ArcusX

Dark Places was her first novel. Maybe she got better and the next one will be on par with Gone Girl.

Looks like we have very similar tastes: "Inferno" is the only one I haven't read yet by Dan Brown. It's on my list. "Sycamore Row" - I saw this the other night and read the synopses, and it looked too similar to another one of his I recently read, "The Testament," so I'll pass. The Testament was good though. Baldacci: A recent discovery of mine. I like him better than Lee Child, but if you like Baldacci, check out Vince Flynn. I didn't want to like him just because of his name, but the first 2-3 books in the Mitch Rapp series were very good. King: I'm a long time fan. Just finished "Doctor sleep." "11/22/63" was awesome! "Gone Girl" - I really liked this one too. I have G. Flynn's previous book in my wish list, but haven't gotten to it yet. One you haven't touched that I recently read and really liked is "Brilliance" by Marcus Sakey.

I just finished Doctor sleep, and The Shining right before that. Did you read 11/22/63? My personal favorite.

In men's defense, it's not as though we can see you from across the room and know what your personality, intelligence or morals are. Can you imagine? "Hey Bob, take a look at her. I bet she's got a GREAT personality!" it's got to start somewhere... On the other hand, the flip side could be this: "Hey Bob, take a look at her. She can barely find the straw in her cocktail. And those tattoos! She probably has NO MORALS!"

Hey Dan, Actually the overall hasn't been as short as it may seem. I started in earnest last October with a previous employer / insurance. I got through all the stuff only to be denied because my employer explicitly excluded bariatric surgery from its coverage. Check my sig / past posts and you'll see. When I got this new job on 29-July I learned that my new insurance does, in fact, cover surgery. Within a couple of weeks, I was in a motorcycle accident and broke my shoulder. Fortunately, I hadn't made my elections yet for the new insurance, so I maxed everything - high-tier coverage & $2500 on FSA so i could cover the ambulance, physical therapy, etc. Now that I'm recovered, I reached out to my surgeon's office, and found that all that stuff I did like the endoscopy, etc., is good for a year, so they just had to submit all my info to the new insurance company. I made the move because i found that the coverage year ends 12/31, so i still have money to burn on the FSA, and I've already hit my deductibles and out of pocket maximums. Might as well try to take advantage!

Hi All: I was in the thick of this last year, ultimately to be denied by insurance because my employer specifically omitted bariatric surgeries of any kind from their coverage due to risk of complications. I found this decision to be an old one, and I set out on a mini-campaign to get this decision at least reviewed, if not changed. I spent about two weeks doing research, and sent a fact-filled, heart-felt letter to the CEO and VP of HR stating my case. When I did this, I posted here on what was VST the contents of my letter. At the time, this forum for research did not exist, and I felt this would be a good home for it. So for your reading pleasure, here's the link to the original post: http://www.bariatricpal.com/topic/237281-letter-to-human-resources-long/ I welcome/encourage any mods to move that post to this forum. Enjoy!

They're not telling me just yet. I emailed the coordinator this morning. She said they couldn't/wouldn't schedule me for pre-op before getting approved. She also said I needed to attend a sleeve class and the next one is next Thursday at 10:00 AM. Not exactly convenient, but I can make it happen. I guess I'm resigned to do as others are doing. Today so far, a couple of shakes, Water, a hard boiled egg and a handful of peanuts. When people say "shake" on the pre-op, how many ounces are they? I've been doing Isopure, which is 12-oz water w/ 2 scoops of powder for 210 cal / 50g Protein.

I think I'm going in on the 16th. I'm scheduled for that date, but I'm still waiting on approval. I actually got a call today from the surgeon's office saying they got a letter from insurance looking for proof of sleep apnea and diabetes. She said that was good. She said she'd get them the info today. My fear now is this shortens my pre-op phase. I'm not even scheduled for a pre-op appointment as a result. I feel like I should be doing something now that I'm not yet doing. What are you all doing today? Vitamins? Diet? Other supplements? As you can see in my sig, I got denied a year ago, and this came up somewhat quickly after starting a new job. Any help or advice is appreciated.

