Dave_NW

The reason nobody at Tricare knew what you were talking about is because Tricare Prime does not require it. But a local surgeon MAY require it. And that's where the confusion sets in. Find a surgeon who does not require it, and you'll be good to go.

Dave

Another example of how everyone is different: I drink with all my meals. Not a lot, but sips of liquid to keep things moving. if I don't, my throat gets dry and I have a hard time swallowing. I discussed this practice with my nutritionist and surgeon, and they don't have a problem with it, since I'm not finding myself to be hungry soon after. So once again, it's an "everything in moderation based on your body" kind of thing.

Dave

I haven't had any issues at all, and have lost 100 pounds in just under seven months. Most people who aren't having issues don't post, so you never hear about them. Relax, have the surgery, and be successful. Why worry about something you probably won't ever have to face?

Dave

As you know, every doctor is different, and some require things others don't. For me, the calendar got in the way. The longest waits I had were due to the busy work schedule between my surgeon and I, and the Thanksgiving holiday period. But it still was quick.

My surgeon manages the bariatric surgery department of a very busy Seattle hospital. He has a psych, nutritionist, physician, insurance coordinator, and several medical support nurses right there on staff. I had four back-to-back evaluation appointments all on the same day, right there in his office. When they were done, I had completed everything I needed except an endoscopy and blood work. That was done within two weeks or so. I was approved for surgery within about three weeks of meeting the surgeon for the first time. It went very fast.

My timeline went like this:

Consult Referral from PCM to WL Surgeon 19-Aug-2010

Attended mandatory WL Seminar 25-Aug-2010

Four Appointments and First Consult with Surgeon and Office Staff 29-Sep-2010

Lab Blood Work 1-Oct-2010

Endoscopy 14-Oct-2010

Surgery Request Submitted to Insurance 15-Oct-2010

Surgery Approval Received from Insurance 20-Oct-2010

Consult - Ventral Hernia Repair (to be done during band surgery) 16-Nov-2010

WL Surgeon Second Consult/Sign Surgery Papers 16-Nov-2010

Lap Band Surgery 6-Dec-2010

Achieved 100 Pounds Lost 3-Jul-2011 (209 days after surgery)

Dave, doing the Happy Dance...

I'm a few days shy of seven months banded, and I hit 100 pounds lost as of today. (Yay!!!) So yes, you can definitely do it.

Good luck on your journey!

Dave

MAJOR MILESTONE for me today: I'm down 100 pounds! Yahoo!!!!! It's been 209 days since my surgery.

Oh yeah, I'm totally LOVING this band!

Dave

I just found out yesterday that tricare denied my lap band surgery. I am so sad and I don't know where to go from here. I sent in a letter of appeal yesterday as well, to try to get the ball rolling there. I really really wanted to have my surgery asap. I am over 100lbs but just barely and I have high chonlesterol and a long history of diabetes in my family but so far I don't have it yet. I wanted to avoid getting any sicker than I am already. Any advice on how to get them to approve me? I just feel like someone knock the wind out of my sails.

Sorry to hear about this. Tricare is very specific about what they will and won't pay for. Their website says these are the requirements to be approved for surgery:

<LI>Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints

You may want to ask Tricare to explain just why you were turned down. If your surgeon recommends you for surgery, they must think you're a good candidate. Hope your appeal works.

Good Luck!

Dave

Essentially, I've got about 100 pounds gone in six months. I'm off most of my meds, I can do my job better, I sleep better, I look years younger, and I look forward to living, not struggling with getting through a day. Oh yeah, the band is totally worth it.

But make no mistake: You need to be in charge. The band is just a tool toward weight loss, and you have to be the one to work that tool. If you manage it right, you can and will lose weight. The rest is all about how well you manage it, for your body and daily life.

Good luck on your journey!

Dave

I sure as heck hope the band isn't a sham. I'd hate to have to regain all this weight I've lost!!!

Seriously, it does work, but you need to figure out why it's not working so well for you. (Although 40 pounds since November isn't that bad. They say 1-2 pounds a week is normal, and that's about where you are.) It's not a magic bullet, as you know, but it does work very well once things are fine-tuned for your body. I'd say examine everything you're doing, (or not doing), go back to square one, and try doing something different. You have to manage the band, not let the band manage you.

Good luck!

Dave

As you get more fills your appetite will decrease, and it'll be easier to avoid Snacks and binge eating. If you aren't hungry all the time, you have a better chance to be successful with your weight loss. Schedule that appointment, and talk to your fill doctor about how to develop realistic expectations.

