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Thanks for all the well wishes everyone! I've actually been doing alright - not too hungry, bit of a gas pain everyonce and a while still but I also know I haven't been walking as much as I should (and to top it off it snowed today lol). But I'm doing alright! Looking forward to moving onto the full liquids stage as the Clear Liquids is starting to get a bit boring. Today was a quiet day so even for day 3 post surgery, it wasn't too shabby. I did however get to take a shower today - first day since surgery that I was allowed and well - that was quite the experience. We just have a stand up shower stall so DF stood at the open door and took a wash cloth to all the iodine, etc on my belly. The Water wasn't super hot the way I usually like it as I thought it was probably not a good idea on my tummy. I had just finished washing my hair and rinsing it when I knew bad things were about to happen. I think it is from a lack of calories/nutrients and the hot water as I opened the door and told DF "must sit now" (he was waiting outside the shower for me in case I needed him) as I knew if I didn't sit down I would have passed out in the bathroom (which isnt very spacious). So dripping wet I made a beeline for the toilet seat and had to sit there, leaning against him while the dark cloud came over me (I don't know if any of you have ever passed out before or almost passed out - but it's not fun). This is not a feeling that I am a stranger too and I knew the signs that it was coming - I've had issues with this since I was a kid (blood tests come back fine though everytime and it's VERY sporadic and occasional). I was leaning against him and I think I did actually pass out (wasn't from pain as I wasn't in any) leaning against him. When I was able to we got me to the bed, I lay down and just chilled there for about an hour. So note to everyone, if your low on your calories/blood sugar, careful with warm showers as that is usually what triggers me on my "near black out" moments, and post-surgery was no exception. On an exciting note - my official "weight day" isn't until Wednesday so I am not updating or putting it on my tracker but so far - down 8 lbs since surgery on the 23rd. I realize that I will likely gain some of this back once I start mushies but I'll be so damn happy to have mushies I don't think I will care!! Hope everyone is doing well! *big hugs and well wishes to you all* It's actually been my experience (as well as that of friends) but also what has been told to me on more than one occasion by doctors. Thank you! If you check out the Canada boards there is a group that posts under different threads related to BC Bandsters, you should check them out some time. None of the lapband procedure is covered by BC Medical unfortunately, and likely won't be any time soon. Gastric Bypass is covered but I believe the waitlist is about 6 years now for it if you have it paid for by medical. I don't know if he does bypasses or not (I don't think he does though) but he does do the "sleeve". His cost is $400 consulation fee (first time you meet with him) and the cost of the surgery is $14,000 (includes free aftercare fills no charge for them). I believe he is accepting patients you just have to call and ask how to go about getting a consult (they send you a questionnaire to fill out) - I'll pm you his number. I will say though - if you are seriously considering the band and have the money to self pay - give it great thought before going to Mexico or the US at this point. Not due to lack of great surgeons but due to there not being very much aftercare options in BC right now. Dr.Leung in Surrey also does the lapband and WILL NOT accept any other surgeons patients. Dr.Woodhead *may* and I say that with great emphasis as I know he prefers not to as well. Other than that, your only other option for aftercare would be to travel to Everett area in Washington to one of the fill places there. So be sure you check out all of your options before settling on a location/surgeon. I would have loved to go to Dr.Kirschenbaum in Denver for a cheaper price but figured by the time I have to go through the hassell and paying for fills (most places charge $150-200 in the states , per fill) that it wasn't worth it and that it was worth shelling out the extra $5000 up front. Good luck on your journey and decisions, feel free to message me at any time. :cursing:

Don't fall for that crap... the only thing that will fix sagging skin or wrinkles is a face lift or some type of surgery. All the claims are just BS. !!!

Congrats & good luck to both of y'all. I was out patient as well so not much advice on that lol. But like Bandista said, WALK, WALK, & WALK some more. It really does help. I wasn't nervous at all! I guess bc I was so obsessed & ready to get my life back. I will say its not been easy, but everyone is different. Just listen to ur body & doctor. I go tomorrow for my 1st fill & I'm not looking forward to going back on liquids & basically starting over when I finally just starting eating last week. But it'll be ok & I know totally worth it! 2MuchFun, love ur post.

