I think I am ready!

[WeekendWarrior 0]

I have been looking at WLS for about 2 months now. I am currently 47 years old, 5 ft 7 and 315 pounds, BMI 49. This is the heaviest I've ever been. I was 140 pounds and 31 inch waist 30 years ago.

Ive tried countless diets, and am pretty good about losing weight, but eventually gain it all back plus some.

I went to an educational seminar about 2 weeks ago. The only 2 options they went over was Roux-en-Y Gastric Bypass (RNY) and the Band.

I was really leaning towards the band, until I started reading a lot about it in the forums. It seems like a great option at first, but with the aftercare, fills, PBing, sliming, getting stuck, bandster hell, and long term complications like erosions and slips. it quickly dropped to last on my list.

I really wasn't really gung ho about RNY as I have a couple of relatives that had that procedure. They initially lost a lot of weight, but seemed to gain back quite a bit 3 and 4 years down the road. I also didn't like the malabsorbtion part and the dumping syndrome. It seems like their pouches have a easier chance of stretching, and the blind stomach can be an issue as they can be prone to ulcers and it also produces ghrelin so they tend to get hungry more often.

I then read about the Duodenal Switch (DS) this seemed like a much better option to me than the first two, but still had the malabsorbtion issues, chronic diarrhea and bad gas, and not many surgeons perform this operation.

I then read about the Vertical Sleeve Gastrectomy (VSG). This seemed like the best option to me. I know to some the removal of a large portion of the stomach seems excessive, but to me if it kills the ghrelin gremlin then it's well worth it.

One of the local hospitals in Des Moines Iowa have been offering VSG for a little over a year. I am scheduled for their educational seminar on Feb. 5th. I will be interested to find out how many VSG procedures they have done. They are a bariatric center of excellence.

Anyone have a list of questions I should ask?

I am going to contact my insurance to find out the specifics of which procedures they will cover.

[Tiffykins 672]

Hi and welcome to VST. I absolutely love the sleeve for the same reasons you listed. I had a band, hated life, now I love my sleeve.

Here are some questions I asked:

How many sleeves has the specific surgeon performed? (once 300 sleeves are done, complications decrease, and technique is well executed and pretty precise)

What size boughie do you use?

Do you oversew the staple line?

What is the recommended pre/post-op diet?

Leak and complication stats?

Do you offer a support group?

Will I have access to a nutritionist?

How long is the typical recovery?

How many leak tests are performed and what type of contrast Fluid is used? (Barium is a no-no for leak tests.)

How many nights in the hospital?

Vitamin/supplement regimen recommended for VSG?

Those are the main ones that concerned me.

Good luck at the seminar, and keep us posted on how everything goes with the insurance company.

[MidwestGirl 8]

Hello! Another Iowan! (I'm a western Illinois transplant...). I had my surgery in Davenport at Genesis (can never remember if it's east or west) by Dr. Matthew Christophersen, also a bariatric center of excellence. Good luck at your meeting!

[mountain_lover 3]

I have been looking at WLS for about 2 months now. I am currently 47 years old, 5 ft 7 and 315 pounds, BMI 49. This is the heaviest I've ever been. I was 140 pounds and 31 inch waist 30 years ago.

Ive tried countless diets, and am pretty good about losing weight, but eventually gain it all back plus some.

I went to an educational seminar about 2 weeks ago. The only 2 options they went over was Roux-en-Y Gastric Bypass (RNY) and the Band.

I was really leaning towards the band, until I started reading a lot about it in the forums. It seems like a great option at first, but with the aftercare, fills, PBing, sliming, getting stuck, bandster hell, and long term complications like erosions and slips. it quickly dropped to last on my list.

I really wasn't really gung ho about RNY as I have a couple of relatives that had that procedure. They initially lost a lot of weight, but seemed to gain back quite a bit 3 and 4 years down the road. I also didn't like the malabsorbtion part and the dumping syndrome. It seems like their pouches have a easier chance of stretching, and the blind stomach can be an issue as they can be prone to ulcers and it also produces ghrelin so they tend to get hungry more often.

I then read about the Duodenal Switch (DS) this seemed like a much better option to me than the first two, but still had the malabsorbtion issues, chronic diarrhea and bad gas, and not many surgeons perform this operation.