There is a period of time at first where you don't have enough Fluid in your band to affect your appetite, and any weight loss is due mainly to will power. They call that "bandster hell." You're in it. Once you have more in your band, you won't be hungry all the time, and the rest of the good work you're doing will have a better effect.

Check my ticker at the bottom of my signature. I'm living proof the band WILL work, once you get it fine-tuned for your body. Hang in there, and go see that doctor! Be aggressive with your questions, and insist they help you get some answers. You paid a lot for your band, and you deserve to have it working as it should. But just like any good tool, it needs to be used by an experienced person - that would be you.

Good luck!

Dave

I asked my surgeon when he came to visit my hospital bed as I was recovering from surgery. He said he'd put 3cc in my band during surgery. He said he does that routinely, because it helps the band stay in place more easily, and once stitched in place, it was less likely to slip. He's done a gazillion band surgeries, so I guess he knows what he's talking about.

Rather than feel like you were hoodwinked, maybe you should look at it the other way around. For me, it's better to discover you had Fluid in your band that you didn't know about, than to think you did and find out you didn't.

At my first fill, they removed all Fluid from my band, just to confirm how much was in it. (It was actually 3.2cc, as I recall.) Then they put it all back in, plus another 2cc past that. I've since had several more fills, and am currently at 9cc in a 14cc band.

Good luck on your journey!

Dave

I agree with Jake. We're here, but a lot of guys tend to keep to themselves. If you guys need anything I can provide, just shoot me a PM and I'll get you my best response.

Dave

Here's my quandry. So if we are counting calories and Protein and fat, sugar, etc., what actual 'role' does the band play? Is it that it shrinks your stomach so you get full faster? Sometimes I feel like if I had stuck to all of these guidelines to begin with, why did I need the band. I'm not trying to be negative here, I'm really asking. How do you feel the lap band is different from all the other programs we've tried?

What's different is that the lap band dims your appetite. It won't stop you from eating badly, or overeating. But if you aren't hungry all the time, you're more likely to be successful in long-term weight loss. As for daily management, you can take things to any extreme you want, but you don't necessarily need to do that. I don't actually count calories, in the traditional sense. I pay attention to, and maximize my Protein, minimize my carbs, and try not to eat a lot of sugar or fat. Actual calories consumed is less important to me. I can tell whether I've eaten 'good" or "bad" for the day by keeping track of what food I've eaten. I don't graze or snack, but I do allow for a planned, healthy midday meal, if I think I need one. it's an eating plan, not really a diet.

This link will probably help clear up some of the confusion. It's by Dr. Terry Simpson, titled "It is NOT About Restriction." I find it's a great help to explain things. http://drsimpson.net...estriction.html

Dave

How's your appetite? Are you still feeling full for several hours after a small amount of food? If your band slipped, you'd probably have pain or acid reflux, or some negative side effect. Stretching your pouch is unlikely, since you'd have to overeat quite often to force things to stretch.

Since so much of what you did was drink liquids, which pass through the band fairly easily, chances are good you did no permanent injury to things. I have days where I have to be very careful because things are really tight, then other days it seems like I can eat everything I want to. One test would be to do as they advise after a fill - go on liquids or mushies for a few days, and see if things don't return to your more normal level.

If you find yourself unexpectedly hungry, or if you experience anything unusual, call your doctor and ask them about it. I'm sure you're not the first person to drink too much and then wonder what happened.

Good luck!

Dave

I am also tri care prime and barely made the requirements!!! You can request a "special hearing" I think that's what it was called! I was almost denied, and became hysterical at 5pm the friday before my surgery, my MD office called to tell me the insurance company called them to tell them there where problems and they wanted more information!!!! Thank goodness they had super office people and the job got done and I got my surgery Monday morning!!!!

Tricare is never is to deal with that is why they aren't accepted in many doctors offices!!!

Good luck!!

Tricare is actually one of the easiest to deal with because their requrements are so specific. If you meet the requirements, you'll get approved. If you don't meet the requirements, you won't get approved. There is no middle ground. The only time I've ever heard of someone being denied by Tricare is if they either don't meet the requirements, or if the paperwork gets messed up. (But once it gets straightened out, the person gets approved, if they meet the requirements.) In my case, I had my approval within three business days of submittal.