Thank you for that info!! My surgeon is Dr.Coates in Modesto!! I looked up Anthem Blue Cross's Medical Policy online and it says they cover the sleeve if you are an eligible candidate. Here's the link: http://www.anthem.com/ca/medicalpolicies/policies/mp_pw_a053317.htm It is listed in the first paragragh along with all the other types of WLS. It is listed as "Sleeve Gastrectomy" This may or may not be the info you need but DONT GIVE UP!! I would call your insurance directly and ask how you can view their medical policy online. They should be able to provide you with a link to your actual plan with them. And it is always better to see it in writing yourself rather than to be possibly told numerous things by different agents... Thank you so much for the advice about maybe having to be with them for a certain amount of time before the surgery is covered. That's a great question to ask my insurance lady when I go in tomorrow to possibly switch my plan!!! As far as Dr.Coates office having a contract with Anthem Blue Cross,I talked to about 4 ppl from their office yesterday that confirmed that Anthem Blue Cross does cover the sleeve with them,bc I kept calling back to make sure!! LOL. I would call Dr.Coates office and talk to them if you may still want to have the surgery done there. They are very helpful and have an awesome pre-authorization worker!! I'm sure if you give her your exact insurance info as far as what plan you are under with Anthem Blue Cross,she should be able to give you some valuable advice. Hope this helps-It would be awesome to go through this journey with someone local!!!

Hi! I also have BCBS FED.... My last NUT appointment is in April. They best advice I could give is to read through your policy and call customer service if you have any questions. My BMI is 40 with no co morb. BCBS doesnt make you lose weight but your surgeon may have you lose some. I had to lose 10% of my excess body weight and that was 8 pounds. It is my understanding that BCBS uses your start weight.

Welcome to a day in the life. We all experience what we term as bandster hell when we are first banded and we don’t have that right level of “restriction”. It’s the holy grail that we bandsters search for. It’s that spot between just right and too tight….and some of us walk that line pretty close and even those of us that think we are not walking that line, could be sitting right on it and all it takes is one small thing to push you over it and I'm over it. In July I had a fill that left me in my just right zone. I was feeling good and eating small portions and working out and banded life was just great. Enter my “real” life and all that goes out the window. I have great band mechanics. I take small bites I chew chew chew. I eat within my 20 minute range time, and I have so much stress in my life I don’t know how I have not had several breakdowns. Must be that spine of steel I often joke about and those brass balls that I keep in a nice little box. I could tell you stories my band friends that would probably curl your hair. There is going to be a time when I sit down and write out all these things because you couldn’t make these things up if you tried and who the heck would want to?! I know we all have our ups and downs but these things are extraordinary, it just doesn't lend to that comic genius in my writing just yet but someday I'll work on it. I am not one that doesn’t practice what she preaches. In fact I won’t sit and talk about anything in a support group that I don’t know about. I am one of those avid learners (yes you might say geek) that will go to school, learn it practice it and then speak about it. Recently I went back to school to become a nutritionist, it’s important to me and my friend and my family so I did it! I really don't have an affinity for people that talk out their ass, or people who look down their nose at people like me because we are obese. It's hard to listen to the twiggy nutritionists talk when they have no idea what it's like to be in my skin. Words are great, but experience, understanding and empathy is what reaches me. OK so my BIG problem….I do too much! I don’t know how to slow down until something crashes into me literally and so that brings me to where I find myself today. In the last couple of months I have had a major car accident, that kept me out of work for 3 whole days! To me that’s a long time, and has kept my body in aches and pains, muscle trauma, and a concussion for about a month. I had to stop going to the gym and working out and I really felt like that was a huge set back for me after finishing my first 5K and finally starting to feel like going to the gym wasn’t the heart attack it once was. On top of that I got sick and had swollen glands and this lovely virus on top of my allergies which has me sliming my head off day and night. Over the course of all this and all the medication that Dr.’s shove down your throat for this symptom and that, my band got tighter and tighter and tighter until last night I hiccupped and (TMI gross alert) vomit came shooting out my mouth and across the room from the sip of Water I just drank! I knew I had to get to the baratric Dr. this was just not right. I knew I had been tight, and I knew that stress was not letting up any time soon. 5 kids, who have varying degrees of drama they like to give their mother a heart attack with on a nearly minute to minute basis, one husband, and then we have two new additions to our family. The furry four legged kind two lovely little PinTzu’s. They are the joy to my day in the morning and at night after a rough work day, but you know what it’s just like having new babies. I love it and the hubs is getting used to it he has never had dogs before so much of the pressure to “train” them all husband and pups and family members that live at home is on me to keep consistency. This morning I woke up and I could barely take my morning meds, and swallow my saliva. Add to that some post nasal drip from being sick and allergies and I knew it was time to see the doctor ASAP. So I called and wouldn’t you know I got the whole we don’t open till 9 am thing. Which is BS I know they are there early in the morning but they don’t open the phone lines until 9 and I wasn’t waiting. I drove straight there and of course once I got there and I told them what was going on with me..they took me in right away. I went down for a video esophageal or barium swallow and x-ray. Wouldn't you know it, sure enough that pouch was dilated. They had to remove 5cc of Fluid and I am now on a 3 week liquid diet to see if the dilation goes back to normal. Ugh, but you know what I have to say…nothing bad! I am grateful that I have a great Dr.’s office and good doctors to take care of me. I am glad that I did not wait for longer to get myself in there and have things checked out so my band didn’t slip or prolapse. I’m confident that I can make it through this liquid diet I have done it before and I will do it again! It is a lesson to learn, a BIG BIG one for me. I can’t tell you how many friends of mine have told me time and again to slow down and stop doing so much to just relax and let things flow. I really honestly have an issue with it. I can be lazy sure we all can and I do have days where I do nothing but vege out and watch TV or read. Most of the time though I just cram every second with something. There are things I want to do, and I find I am always battling against the things that I have to do, and my “responsibilities” and commitments. Those things make me feel pressured to be more and do more. It’s exhausting and I always get to the point where something has to knock me down to sit me down. This can’t be a good thing. So here I am in band “reset” mode. What have I learned from this….? Or perhaps the better question is what will I learn from this? So far today I have learned that I need to put up some really strong boundaries. I can’t save the world unless of course the power that be would like to get behind my idea of dropping large portions of Prozac in the water supply of all the middle eastern and certain other countries....happy people just don't decapitate other people. I don’t know quite yet how I am going to corral the issues that I have with my children and my family, those seem to plague me the worst. I have come to realize that work is work and I can give that 100% of effort in relation to the amount of effort extrapolated by those around me which should leave me with plenty of reserve energy to get to the gym and take care of myself. I am going to set some small goals, and keep myself accountable to them. Not just when it comes to my band but when it comes to taking care of myself as a whole person. I am going to keep myself accountable… Today’s goal: Body: Set a pattern for liquid diet protocol and hydrate in between. Mind: Get outside for some fresh air Soul: Practice some deep breathing