While tentatively scheduled for surgery on 16-December, I am awaiting approval. I just got a call today that the surgeon's office received a letter from insurance looking for proof of my sleep apnea and diabetes. She said that was good news. Fortunately, I saw the sleep doctor and had blood work in the past month or so, so she says I should be in good shape. My only worry now is that I think I'm supposed to be starting my pre-op diet, and they're holding off, pending approval. <sigh> - John

I've been absent from this site for around 10 or 11 months. Last year, starting in October, I started down the path of getting the sleeve done. Doctor's office said I was covered, and after loosing 25# and going through (and paying for) all the pre-op stuff, when they submitted me for approval in December, I found my employer expressly omitted WLS from their coverage. Fast forward and in August, I started a new job, and was pleased to find that WLS is covered under their plan. A week later, I broke my shoulder in a MC accident, so it gave me the opportunity to get the maximum coverage, and maximum FSA for medical. Now in order to maximize my deductibles, I'm looking at - and currently (tentatively) scheduled - for surgery on 16-December. I had done pretty well the first few months after being denied with keeping the weight I had lost off, but eventually I fell back into old habits. I didn't put it all back on - maybe around 10# of the original 15, but I'm not eating like I should. I'm not drinking nothing but Water the way I was, and the way I should. While I did get a letter from the surgeon's office Friday about needing to pay for the surgical assistant, I still don't know if I'm approved at this point. I had planned to call on Monday for an update anyway. I don't think the letter necessarily means I'm approved, and I think that's why I'm in the funk that I am. I know what I need to be doing, but I'm not motivated at all, feeling like I'm just going to get declined anyway.

don't know how good it is, but Fitbit has one: http://www.amazon.com/Fitbit-Wi-Fi-Smart-Scale-Black/dp/B0077L8YOO/ref=sr_1_1?ie=UTF8&qid=1360086913&sr=8-1&keywords=fitbit+aria Seems to have favorable reviews.

I've mentioned this before here in the Man Room, but the product is so good, it's worth repeating: if you shave with a razor, I highly recommend trying Billy Jealousy's Hydroplane Super Slick Shave Cream: http://www.amazon.com/Billy-Jealousy-Hydroplane-8-Ounce-Bottle/dp/B000A5CPJ4/ref=sr_1_1?ie=UTF8&qid=1360008459&sr=8-1&keywords=billy+jealousy I shave my head now too, and it works so much better than anything I ever used in a can. I regularly shave against the grain without any irritation, and I'm using a cheap Schick Extreme 3 disposable razor (for the contour of my head), and still get great results because of the cream. Do yourself a favor and try it. You probably won't go back!

I prefer the Isopure low/no carb powders. Vanilla, dutch chocolate and banana were all very good. I didn't like the Orange-Banana-Pineapple one at all. The one's KittenKate is referring to are the RTD bottles, which I was told were really good for your clear liquid stage immediately following surgery.

I posted a poll a while back. Celebrate came in on top for taste: http://www.verticalsleevetalk.com/topic/58030-chewable-multivitamin-taste-survey/

Statistically, bariatric surgery resolves 74-98% of obstructive sleep apnea.

Amy and All - I've had really good success at following recommendations by Consumer Reports. I think a year's subscription is only about $25 that is money well spent. I'm certain they have something for all sorts of fitness equipment - especially treadmills. Any recommendation I've followed from them, I've been extremely happy with.

After being denied, I'm continuing dieting. I'm still doing well. I fear too well. If it ever comes around, maybe my BMI will be too low... oh well. There are worse problems to have.

Sorry to hear about your complications, Princesstia. How did the doctor feel about your prognosis moving forward after the second surgery? Are the continuing discomfort what he expected? I would stay in CLOSE contact with the doctor's office until you feel better. Daily.

Thanks Nicolaz and Susie. And by the way, that passive aggressive approach is better than out-and-out "No!" and being obstructive to the process.