I then read about the Vertical Sleeve Gastrectomy (VSG). This seemed like the best option to me. I know to some the removal of a large portion of the stomach seems excessive, but to me if it kills the ghrelin gremlin then it's well worth it.

One of the local hospitals in Des Moines Iowa have been offering VSG for a little over a year. I am scheduled for their educational seminar on Feb. 5th. I will be interested to find out how many VSG procedures they have done. They are a bariatric center of excellence.

Anyone have a list of questions I should ask?

I am going to contact my insurance to find out the specifics of which procedures they will cover.

I started out wanting to have the band and nothing else. I didn't want to have any drastic surgery, but the more I learned about all the procedures the more I leaned towards the sleeve. I had the sleeve done on Dec. 2 and I have no regrets. I lost 34 pounds before the surgery and I have lost 28 pounds after surgery.

The only pain I had after surgery from the gas pains and nausea. I only had one 2 inch incision above my belly button. I was Dr. Husted's second patient that had only one incision instead of the normal 5 incisions for the laprascopic procedure. He did not perform any leak tests. He has a very good reputation for sucessful surgeries.

I am very happy that the sleeve helps by cutting down on the hunger by getting rid of the part of the stomach which produces alot of ghrellin. I eat now because I know I need to eat something or because I am trying to get in enough Protein. Sometimes I do get the head hunger, but I usually find out that my new stomach cannot handle the item as well as my head told me it would. I have a hard time eating real sweet or real greasy fatty foods, which is a very big difference than before surgery. Also overeating at one meal is out of the question. I do not like the feeling of getting ready to vomit, so now I really try hard not to overeat and I wait a little while before finishing my meal. I try to eat three meals and I try to eat healtier Snacks such as nuts, Sun chips, frozen yogurt, ect.

I sure hope your insurance covers the sleeve procedure. When I first started my journey, the sleeve was not covered by Medicaid here in Kentucky, but the month before my surgery it became a covered procedure. The sleeve is the first part of the Dueodenal Switch. Many insurance companies do cover the Dueodenal Switch but not the Sleeve. There are many good comments about insurance coverage in other threads on this forum.

I wish you all the best, and it sounds like you have been doing alot of research on the procedures and I do believe that you are making good decisions based on your knowledge.

Please keep us posted with your story and your progress. Thank you for posting!!

[WeekendWarrior 0]

I started checking into the insurance today.

I have Wellmark Bluecross and Blueshield. (I didn't know that BCBS is over 39 separate health insurance companies.)

I gave them a call and asked them what type of bariatric surgeries they covered, and was told the following.

• Vertical-banded gastroplasty
  
• Adjustable gastric banding
  
• Gastric bypass (Roux-en-Y gastroenterostomy)
  
• Minibypass
  
• Sleeve gastrectomy
  
• Duodenal switch with a BMI of 50+
  

I hung up and thought great, they cover the VSG!

Later I started thinking that I wanted to make sure this wasn't too good to be true, so I called them back and asked again, and wanted to know if they could send me the policy by mail or e-mail. This person told me that I could read it on the wellmark website, and gave me the following link.

Bariatric Surgery for Morbid Obesity*

Well I read the policy, and it looked like they would cover it, until I got to the very end, and noted.

Sleeve gastrectomy as a stand alone procedure OR in combination with a malabsorptive procedure was considered investigational!

Looks like I may have to fight them on this.

Anyone know of a comprehensive list of Insurance companies that will cover VSG? I don't know if giving them a list showing that other insurance companies no longer consider it investigational will help.

Any good resources out there on how to fight the insurance company?

Should I just wait for my seminar, and ask the surgeon if they have gotten any BCBS insurances to cover it?

[Tiffykins 672]

If you don't mind shoot me a Private message, and in the subject line just type "how to appeal insurance decision".

I will go grab you some links, and get you sample letters, and information. It may take me a couple of days to get all the information together. So, if I have a PM in my inbox, I will be able to gather everything, and send one message rather than trying to find this thread again to reply to.

I know BCBS is one of the more difficult to get approval from (just based on what I've read here and on other WLS forums) but it's not always impossible.