hello coneflower! I love your attitude and your patience is something I admire! Congrats on being so close to getting all your ducks in line for surgery! This forum is such a great place to get started! I will spare you my story here...bc I am rather long winded and ramble a lot :tt1:, but the link to my blog is in my signature. The lapband blogs out there are so full of information, laughter, truth...and really great people! Good luck and holler if you have any questions! Amy

I do still have it in my system they say once you have it , its almost impossible to get it completely out your system but I can definitely tell its there BC I have the heart burn with anything I eat. I'll keep ya posted!

I've never had regular periods. In fact, AF went missing pretty much between 1995 and 2005. (then I had babies and they sorta kinda came back every 5-6 weeks) And I have PCOS. I don't want to get pregnant right now because I'm on this weight loss journey so first I was put on Yaz. But my periods started happening EVERY 3 FREAKING WEEKS! I complained to my doc and he said Yaz shouldn't be perscribed to overweight women bc it doesn't have enough hormones for the weight. So he put me on Microgestin, which is supposed to be stronger. So finally the first month, I got 4 weeks between periods. And now, 2 weeks after my last AF, she's here AGAIN! What gives???? I've had AF FIVE times in 2.5 months! (which happens to coincide with when I started the whole lap band thing...) Someone please tell me you've been through this...

I have multiple pairs of Old Navy St Johns Bay and Lane Bryant shorts for sale in sizes 22. I bought them bigger bc I have a larger hip/butt area....email me Simms148@gmail.com if interested. I will send pics and will pay for shipping.

I was not told to stop the pill...? hmm weird, he actually said you might want to double up on bc because you will become more fertile!

Congrats!! June 10th...that is so exciting and scary at the same time. I had originally set a date for June 19, but had to change it bc of nursing clinicals. I still have every intention of having it done but I have to work around class but I will eventually get it all in order. I am so happy for you. It sounds like we have both done a lot of thinking and praying about this. I know that it has and still is one of the hardest decisions that I have ever tried to make, but I do feel like it is in my best interest to do it. Thank you so much for sharing with me and I would love to know how everything goes for you. Will you be at Trinity or at the surgery center? I will be going to the surgery center bc I am self pay and I will still have the same wonderful doctor, it will just cost a little less. FYI, I heard that Dr. T and Pennington are wonderful. I work with a few nurses that think the world of both of them, not only of their bedside manner but also of their skills. I think you will be in good hands. I will keep you in my prayers and hope you have a speedy and painless recovery. Please let us all know how you are doing as soon as you feel up to it. GOOD LUCK!