Some amature observations: She's against the surgery, but doesn't want to come right out and say so. This is the "passive aggressive'" approach. All excellent reasons you've given YOURSELF for moving forward with surgery. She doesn't get this part.. at least not yet. Here's where I have a little more direct experience. My wife doesn't work and I have little control over meal planning - particularly for dinner. I began this most recent diet in October. Here is my approach: I have 100% control over Breakfast and lunch during the work week. I drink an Isopure shake for breakfast and have a simple sandwich for lunch. If I snack, it's hard-boiled eggs that I prepare at home and bring in to work. I keep the stuff for sandwiches at work, and make them myself. I'd do this at home if I had to, but since I don't, and my only focus in the morning is getting out the door, this is what works for me. Dinner is where my control is lost. About half the time, she cooks meals that are not too bad for me, like stir fry vegetables The rest of the time - like just last night where she made frozen pizzas - it's up to me to simply control myself - my portions. My 9-year old ate twice as much pizza than I did last night. Simply put, I've made the decision to eat better (despite being denied for surgery from insurance), and if I fail to do that, I have only myself to blame. I think you're 100% right here. My guess is, if she ever becomes supportive, it won't be until post surgery and you're feeling good and she's able to see the results. My advice: Ever paid attention to the flight attendants safety talk/demonstration when you fly somewhere? When the oxygen mask falls from the ceiling, you are supposed to put your own mask on before assisting your children. This is because if you don't take care of yourself first, you may not be able to help anyone else. To me, this concept is universal. You first fund your own retirement and emergency savings, before funding your children's college. This same concept needs to be considered here for your health; if you do not take care of yourself first, you may not be alive to have that happy marriage. It's just like they say, it's up to you to make your self happy; it's not your wife's job to MAKE you happy - it's up to you. If you are not healthy and happy, it will make your marriage less healthy and happy. Your first duty is to yourself. Make the decision that's best for YOU, and make the rest work.

Best case scenario, they'll cover it for re-enrollment in June. But at least I'll have said my peace. I'll not pursue it further with them. If they do not make changes, my choices are to either look for a new job, self pay, or not do surgery at all.

Please do. I spent a lot of time looking for relevant and CURRENT statistical information. My reason for posting it here is maybe my time will be made more useful if others can benefit from it too.