[WeekendWarrior 0]

Update:

I went to the seminar today. Dr. Teresa Lamasters did the first part. They have a very nice binder with information explaining all the surgeries. It has about anything you can think of covered, from pre-op and post op diets, suppliments, and recipies. They also had sheets of different Protein suppliments with where to buy them and costs per serving. They have a monthly support group and they sample different Protein suppliments.

Dr. Lamasters does her laproscopic surgeries using the da vinci robotic surgery device. She said that this device makes the old procedures seem like using chopsticks. The robot has much better articulation and stereoscopic vision.

The last person to talk was the insurance specialist. She said medicaid, and a couple other insurance companies cover the sleeve, but my insurance doesn't. She is not aware of anyone who has been able to win an appeal.

I told her of my need to take nsaids, and my family history of stomach cancer and how I believed this was the only procedure besides DS that is appropriate. She had me make a appointment with the surgeon and would see if we could get wellmark to make an exception.

So now I guess I wait until my appointment on the 23rd, to take the next step.

[sleevegenie 0]

'Tiffy, why do you say barium is a no no, i thought i read on someones page that they did a barium leak check???

[sleevegenie 0]

tif, is oversewing the staple line good??? what's that about the barium leak check??

[WeekendWarrior 0]

I remember seeing something about a baruim swallow leak test also.

I googled it and found

Dr. Guillermo Alvarez

Dr. Guillermo Alvarez: Gastric Sleeve (VSG) & Lap-Band®

Not sure why they would use barium for a leak test when it seems to be contradicted in the case of a leak?

Oversewing the staple line is supposed to strengthen and prevent leaks.

Found a study that gives some conflicting data.

(Link)

Looks like some use a buttressing material, and some may use a fibrin glue, or a combination of all of the above.

Am I reading the following right? a 42.6 percent leak rate when using a buttress material?

A review of sleeve gastrectomies in Germany[22] demonstrated a leak rate of seven percent in 144 patients and 42.6 percent in patients who had a buttress material employed with the staple line. Uglioni et al[23] reviewed 74 patients who had their staple line oversewn. There were no leaks, although one patient had dysphagia caused by excessive narrowing of the tube due to oversewing.

[Mary Gordon 3]

go for it!!! you won't regret it and it'll all be worth it.....you'll just love it when you start losing the weight.:svengo:

[coco517117 0]

Just Sleeved by Dr. Alvarez on 2/15 -

The leak test wasn't a "barium" nor an upper GI. It was actually a thick, nice-tasting liquid that was shown in real-time as you swallowed in front of a camera. He only allows you to take a small sip from a straw so you can both follow it pass down (on the screen). After that - you're graduate to ice chips!

I was also conflicted with oversew vs. buttressing material. Dr. Alvarez provided me with the option for the Fibrant Sealant (Tisseel) - but, didn't find it as strong as the oversew (despite the fact he makes more money on the sealant - extra $500 per staple fire). He felt safer with oversew regarding leaks - I was always able to change my mind as the hospital was fully equipped with buttressing products - but I chose his experience/advice in end.

Read in an article that US hospital operating rooms are very expensive, and so many surgeons opt to quickly put a sealant over staple line - and not spend the $$$ time to oversew. Sounded logical given our high costs of hospitals/healthcare.

Hope this helps.

Edited February 23, 2010 by coco517117

[Lee 19]

I had the same swallow as Coco. I was not allowed a sip of Water or ice chip from surgery until the swallow 24 hours later. I didn't gag at the swallow and it went very quickly. It was around 6-8 sips and the surgeon told me later it could have been done with 4-5 sips.

I had the Buttressing material over my staple line. No problems here!

[WeekendWarrior 0]

Well tommorow morning is my first consult with the surgeon.

Then I supposed the games with the insurance company will begin.

Hopefully I can convince them that the sleeve is the only option for me.

I could gain a little more weight and qualify for a DS, but not sure I want to. Not sure how well the malabsorbtion will be when your elderly.

The sleeve just seems to be the most logical choice for me.

[Tiffykins 672]

Best wishes tomorrow with your consult. I hope you get some definitive answers with the insurance company. The DS is definitely not something for me, but I know some people love it. The amount of malabsorption is just not my cup o' tea.