Ummm... You're maybe not losing Bc you're "eating whatever you want". Anyway, try less than 50 carbs a day. You'll start losing again.

Banana. You did not deserve the unprofessional scolding. Could your hormonal issue be treated by a family practitioner? All of us have experience people that value appearance. It's fed to us daily. We are bombarded with the message we are not good enough just to sell us a products. The only validation you need comes from you. The rest of the world can bite it.

So I am looking to have this surgery and going through all my glasses required by my surgeon and so forth it's a total of a 6 month program I'm on my 4 th month but my main concern is I'm 270 lbs and so afraid of having loose skin and my insurance not covering skin surgery I'm interested in hearing from people who have had this surgery around my weight and if they had a bunch of loose skin at my classes they say bc I'm young yet 36( not that young lol) that it will still have a lot of elasticity I have had three kids and just don't wanna have a bunch of loose skin and stretch marks already have the stretch marks. Anyone's stories or ways to prevent loose skin ect would be greatly appreciated Sent from my iPhone using the BariatricPal App

So I'm looking to do the powder mix for Protein shake bc it seems cheaper then the pre made. Does anyone have a good affordable suggestion for two week pre op diet ???? I see the surgeon tomorrow to find out when my surgery will be!!! Sent from my iPhone using the BariatricPal App

geez..the company makes enough money to just let someone order off the kids menu. i would write a letter to their home office. i have found most restaurants are accomodating, i've yet to have been told no. im waiting for the day tho. lol. but yea, so dumb, bc they lost out..they couldnt let u pay for a what..$6-8 meal..instead they'd rather not take ur money? ugh..this fustrates me.

You did good-- ate and didnt feel left out... I have a friend who had the band last year and I'm amazed by how much (and what) she eats. She hasn't lost much and has been stalled for months. She's so discouraged. My heart feels so badly for her bc I know she isn't happy.

Hi. I'm new on here, well at least for posting or replying, but I have lounged around and read for almost a year. I tried to go through bc/bs last year and they refused to pay bc my weight has always went up and down so now I have decided to just go ahead and pay out of pocket (which is a really big decision bc I am in nursing school right now). To make a long story short, Dr. T will also be my doctor but I will be going through the surgery clinic and not the hospital. I am really nervous and really scared but at the same time very very excited. Will you please tell me about your experience with Dr. T? Maybe give me some helpful hints such as what is clear liquid besides broth, jello, and water and anything else that will make this journey a little easier and a little less mentally exhausting. I think I can handle the physical pain but I am really trying to pump myself up to help with the mental/head hunger stuff that I hear everyone talking about. I sent this to you bc I saw that Dr. T was your doctor but I appreciate any info/advice that anyone wants to give. I am new to this so as much research and studing that I have done, I still know there are those that are already banded that can tell me hundreds of things that I dont know yet. Wish me luck, I hope to have this done the month of June if all goes well, if not it will definitely be in July.

It doesn't sound to me like u did damage but it sounds like its just irritated. Can you take some pepto or a acid blocker? Try that if u can. Also, can't remember who asked about medicine. If your able to what I did with Medicine is I asked for liquid medication and then paid to Flavor it. Those rx u can't get in liquid I would put in applesauce and do like a chaser of a drink. I always did a sip of soy milk. Be quick at it like spoon then SIP-swallow. That's what helped me and make sure u rinse ur mouth after medication. I was on antibiotics liquid and didn't do this and it caused thrush in my mouth severe. Hope that helps yall. I feel for ya bc I've been there. ((Hugs))

I followed up with my NUT and gave her the example of what I am eating she said any Calcium (yogurt, 1-2oz soft cheese, milk ect) does not count as a meal and I can add Protein powder to it for my daily goal but I should have 3 servings of calcium a day and as for my meals - it is normal that I can "hold" 4-5oz right now but she wants me to aim for 1-3oz instead bc my pouch is still healing. I have stopped eating as I was before & started doing only 1-3oz 1x a day and just protein shakes the rest of the time. Sent from my Z970 using the BariatricPal App

ok. yay so im sooo excited. yesterday was my pre op appt where i met the surgeon and did the rest of my tests. so im all good to go. im on optifast for the rest of the week. its day 1 today and its not too bad, i feel im can do it, hey i been doing it, but everyone around me thinks i cant. great encouragement guys!! i mean come on!! i wish i had some more support around me physically. oh well i can do it no matter what. so yea, my surgery is next thursday the 13th at 10am..sooo happy. its gonna be such a long week.lol the time is not going to wana pass bc im so excited. well gotta go have another optifast. yay. lol:thumbup:

I am having a really hard time right now. I am EATING anything and everything. I am Pre-op and my consultation appointment isn't until April 11th and I feel like I'm gorging myself... I'm sure I'm not the only one who has done this bit I can't seem to get my head on straight! It's terrible and I feel so bad. On one hand I'm like, "I'm not going to be able to eat ANYTHING for over 6+ months." On the other hand I'm like, "you are dumb! Hello?! This is why you NEED surgery-stop!" I'm lost and don't know what to do. My surgeon is DR Malik in Victoria, BC. And I haven't even met the man yet and I'm scared he's going to make me do a 6 month diet. I've been on a 18 year diet lol! I don't think I could handle another 6 months.. I'm sorry, but I needed to get this off of my mind and no one in my life really understands. I could talk to my hubby and he would be supportive, but he wouldn't be able to truly know where I'm coming from. Thanks Sheena

just reading this ... I have 4 more days of fluids only and soooo fed up! a little encouraged to hang in there for a bit more but if I see another chicken soup am going to scream!!!!

Help Center -Department of Managed Care This I my appeal letter to ask that you reconsider and approve the Sleeve Gastrectomy Weight Loss Surgery that was denied by Anthem Blue Cross because they consider the procedure investigational. I believe this surgery is exactly the tool I need to improve my health and the quality of the rest of my life. I have been told by several of Anthem Blue Cross customer service representatives that 43775 is a covered procedure and that as long as my HMO approved they would pay for the surgery. This is not what I am being told now. I have been getting the runaround on this for two months. I received a letter from my HMO dated 2/6/10(copy enclosed) stating this is not a denial of service but Anthem considers this procedure experimental and has to go to the Utilization Dept for a decision. The number to call this department was on the letter. I called this Dept. a minimum of 5 times and was told they don’t know what I am talking about, this dept. doesn’t handle HMO. So I call my HMO and they say “oh you have to appeal” so I send my appeal letter to Anthem on 2/16 and wait the 30 days for a decision. On the 28th day they inform me that I cannot appeal because I haven’t been denied, oh and the people in the Utilization Dept. don’t know that their department handles this?? So they send it back to the Utilization Dept and now I have officially been denied. This part of this process has taken two months, very frustrating. I. PATIENT BACKGROUND My name is Jeani Xxxxxxx and I am insured under group plan xxxxxxxxxx. My member ID # xxxxxxxxxxxxx. I am now 59 years old. I am 5/5 tall and at this time I weigh 233 lbs. I am seeking approval for weight loss surgery. I have been overweight to one degree or another since I was a young child and was advised by my pediatrician to diet at age 10. I have made numerous efforts at weight loss throughout my teenage years and adult life. I dieted frequently as a teenager and young adult. Numerous times I have lost 40-80 pounds or more but eventually the weight returns. Weight loss programs I tried include juice fasts, traditional calorie counting on quite a few occasions, Weight Watchers, Slim Fast, Nurti-system, the Atkins diet, Cabbage soup, Mayo Clinic diet, the Zone, gym membership, lap swimming, weight training, water aerobics, walking programs, various buddy-system diets and individual, self hypnosis, ”Think yourself Thin” “ Think yourself Thin Automatically, tape you listen to in the car” Dexatrim, Metabalite, Hoodia, Green Tea Extract, and numerous other fad diets. In all cases I lost weight but each time the weight crept back, usually with a little more. Eventually I realized that traditional dieting seemed to actually cause weight gain due to increased hunger that seems to occur after significant weight loss. I believe science is only now beginning to understand the reasons for this phenomenon which is consistently reported by clinically obese people. Studies also show that genetics plays a larger role than once thought and there are morbidly obese people in my family as well as slim people. My co-morbidities include high blood pressure, high triglycerides, low good cholesterol, have had abnormal EKGs, borderline diabetes, and osteoarthritis in my hip, which my doctor said weight loss would help significantly. I have also had sever back pain most of my life. I take hydrochlorothiazide and verapamil for high blood pressure which is effective. I take medicine, Niacin for high triglycerides. I have a family history of cancer as well as strokes, heart disease and severe arthritis. I take nabumetone almost daily and ibuprofen to help with severe leg pain related to arthritis in my hip. I have taken ibuprofin for back pain that i have had most of my life even when I was not overweight. I believe I will need NSAIDS even after WLS which is why I need the sleeve as this is the only WLS that you can still take anti-inflammatory medications. I buy over the counter ibuprofen as I can get 500-200mg pills for $10.00 which last over 6 months, whereas when getting prescription I only get 30 -800 milligrams for a co-payment of $10 which only last a month. My excess