Thanks. Edited! Don't want to get into any trouble

Today I'm sending the following letter off to the VP of HR and CC'ing the CEO. Hopefully you will never need to do anything similar, but in case you do, feel free to purger me. Enjoy! Dear <VP of HR>: My name is John and I have been with <my company> for a little over two years. I love working for <my company>. The people I work with are all second to none. We have a fantastic team here, and I wouldn’t trade it for anything. I’ve been married for 14 years and I have two boys, ages 7 and 9. I’m a Den Leader and Committee Member in my children’s Cub Scout Pack. Unfortunately, before the kids came along – in fact just after I married – I broke my foot and was in a cast for a long time – nearly 18 months. During that time, and the months that followed, I gained around 60 pounds, and have managed to slowly put on another 40 over the past 12 years. Now I’m what you would call Morbidly Obese. Worse, over the past 6 years I have also developed Type 2 Diabetes, Obstructive sleep Apnea and Gastroesophageal Reflux Disease (Acid Reflux). The diabetes and sleep apnea are serious conditions with potentially life threatening affects on the body. Besides the medical issues, it’s difficult to do things with my kids; it’s not fun staking a tent with 100 pounds of belly in your way. My weight was floating at around 290 pounds, which at 5’11” tall put my BMI over 40. When I saw my doctor in the fall and knowing that my weight was the main reason for all of my medical issues, I asked if he thought I was a candidate for some form of Weight Loss Surgery. You see, I’ve been with him for a while, and he’s always advised me to go the way of “eat less, move more.” Not in so many words, but that’s a good summary. This time he considered the thought and said he would refer me to someone he knew. I started down the road of research, attended a seminar, and following the seminar had a consultation with a bariatric surgeon. I was told that insurance had been verified, and since the first week of October, I have gone through all of the steps – and incurred the costs – needed to prepare for surgery. I’ve had an EGD and gallbladder ultrasound, a chest x-ray, a psychological evaluation and worked with a nutritionist for three months. I even lost about 25 pounds by the time all of my documentation was submitted to Cigna for approval, only to find that bariatric surgery of any kind is specifically excluded from my coverage. When I confirmed this finding with HR, I asked why bariatric surgery is excluded, this was the answer I got: “We don't cover it due to the other complications that can arise from this particular surgery which in turn can cause higher claims.” I have found it difficult to understand this policy. Research shows that bariatric surgery resolves – not just improves, but resolves – Type 2 Diabetes in 83% of cases, Sleep Apnea in 74-98% of cases, and GERD in 72-98% of cases. I would like to think that the decision to omit bariatric surgeries was made so many years ago and that the data has improved so much since then, if it were to be reconsidered and reevaluated today, <my company> might add this service to the benefits covered by the medical insurance offerings. The information below will illustrate that there is a cost associated with NOT offering bariatric surgery as a treatment option. Diabetes alone costs <company name> and its employees an estimated $2.6 Million annually. I have spent many hours gathering this information, and I hope that you at least take the few minutes it will take to read through the information herein: Obesity is one of the greatest public health and economic threats facing the United States. Approximately 72 million Americans are obese and, according to the American Society for Metabolic & Bariatric Surgery (ASMBS), about 18 million have morbid obesity (roughly 6% of the population). Obese individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals as well as an increased risk of developing more than 40 obesity-related diseases and conditions including Type 2 diabetes, heart disease and cancer. The federal government estimated that in 2008, annual obesity-related health spending reached $147 billion, double what it was a decade ago, and projects spending to rise to $344 billion each year by 2018. Co-morbidities associated with obesity: The evidence is overwhelming on the association of obesity to a number of medical conditions. These include: insulin resistance, glucose intolerance, diabetes mellitus (specific statistics for this co-morbidity provided below), hypertension, dyslipidemia (high cholesterol), sleep apnea, arthritis, hyperuricemia (gout), gall bladder disease, and certain types of cancer. The independent association of obesity seems also clearly established for coronary artery disease, heart failure, cardiac arrhythmia, stroke, and menstrual irregularities. http://www.ncbi.nlm....pubmed/10593535 Diabetes Statistics: Total: 25.8 million children and adults in the United States—8.3% of the population—have diabetes. <my company> having some 4,800 employees, statistically, 398 of them have diabetes. New Cases: 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older in 2010. Morbidity and Mortality of Diabetes 575]· In 2007, diabetes was listed as the underlying cause on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths. Complications of Diabetes Heart disease and stroke 025]· In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older. 025]· In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older. 025]· Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. 025]· The risk for stroke is 2 to 4 times higher among people with diabetes. High blood pressure 025]· In 2005-2008, of adults aged 20 years or older with self-reported diabetes, 67% had blood pressure greater than or equal to 140/90 mmHg or used prescription medications for hypertension. Blindness 025]· Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years. 025]· In 2005-2008, 4.2 million (28.5%) people with diabetes aged 40 years or older had diabetic retinopathy, and of these, almost 0.7 million (4.4% of those with diabetes) had advanced diabetic retinopathy that could lead to severe vision loss. Kidney disease 025]· Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008. 025]· In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease in the United States. 025]· In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States. Nervous system disease (Neuropathy) 025]· About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. Amputation 025]· More than 60% of nontraumatic lower-limb amputations occur in people with diabetes. 