Then wash with the hibiclens, avoiding head and genitalia, and using hands only - no wash cloth. Leave on skin for 5 minutes, then rinse. Check. No lotions. Check. No contact with pets. Check. Surgery Day. i showered using the hibiclens again. I worked 1/2 a day. Surgery was in the afternoon and went like clockwork. I arrived on time, got set up in Pre-op, and was wheeled into OR. My last memory before I fell asleep was the digital clock. 1:59:38. Surgery set for 2 pm. Perfect. I awoke feeling deep ache pain high up on my tummy, just under my breasts and in a very small localized area. I was aware of a couple of other tender places on my tummy, but they didn't bother me like the one high up. I kept saying, "Pain.... nausea. ... Pain... Nausea..." over and over, figuring if I was a nuisance, they'd knock me out again. The fact is, the pain was probably a 7 in a tiny spot. The nausea was about a 3... Hardly there, but I knew it would get worse before it got better and I don't handle nausea with grace. They shot me up with pain and nausea drugs and I stopped mumbling and slept, still aware of the ache, but it wasn't as intense. I was in my private room by 5 pm... Maybe even 4? I'm not sure. The nurse was all over me wanting to make sure I was comfortable, offering me morphine (I can't take Vicodin, their standard pain-killer issue) and Zofran (nix the Phenergan, too...allergic). I eagerly accepted her offer. Not really nauseous, but aware that it was lurking close by. My voice was cracked from intubation. No sore throat. But my mouth was dried out and I offered $1,000 for ONE ice chip. Nope. IV hydration/nutrition given. NPO until the next morning's upper GI test. My sweet husband wouldn't crater to my begging for just one little ice chip either. He did break down and wet a wash cloth so I could wipe out the inside of my mouth. My Pre-Op Nurse had this same surgery 14 months ago and said her hubby did that for her, so my hubby decided it was ok to cheat that much. He stayed with me all night long making sure no mistakes were made. (We've experienced enough errors in hospitals in the past to KNOW one should NEVER be left alone in a hospital. They need someone to champion them). I slept on my back all night long, which felt weird, since I'm a side sleeper. No-way was I going to roll over on my sore tummy. At 3 am, I stood up and walked to the bathroom - with the nurse, of course, and I peed. First two hurdles done! Walk and Pee! Day 2. Early morning, whisked off to do the upper GI. This is to check to make sure there are no leaks. They warned me that the barium i was about to swallow tastes really bad. They had a cute little barf bag handy and said, "you might need to throw up, so, take this." I was determined to NOT need to throw up. I told myself, this is going to taste bad. It will only last a few minutes and I can rinse out my mouth. Yeah, I can do this. I'm tough! I had to stand on a pedestal and drink the most Gawd-awful swill known to man while they xrayed it going down my newly designed pipe. I thought breathing through my mouth would make it easier. It made it worse. What did it taste like? The only word I can come up with is BITTER. Not sour, not fragrant. Just BITTER. To the eleventh degree. I was given water, which I gargled with, but hesitated to swallow, since I already had about six big gulps of the swill churning inside me. Nauseous? Yeah. But, I can handle it! No leaks, so I was taken back to my room. As I sat up to stand and get out of my wheelchair, the nausea went BAM! "Give me the bag." I lost that battle. But, it didn't hurt as bad as I feared. My tummy just felt a little sore. And all I did was dry-heave, so it was very brief. Ok! I CAN. handle this! I was given more Zofran and morphine and a BIG cup of soft ice. Ah, heaven! I wasn't interested at all in eating, but the ice was great to melt in my mouth. A few minutes later, a tray was brought in with chicken broth, orange jello, and decaf tea. The hospital has a nurse that rounds all the weight-loss surgical patients and she sat with me and showed me exactly how much I was to "sip" SLOWLY in a fifteen minute period. Which meant I had to pace myself and be sipping every 5 minutes on something. I actually thought it was fun! (What do I know... I was drunk.) I tolerated feeding very well, being cautious to not gulp. I did notice that if I swallowed too much too close together, I'd feel a twinge in my sternum that would say, hey, slow down or I'm going to start spasming. I'm learning to pay closer attention to my body and her signals. I've decided to give my body her own identity. Her name is Ethyl. Ethyl has no idea WHY I'm so mean to her. The second morning was a lot of sipping and napping and walking around the unit. I was discharged and home in my own bed by 2 pm. Exactly 24 hours after surgery started. I like it when everything is done efficiently. I already had a wide variety of clear liquid choices, so I sipped on chicken broth, decaf tea, and sugar-free Popsicles. I walked the length of my house about three times. And napped a lot. I took my Ultram and Zofran pills on time (pain and nausea) because they told me to. "Don't be a hero." OK! Sleep was interrupted frequently with Ethyl barking at me. Especially when I would try to roll over on my side. I learned to try to sneak side-rolling past her by doing it slowly and with a pillow supporting my tummy. It worked. End of Day 2. 7 lbs gone. Day 3. Lost another lb. 8 total. At 2 am, I had my last pain and nausea pills. I'm done with them. Back to sleep. I awoke at 7 am, put on my yoga pants, t-shirt and sweater, grabbed the leash and took our dog for a walk around the block, sipping on a bottle of water as we walked. It was 38 degrees outside, so we only did one block and came back in. I started my Full Liquid diet. I had my tea. Missing the caffeine. Throbbing headache. And sinus drainage. Nothing to do with the surgery, yet a welcomed distraction from Ethyl's whining. I made a pitcher full of Double-milk. 1 cup skim milk mixed with 1/3 cup of dry non-fat milk. Double milk = double protein intake. And foods made with it taste richer. I made instant grits with it. They were really creamy and... Well... FUNKY tasting. I'll have to work on that. I went on a shopping outing with my sister for about an hour, and found my legs feeling wobbly when we got home. i did well, but obviously need to lay low and quiet. I've been active enough today. I was told to go outside on Day 3. Check. I mixed 1/2 can of Campbell's Cream of Chicken with Herbs with 1/2 can of Campbell's Cream of Mushroom With Garlic soups and 3/4 cup of Double milk. Heated it up and poured it into a deep mug. Not only did it taste pretty good, it also tricked Ethyl into thinking I had chewed up a whole meal! I just sipped on it slowly over a couple of hours, intermittently sipping on water, too. Score! Ethyl didn't know the difference! I also had SF vanilla pudding and tomato soup, along with some of a protein drink. Everything was tolerated very well. I just have to be careful to not take in too much, too Fast. If I do, I cramp. And, walking around makes it subside faster. End of Day 3. Another 2 lbs gone. 10 total. Day 4. Lost another 3 lbs. 13 total. Wow! How can I drop THREE pounds in 10 hours?!? I checked again. Yep! Three pounds! I awoke feeling like I've had a setback. Guess Ethyl didn't like all the activity yesterday. It's noon and I'm still in bed only sipping tea. I need to go make some soup. The caffeine-withdrawal headache isn't as bad today. Time to walk. I feel lousy. Nothing specific. Just weak... Disjointed... And bummed that my adrenaline high is gone. I'm weepy. Broccoli Cheese soup mixed with double milk and heated. Peach tea. I need to cut myself some slack. I'm still on track and the intermittent blues are to be expected. No significant pain. Nausea totally gone. Today will be a Still and Quiet day.

How can I get the little weight scale tracking bar that I see here so frequently?

Had mine last Wednesday, April 17th and I'm already down 13 lbs. I'm thrilled!