weight and other health issues makes everyday activities difficult including housework, shopping, standing, walking significant distances, working and recreation. It effectively makes my world smaller limiting the number of things I can do each day. I have lived with obesity for years and strongly wish to change this aspect of my life. I fear the consequences of my high triglycerides especially considering the family history i have of heart disease. Many members of my family died of heart attack and stroke. I was stunned to learn that my weight is in the obese category but heartened to learn of this newer treatment with fewer side effects and shorter recovery. I am highly motivated to succeed with VSG and understand that food intake will be significantly limited for the rest of my life and that I must continue to exercise to be successful. Before I found out about the arthritis, which is the result of a subtle fracture at some point in my life that affected the curvature and angle of my right hip bone (this was found by an MRI that was done after pain medication didn’t help and physical therapy made the pain worst), I used to walk a minimum of 30-60 minutes a day at least 5 days a week. Since this pain in my leg as a result of the hip arthritis I no longer can do that and I am afraid that the weight will just continue to creep up on me. My particular problem is in volume eating. I eat good food, lots of chicken and turkey, lots of fruits and vegetables, the thing is I am always hungry and I eat until I am full. Having a smaller stomach and feeling full sooner seems like exactly the kind of help I need. I had given up on traditional dieting as it always resulted in failure and am pleased to have found the VSG surgical option which appears to be the only tool offering a realistic possibility of lifelong weight control for me. I believe VSG is the best surgery for me because it offers restriction like the lap-band and the RNY but without the malabsorption of the RNY. The RNY is not an option because I very much need regular doses of nabumetone and ibuprofen for the leg pain related to my hip pain and even once I lose the weight believe I will still need ibuprofen for my back pain which I have suffered with most of my adult life. Tylenol is not effective for me. I am allergic to codeine, vicodin, any pain medication of that type I cannot take. Narcotic pain relievers make my head seem fuzzy but do not help with pain. I have the same concern about the lap band. I also understand that as many as 27 percent of lap band patients require band removal and weight loss is often unsatisfactory (I think the number is even higher now). Most importantly, the VSG removal of a large portion of the stomach removes many of the cells that produce the hormone ghrelin which is known to cause hunger and appetite. The RNY and lap band don’t have this advantage. At age 59 I am concerned about the side effects of the RNY and do not want to spend 6 or more months with dumping syndrome and feeling rotten. I also worry about the ability to take and absorb other medications I might need in the future as I age. The VSG appears to offer the fastest recovery, weight loss similar to the RNY and the least amount of side effects. One recent publication, “The Best Bariatric Operation for Older Patients “ by Drs Lee, Cirangle, Taller, Feng and Jossart, 2005, concludes that “These data suggest that the best bariatric operation for older patients may be the laparoscopic VG because it achieves the greatest weight loss with the shortest operative time and the fewest complications”. I have investigated this procedure very thoroughly including attending support groups and talking with others who have had it. I have completed most of the preoperative testing and strongly believe this is the best procedure for my circumstances II. THE VSG SHOULD NO LONGER BE CONSIDERED INVESTIGATIONAL The only stated reason for denying approval for the VSG is that it is investigational and …” current available medical studies do not show that this service improves health outcomes, is as good as or better than standard alternatives, or shows improvement outside the research setting”. It is respectfully submitted that this conclusion is incorrect. The conclusion ignores the 36 studies now available on the effectiveness of VSG which indicate that excess weight loss is similar to the RNY and that complications from surgery are actually lower than RNY. It also ignores the fact that the VSG is now widely performed and is routine for many bariatric surgeons and has long been performed outside the research setting. Anthem’s policy on Surgery for Clinically Severe Obesity is set forth in a document with an effective date of April 22, 2009. This document reviews the various forms of bariatric surgery and explains when weight loss surgery is considered medically necessary. VSG is excluded from ever being medically necessary because it is designated as investigational and that “…there is insufficient convincing evidence in the peer reviewed medical literature, in terms of safety, to support the use of …sleeve gastrectomy…other than biliopancreatic bypass with duodenal switch, in individuals with clinically severe obesity.”