The biggest reason Tricare isn't accepted by a lot of doctor's offices is because they won't pay for highly inflated billings. In the case of my surgery, the hospital and surgeon's office billed Tricare more than $75000 for my surgery. Tricare paid them $12000. The medical office has to be willing to accept what Tricare pays, and many of them don't want to do that.

Dave

I have a really stupid question because I'm confused. My PA this a.m. says that the band "won't help your hunger." I thought that was the purpose? She said it's only purpose was to control portion size. This was NOT the impression I was given while going through the process. Here is what I thought....The band will help control your portions by making you feel fuller longer (i.e. that helps my hunger, right?).

I'm confused....and also wondering why did I do this....I'm waiting for better results and not giving up yet because I can tell a difference. I'm glad in one instance that I did this because I've failed with WW, Bariatrics, etc. to only gain it back. I've lost some weight and even if this band stops me from gaining I would consider it a slight success

There is so much confusion and misinformation around. I've had one person at my surgeon's office tell me one thing, and then ten minutes later another person tells me something just the opposite. I've taken things under my own control, and I do what I think works best for me. So far, so good.

This link is one of the most informational links I've ever read. It will help clear up some of the confusion, and I know it'll help you, too. Dr. Terry Simpson "It is NOT About Restriction." (Moderators, how about making this link a sticky?) http://drsimpson.net...estriction.html

Dave

Hi everyone....I know that I havent reached my total goal yet, i have so much to lose that I havent set myself a total goal yet just a series of mini goals, but this one is significant to me.....I was banded in November 09 and have had a total of 4 new ports in the first year of the band so needless to say I have had a lot of setbacks......but I have still been trying really hard the entire time even though its needed a LOT of will power for the times when i go back in for a re op and start again almost from scratch with my fills!!!!!

For anyone who says that this is the easy option, tell them to talk to me and I will let them know how hard it can really be!!!!

Anyway I started at 150 kg (pre band) and have set a lot of mini goals for myself and I am so proud that when i hopped on the scales today I weighed in at 108.5kg.....under 110 I can't believe it!!!! Over 40kg in total lost now and I am so so plesed.....I am now full steam ahead on getting into double figures (under 100kg)

I havent weighed under 110 in over 15 years or more and havent been able to fit into a size 20 jeans since bfore i had children almost 18 years ago

I LOVE MY BAND!!!!!

Thaks for listening

That's excellent news, Stevee. Congratulations! You deserve a medal for having dealt with so many problems. Keep up the great work!

Dave

Nipper, I was banded two days before you, and I've lost 97 pounds so far. So I can tell you the band definitely does work, if it is managed right. I strongly recommend you revisit your processes - check what/when you're eating, your calories/protein/carb amounts, your restriction/fill levels, and anything else you need to do to get control over your situation. If your band is working properly, and if you're working it properly, you should be well on your way by now. Talk to your surgeon, and find out what's going on. Something is not right.

Good luck!

Dave

If I'm in a restaurant I need to be super aware of the size of the bite, and how much I chew. If I'm going to get stuck, it'll be in a restaurant. I've never gotten stuck at home. Hmm. That just occurred to me... Interesting!

So it may not be the shrimp as much as it's the location.

Dave

I don't know if Tricare has OFFICIALLY changed their requirements. They are quite specific about what they will cover, and what they won't, based on the Medicare standards. The following is taken directly from the Tricare website:

*****************************************

"Gastric Bypass

TRICARE covers gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery) is covered only when the beneficiary meets one of the following conditions:

• Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints
• Is 200 percent or more over ideal weight for height and bone structure
• Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown)"

***************************************

If you don't fall within these limits, Tricare will probably deny your request. if you DO fall within these limits, then something your surgeon's office is requesting is out of line. If you have any doubts, call Tricare directly and talk to them about what they will and won't pay for, and why you're being denied. This surgery is expensive, but there is no reason to pay for it if you don't need to.

Good luck!

Dave

Hello my name is Teresa

I was banded last tuesday june 21. I am starting to feel a bit better but I think that i am having some possible depression and am not sure what to do about it. I am looking for support from other banders that might be dealing with or have gone through a dark period and how it was resolved or is being resloved.

thanks

Teresa

Hi Teresa,

I'm not sure where you were banded, or which area you live in. Your band profile says one thing, but your surgeon info says another. I'm across the Sound from you (I think.) Have you asked your surgeon's office about support groups? Some will have their own group, or a counselor you can talk with about things. If you happen to be military, you may be able to ask Madigan Hospital or your primary physician if there are any groups they can recommend in your area. If you're actually in Bellingham, give a call to Dr. Walt Medlin's office - he runs a support group that is open to any bariatric patient. When I attended a meeting last year, it was all bypass patients, but they were very welcoming. If you can't find any place to go to, post your questions here. There are lots of folks at LBT who have been right where you are. Don't be afraid to ask for assistance.