025]· In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes. Cost of Diabetes 575]· $174 billion: Total costs of diagnosed diabetes in the United States in 2007. That’s $6744 per person who has diabetes per year. $2,684,186 for the 389 <my company> employees per year 575]· $116 billion for direct medical costs 575]· $58 billion for indirect costs (disability, work loss, premature mortality) After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes. Bariatric surgery is the only reliable treatment that offers sustained, long-term weight loss. This results in cure or improvement in almost all of the obesity-associated diseases and translates into reduction in the relative risk of death or increased longevity of the operated morbidly obese population. Since the treatment of obesity-associated conditions is very costly, bariatric surgery also results in significant reductions in healthcare costs with a return on investment of 3 years. It is not just weight loss, it is health gain. http://www.ncbi.nlm....pubmed/19440652 The treatment of obesity and related comorbidities are significant financial burdens and sources of resource expenditure. This study was conducted in order to assess the impact of weight-reduction surgery on health-related costs. Patients having undergone bariatric surgery had significant reductions in mean percent initial excess weight loss (67.1%, P <0.001) and in percent change in initial body mass index (34.6%, P <0.001). Bariatric surgery patients had higher total costs for hospitalizations (per 1,000 patients) in the first year following cohort inception (surgery cohort = CDN 12,461,938 dollars; control cohort = CDN 3,609,680 dollars). At 5 years after cohort inception, average cumulative costs for operated patients were CDN 19,516,667 dollars versus CDN 25,264,608 dollars, for an absolute difference of almost CDN 6,000,000 dollars per 1,000 patients. Conslusion: Weight-reduction surgery in morbidly obese patients produces effective weight loss and decreases long-term direct health-care costs. The initial costs of surgery can be amortized over 3.5 years. http://www.ncbi.nlm....pubmed/15329183 Bariatric Surgery As Treatment For Obesity And Therefore Other Co-Moridities Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions and results in significant weight loss. In the United States, about 200,000 adults have metabolic/bariatric surgery each year. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques. The risk of death is about 0.1 percent and the overall likelihood of major complications is about 4 percent. The 30-day mortality rate for sleeve gastrectomy was 0.08 percent, while the rate for gastric bypass was 0.14 percent and 0.03 percent for gastric banding. These mortality and complication rates are lower than those typically associated with gallbladder or hip replacement surgery. One study published in 2010 in the Journal of the Society of Laparoendoscopic Surgeons by the Surgeons Group of Baton Rouge, following the groups first 100 consecutive Laparoscopic Sleeve Gastrectomy, a relatively newer procedure included the following results: The percentage of excess body weight loss at the 3- and 6-month marks was 34.2% and 49.1%, respectively. Comorbidities were also improved at the 3- and 6-month marks. Hypertension resolved in 38%, hyperlipidemia resolved in 19%, and diabetes in 46%. Complication rate during the first 6 months was 10%. Major complications included 2 patients with postoperative bleeding, 2 patients with acute renal failure from dehydration, and 1 postoperative bleeding patient who developed a gastric fistula. No surgical reintervention was required for any complication. Conclusion: Our technique is a safe method that is easily reproducible and does not require any modification. Laparoscopic sleeve gastrectomy is an excellent surgical option with a low complication rate. http://www.ncbi.nlm....les/PMC3083039/ In the March 26, 2012 issue of the New England Journal of Medicine, Schauer et a published “Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes.” In this randomized controlled trial, the efficacy of intensive medical diabetes management alone versus laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes was performed. The results were enlightening. In this specific population, the sleeve gastrectomy outcomes were equivalent to Roux-en-Y gastric bypass, a CMS covered surgical benefit. At the end of the one-year trial, hemoglobin A1C was 7.5 for intensive medical diabetes management, 6.4 for Roux-en-Y gastric bypass, and 6.6 for sleeve gastrectomy. As expected, weight loss outcomes had similar results namely, an end-point BMI (kg/m2) of 34.4 for intensive medical diabetes management, 26.8 for Roux-en-Y gastric bypass, and 27.2 for sleeve gastrectomy. Of note, when examining serious adverse events requiring hospitalizations, intensive medical diabetes management (non surgical treatment) and sleeve gastrectomy (bariatric surgery) hospitalizations were equivalent! (9 vs. 8 %, respectively). This trial was published in the New England Journal of Medicine, which leads all general medical journals in its impact factor. There is no question that this trial is of the highest methodological quality and should be part of the External Technology Assessment of the proposed decision memo. In the April 16, 2012 issue of the Archives of Surgery, Leonetti and colleagues published Obesity, Type 2 Diabetes Mellitus, and Other Comorbidities: A Prospective Cohort Study of Laparoscopic Sleeve Gastrectomy (LSG) vs. Medical Treatment. From trial initiation to trial end at 18 months, the medical treatment control group gained weight (BMI, 39 to 39.8 kg/m2) and saw modest declines in Fasting Plasma Glucose (FPG) (183 to 150 mg/dL). In contradistinction, the LSG group saw substantial declines in both weight, BMI 41.3 to 28.3 kg/m2) and FPG (166 to 97 mg/dL) (note that 100-150 is considered “pre-diabetic,” and below 100 is “normal”). Cardiac risk factor assessment showed consistent superiority of Laparoscopic Sleeve Gastrectomy over medical therapy particularly for Triglycerides, mg/dl (LSG, 169 to 97; Medical, 199 to 173). http://asmbs.org/201...verage-decision Since February 21, 2006, the Centers for Medicaid and Medicare Services (CMS) have covered Open and laparoscopic Roux-en-Y gastric bypass (RYGBP), open and laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS), and laparoscopic adjustable gastric banding (LAGB) are covered for Medicare beneficiaries who have a body-mass index > 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity. Also, effective June 27, 2012, Laparoscopic Sleeve Gastrectomy has been added to the list for National Coverage Determination (NCD) for Bariatric Surgery for Treatment of Morbid Obesity (100.1). http://alturl.com/wnbko I urge you to consider adding bariatric surgery to the list of covered services to <my company> medical insurance offerings by leaving you to ponder the following: How many morbidly obese senior citizens do you know? How many do you even see? I’d be willing to bet the number is zero – I know that I don’t know any – because obesity has been proven to shorten a person’s life expectancy. Sincerely,

You know... I never get tired of hearing that!