. Nevertheless, the lap band and Realize band procedures are approved as medically necessary in this same document based upon what appears to be two three year studies involving 219 and 352 patients respectively. There is now a considerable body of data and studies supporting the safety and effectiveness of the VSG as a primary procedure for weight loss. The June 2009 Supplement to Bariatric Times reporting on the Second International Consensus Summit on Sleeve Gastrectomy (available at www.bariatrictimes.com) includes 10 papers pertaining to the safety and effectiveness of the VSG presented by leading bariatric surgeons. In Reducing Risk in Bariatric Surgery: Rational for Sleeve Gastrectomy, Dr. Eric J. DeMaria concludes that “A growing body of evidence suggests sleeve gastrectomy may be an appropriate primary bariatric surgical procedure primarily due to low risk and ease of surgical revision when required.” In the paper presented by Drs Jossart and Cirangle, four years of data showed a 68% excess weight loss by VSG patients, a figure not largely different than RNY patients of the same time range. Most significantly, in Debates and Consensus: a Summary by Dr. Michael Gagner, important questions concerning the VSG were debated and conclusions reached by the 400 conference participants. Question 6 was as follows: “Question 6: In your opinion, is there currently enough published data to support the sleeve gastrectomy as a primary procedure to treat morbid obesity on par with adjustable gastric banding and Roux-en-Y gastric bypass? Several groups presented cohorts of patients with follow-up periods of 4 to 8 years the day before. Jossart and colleagues in San Francisco presented eight years’ experience including 1,200 cases, whereas at more than four years, weight loss resulted in a similar curve to gastric bypass. At higher BMI (greater than 55kg/m2) a plateau of nearly 40kg/m2 demanded a second stage, but below a BMI of 55, the operation was terrific. Schauer and colleagues assessed the literature from 35 reports, studied more than 3,000 published sleeve gastrectomy cases, and found an extremely low mortality rate (near 0.12%). Results have shown excellent weight loss and co morbidity reduction that is comparable to or exceeds other bariatric operations and that the sleeve gastrectomy is safe and efficacious. Himpens of Belgium analyzed his patients from 2001 through 2002(sic) to attain six-year follow-up. Sixty-five percent of 46 patients were considered a “success” (%EWL greater than 50 ) at two years. At six years the success rate was maintained at 59 percent. Weiner from Frankfurt and MacMahon of Leeds, who started in 2000, also had similar results. *** Certainly, the audience thought there was enough evidence published to support the sleeve gastrectomy as a primary procedure to treat morbid obesity on par with adjustable gastric banding and Roux-en-Y gastric bypass with a yes vote of 77 percent. This is perhaps the strongest contribution to this second consensus conference.” A review article entitled “Systematic Review of Sleeve Gastrectomy as Staging and Primary Bariatric Procedure” was recently posted on the web site of the American Society of Bariatric and Metabolic Surgeons dated May 26, 2009. The authors are Drs Brethaur and Schaur and Jeffrey Hammel M.S. of the Bariatric and Metabolic Institute of the Cleveland Clinic, Cleveland, Ohio. Thirty-six studies involving 2570 patients who had the VSG procedure were analyzed. Their conclusion was: “From the current evidence, including 36 studies and 2570 patients, LSG is an effective weight loss procedure that can be performed safely as a first stage or primary procedure. From this large volume of case series data, a matched cohort analysis and 2 randomized trials, LSG results in excellent weight loss and co-morbidity reductions that exceeds , or is comparable to, that of other accepted bariatric procedures. The postoperative major complication rates and mortality rates have been acceptably low. Long-term data are limited but the 3- and 5- year follow up data have demonstrated the durability of the SG procedure. “ To date ten thousand patients have had the VSG surgery with good success. Many are going to Mexico or other foreign countries because their insurers refuse to pay for the VSG even though it is less expensive than the RNY procedure, the so called “gold standard” of weight loss surgery which takes several hours and requires a hospital stay of 3 or 4 days. The VSG can be completed in one hour by a skilled surgeon and most patients stay only one night in the hospital. While there is certainly follow up care, the repeated fill and unfill procedures required by gastric banding are unneeded for the VSG. Nutritional supplements are much less of a problem than with the RNY. Many insurance companies are recognizing the value and cost effectiveness of the VSG and have approved the VSG for at least some patients, including BSBC Federal, Tri-west Tri-care Prime, United Healthcare, the Veterans Administration, Aetna, Blue Care Network HMO, Healthnet, Anthem BC of Connecticut, Definity Health/United Healthcare, PPO, Empire Blue Cross Anthem, and UHC. The VSG sleeve gastrectomy is now routinely offered by Kaiser Permanente to all patients that qualify for Weight Loss Surgery and would not do so if this surgery was not proven to work. I don’t think it is fair