NotGivingUp2023

On 11/19/2022 at 7:02 PM, NewlySleeved12282020 said:

I had my surgery in December of 2020. Been experiencing reflux so bad. I have Blue Cross Blue Shield. I read on their website that your BMI can’t be below 35 and you have to have issues. I’m at a 31 BMI. I’m really hoping they approve the surgery because this reflux sucks.

did you ever have your surgery? I am where you are and diagnosed with extreme GERD, Barrett's Esophagus. Im chocking on acid. I see the nutritionist tomorrow. She said we are going over bypass pre-op diet. My surgeon didn't even sound like he was comfortable with a revision. So, I am a little confused. I know if you're under 35 with other health issues, it is covered and surgeon said with my health issues, he's not worried about the approval. He's more worried about the lifestyle changes and my health issues. I just don't know. What I am 100% certain of......I cannot live with this pain anymore. It doesn't matter what I eat, if I don't eat.

6 minutes ago, hayyouljkb said:

Hi! I am so sorry you are going through this. I am really surprised that your barium swallow test did not show anything if you are having such bad reflux.

All of this is so frustrating. You go through the first surgery thinking that everything will be just fine and then find out something else has to be done, and then you have to fight with insurances and Dr.'s just to help you. I am lucky, I have amazing Dr.'s who have fought, I just don't have an insurance who will help me.

I did not even know that the sleeve could cause reflux to get worse until I had a surgery consult in 2021. My reflux was slowly increasing since I was sleeved in 2015 and finally in 2020/2021 I could not take it any longer. Every night acid would come out of my nose, despite having an adjustable bed and practically sleeping sitting up, not eating or drinking 2-3 hours before bed. I was doing everything. I had an upper endoscopy that showed a hiatal hernia and I was referred to a surgeon. To my luck the surgeon was the leading bariatric surgeon in my region. He said that since I had the sleeve he could not fix my hernia that the only fix was to convert to the Bypass. I had no idea that was even an option, and he explained to me what was going on. I was blown away. He then sent me for the barium swallow. The radiologist said that she had never seen anyone with as bad reflux as I had. I refluxed the barium standing up! She had never seen that before. It was very clear what was needed and I was immediately fast-tracked through the Bariatric program since it had been so long since I had been through a program, and my first program was in a different area and through different insurance. Then came the brick wall. My insurance denied the surgery. They stated that my reflux was a complication from the first surgery, even though I had reflux prior to the surgery. I appealed and sent medical documentation to show I had reflux prior to the surgery and they still denied. I did 3 levels of appeal, and my surgeon also did a pier to pier review with the medical director with the insurance and they denied again. And I finally found out the real reason. I have my insurance through my husbands insurance through his work, and his company specifically excluded bariatric procedures, so bottom line, no matter the reason why I am getting the surgery they will not cover it because it is still coded as a bariatric surgery. And I have to now pay cash for the surgery. But it is worth it if it fixes the problem and I don't have to deal with the reflux!

However this is my experience with my insurance. I hope you don't have the same experience with your insurance.

Are there any other surgeons in your area? You are always free to get a second opinion. It is sad but sometimes you have to push Dr.'s to listen to you, and you have to be your own advocate and not wait for them. Please don't be afraid to fight for yourself and your health!!!

I would think that they would take into consideration the medication that you have to take, and the conditions that the reflux is already causing.

Good Luck!!!

I am so sorry you're dealing with this, as well! It just doesn't seem acceptable, just the hernia and reflux alone, is reason enough! Are you staying local to you or going to Mexico? I've read a lot of people going that route.

I did see another surgeon, a televisit. They took the time to review my medical history, before talking to me. They also called my insurance. Insurance will approve, depending on the circumstances. I doubt regain is one of them but that is the least of my worries, right now. However, this surgeon did not feel comfortable with my pulmonary arterial hypertension, to perform surgery. I go through this ALL the time! Never had an issue with surgery and my specialist says he has no issues, but Dr's hear that diagnosis and freak out!

I don't understand how the barium swallow doesn't show the reflux, either but an endoscopy and biopsy are much more reliable than an X-ray. If this Dr. has no intentions on moving forward, I will definitely have to find someone else, I just figured I would go with the associate of my original procedure. My surgeon actually left the state.

At least I will have the EGD's done, barium swallow, just had pulmonary tests done, EKG/ECG, complete blood panel and see the nutritionist Thursday. My insurance runs April-April, so I was hoping to get this done before the new year begins. I just wasn't sure if this is as extensive as the first surgery. That took a good 6 months to get through.

I wish you all the best! I know how bad reflux is, I have battled this since my late 20's but not to the point that I risk aspirating in my sleep. It is far too dangerous for me.

I am curious the process people went through for Sleeve to Bypass? I've been seeing a gastroenterologist for pain, nausea, vomiting. I have had 2 EGD's, both show chronic inflammation and gastritis, due to reflux. My surgeon is sounding very reluctant to do this surgery. I did get down to 115 lbs and have put on 50 lbs since my lowest. He is blaming the reflux on the weight gain, but I was at my lowest, when the first EGD showed inflammation due to reflux.

He just ordered a barium swallow, and all came back normal. I am seeing the nutritionist, she said she spoke with the surgeon, and we would be going over the new pre-op diet, since it is different than the sleeve and has changed since I had the sleeve in 2019.

I am afraid he will refuse to do the surgery and I will be left with this pain, nausea and vomiting; I have been battling for almost 3 years, with no relief. My gastroenterologist is at his wits end and doesn't want to continue seeing me go through this. I wake up choking on acid, had tests run by my pulmonologist and cardiologist. My asthma had gone away but returned. The surgeon also blames that on the weight gain.

Pre-sleeve, I had walked 27,000 steps in a year. This year, I am at 1.7 million steps and ride a stationary bike 10-15 miles a day. This is huge for me, I have something called Pulmonary Arterial Hypertension. Pre-sleeve, I was knocking on deaths door. I only found this "terminal" illness, from my pre-op tests for the sleeve. Since the weight loss, I went from 6 months to live, to medication that has me at "normal/high" levels vs "high". My specialist is afraid the weight gain is spiraling and illness progressing. What changed for me, the medication I take for PAH, you have to consume 250-300 calories per dose with 30-50% fat content. Otherwise, you get violently ill. I take 3 doses a day. When I was diagnosed and first 2 years, I was on a CADD pump and that medication didn't have dietary requirements.

Sorry for the long story........I just can't take the reflux (even though the barium swallow does not show but EGD definitely does and has, in 3 different tests) and the weight gain is scaring me to death.

What was your process with your surgeons, going from sleeve to bypass? Is this a long process? Did you have a difficult time with insurance approval? Any suggestions on getting this done?

Your experience and help, is greatly appreciated!