After I was banded I had a period when I was wondering what the heck I'd done to myself. I was sore and feeling pretty sorry for myself. I could only drink a little bit of Fluid at a time, and I was feeling pretty much on my own. I was mourning the loss of being able to eat like I had pre-surgery. But I had read about so many band success stories, I knew I had to just dig in my heels and follow through with the plan I'd started for myself. Within a few weeks my discomfort was gone, I was back to eating real food (from a bandster's perspective,) and I was up and around like normal. My biggest life journey had finally gotten started. And I have never looked back. Six months later I am well down the road toward my goal, and I am absolutely delighted. Nothing I have ever done for myself has been as rewarding.

Hang in there. It does get better. Good luck!

Dave

Pre-banding, I ate like I was on fire. Speed was everything. (Blame the 20 years I spent in the Navy - there was always a lot of food, but never enough time to eat it at normal speed. I could clear a full tray of food in a matter of five minutes.) Now, I eat much more slowly, because eating fast causes me to get stuck. I don't have the time to wait a full minute between bites - that just wouldn't work for me. But I can feel when food passes through my band, so I know when I can have another bite, or at least when to slow down. I try to chew well, but it doesn't always work so easily, especially at different times of day. So each meal is a matter of swallow-and-feel-how-its-going. If I feel food hasn't passed through the band, I put down my fork and wait till I feel the pressure change as it does move through. It's a new feeling for me, but seems to be a good indicator of where I am with that meal.

I also can't do just three meals a day. I get a hypoglycemic thing, and my blood sugars drops, (I guess?), and I get shaky if I don't eat. But if I eat a few ounces of dense Protein about every four hours or so, I'm good to go. I don't snack or graze, in the "junk food" sense of the word. If I need a snack, I make it a healthy one, or part of a Protein Bar, or something that matters. And I count those calories in my daily tally, because I know there is no such thing as a free lunch. (Or mid-afternoon snack, or nighttime munchies... ) When I read about people who say they're "cheating" with junk food, or grazing on bad food all day, I just don't see how that's possible to do. At least for me - everyone does things their own way. (I have a banded cowroker who eats junk food all day, drinks soda like there's no tomorrow, and never exercises, then complains that he isn't losing weight. Duh!)

Given how much my stomach growls and roils and rumbles throughout the day since banding, Jacqui's comments about food passing up and down through the band all day makes sense. I don't remember my system ever being this loud before, and since I'm eating way less than before, I couldn't figure out why there was so much going on. Must be a quantity of food thing.

And the incredible, long, loud, deep belches? OMG!!! Jeez, sometimes I feel like I should be a trucker or something. LOL!

Dave

This article describes a phony "doctor" who was arrested in Oregon. if you read the article, the woman who ended his charade was someone who had given him "several thousand dollars for gastric bypass surgery." Now maybe it's just me, but don't you think a potential patient for this kind of surgery would do a smidge of research into her potential surgeon, before letting just anyone cut them open? Strange how trusting some people are. Or how easily they can be duped, I guess. Good thing the surgery never happened!

Dave

http://abcnews.go.com/Health/lucas-orlin-ebert-poses-doctor-dangerously-treats-patient/story?id=13922730

Welcome! Search the forums here. There are numerous threads about Tricare Prime and getting approvals. They are one of the easiest insurance carriers to work with, and approvals are pretty fast. I have Tricare Prime, and from the time my surgeon submitted my request for surgery to the day of approval, it was three business days.

I met my surgeon twice before surgery, but still had an evaluation with him, a psychologist, a physician, a nutritionist, and an insurance coordinator. I had extensve blood work done at a lab, an endoscopy, and an evaluation with another surgeon for repairing a ventral hernia. Despite all of that, the entire process took less than three weeks. If you meet the Tricare requirements, approval will be very fast.

Yes, they pay for fills, as well as followup visits. They also paid for the entire surgery, with no deductible. My total out of pocket since starting this is less than $400. That includes copays.

Good luck!

Dave

Boy, am I out of touch. I read the title of your post, and thought you were eating the seeds that come with a Chia Pet! LOL!

Dave