that if you have five people, one with Kaiser, one with United, one with Aetna, one with Cigna and me with Anthem Blue Cross of California, the other four will be offered the sleeve and I will not. The California Department of Insurance has recognized that VSG is widely accepted by the American Society for Metabolic and Bariatric Surgery as a standard procedure at medical centers for excellence. In Decision #EI09-9645 the physician reviewers reversed the health plan’s denial of the patient’s VSG request and concluded that VSG was the most appropriate option for the patient. The same conclusion was also reached in EI06-5882 though the patient had significantly more co-morbidities. That decision noted the important fact that the VSG is nothing more than the first part of the duodenal switch operation which includes the second step of intestinal modification and as such, the VSG portion has been performed for many years as part of the DS procedure. Some patients have the VSG first as part of a two stage procedure and find that they do not need the second stage. Thus, the VSG is not as new and investigational as Anthem’s conclusions seem to imply. Anthem does cover the DS procedure which includes the VSG as one part. According to an article published in the Detroit Free Press on August 17, 2009, Blue Cross Blue Shield of Michigan, in conjunction with the University of Michigan, has been compiling a large detailed data base on bariatric surgery in order to improve surgical outcomes and provide cost savings. In three years of data collection, it appears that the VSG now accounts for as much as 12% of all bariatric procedures. This percentage indicates that the procedure is far beyond investigational status. This data base indicates that 10,000 VSG procedures are known to have been performed. My Anthem group policy excludes investigational procedures and defines that term as procedures: “ 1) that have progressed to limited use on humans, but which are not generally accepted as proven and effective procedures within the organized medical community; or 2) that do not have final approval from the appropriate governmental regulatory body; or 3) that are not supported by scientific evidence which permits conclusions concerning the effect of the service, drug or device on health outcomes; or 4) that do not improve the health outcome of the patient treated; or 5) that are not as beneficial as any established alternative; or 6) whose results outside the investigational setting cannot be demonstrated or duplicated; or 7) that are not generally approved or used by Physicians in the medical community. It appears that the VSG, based upon the articles cited above, has been performed on thousands of patients, has been accepted by a consensus of participating members of an international conference devoted to this subject, is widely accepted by the ASMBS, does not require FDA or similar government approval, is in fact supported by at least 36 studies analyzed by highly respected physicians, is as effective as the RNY and more effective than gastric banding in terms of percentage of excess weight loss, has fewer complications than the RNY, has as good or better reduction of co morbidities as other procedures, and has results that are similar in studies by both United States and foreign physicians. The VSG therefore no longer falls within the definition of investigational procedures excluded from coverage. The conclusions stated in the previously cited Anthem Policy on Surgery for Clinically Severe Obesity are simply no longer correct and that policy should be updated to include VSG coverage or disregarded. With the VSG patients lose about 68% of excess weight and lower BMI patients like me often do much better. Weight loss will most certainly help my back and hip pain and improve ability to exercise. High triglycerides, high blood pressure, and borderline diabetes are corrected in about 76 percent of WLS cases and I am hoping for this result. It is therefore highly likely that my health will be improved by this procedure and I respectfully ask for your reversal of this denial. I am a mother and soon to be a Grandmother and I want to improve the quality of my life so that I will be healthier and able to help raise my grandchildren and be able to take an active role in their life.Thank you for your review of this matter. I greatly appreciate the fact that the state of California has a procedure to help insured patients who find themselves in disagreement with their insurance companies. I strongly believe this decision will greatly affect the quality of the rest of my life. Thank you for your time. I eagerly await your decision regarding this. I can be reached as indicated below if further information is needed. Enclosed is a copy of my denial letter from Anthem Blue Cross My HMO is Healthcare Partners Primary Care Provider is xxxxxxxxxxxxx Gastric Surgeon xxxxxxxxxxxxx Sports Medicine xxxxxxxxxxxx who ordered MRI and diagnosed arthritis Cardiologist xxxxxxxxxxxxx did my last EKG and stress test All these doctors agree Weight Loss Surgery is a good option for me. Respectfully yours, Jeani Anderson xxxxxxxxxxxxxxx xxxxxxxxxxxxxxx (xxx) xxx-xxxx Work info: xxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxx xxxxxxxxxxx CA 91101 (xxx)xxx-xxxx ext. 244