Confusion About Requirements (Denmark)

[BoredFatGirl 134]

Some history: I am a 29-year-old American woman living in Denmark on a residency permit with my husband and his kids. We tried to get pregnant for a while, but after many failed attempts, we decided to bring our concerns to an OB/GYN. I was diagnosed with PCOS and was asked to lose quite a bit of weight before they would help via fertility treatments. It has been a struggle to get any assistance at all in regards to PCOS related symptoms because of my weight, never mind the fertility issues that come along with it. I decided to go for bariatric surgery, as recommended by my GP.

Meetings held & requirements so far:

• A week prior to my meetings, I was required to get an EKG and blood test done.
• 12/09/2019 (141kg / 310lbs) - I had my first meeting with one of the doctors at the diabetes center. It was basically just the start of a medical journal. He got my starting weight, illnesses, medication, and allergies. I was told that I need to lose 8% of my current weight, which would put me at 129kg / 284lbs. He told me that it looked like I would be offered surgery since I met the requirements (a BMI over 35 with concurrent related diseases, which, for me, is PCOS, sleep apnea, and a history of hypertension), but I would find out on my next visit.
• The day before I left on vacation (12/17/2019), I weighed 136kg / 299lbs! While I had a great time visiting family, I ate way too much unhealthy food and shot back up to 142kg / 313lbs when I returned home (01/09/2020). Yikes! 😩 I managed to get the weight back off before my next visit though!
• 01/15/2020 (135kg /297lbs) - This was my second meeting, but this time it was with a senior doctor. He described the pros and cons of each option for surgery. Due to me having a history of occasional acid reflux and heartburn, he suggested that I go with the bypass surgery. However, he told me that I could choose for myself. I have decided to stick with what he recommended. By the end of the conversation, he offered me the surgery (as I figured at this point 😂) and set up an appointment for me to see a dietitian. He also said that my EKG and blood tests came back normal.
• Within two weeks of the previous meeting, I had to send in a stool sample.

Upcoming meetings:

• 02/18/2020 - My first appointment with a dietitian.
• 03/06/2020 - Normally, I would be required to attend a patient seminar with other overweight people prior to surgery, but because I do not speak fluent Danish, I will have to participate in a 1-on-1 meeting with the details of how the operation takes place, how to prepare, and how to eat/live after the operation. This is a plus to me, as I am normally uncomfortable in large groups of people.

As of today (01/26/2020), I weigh 133kg / 293lbs! With this current rate of weight loss, I imagine I will have met my goal weight for surgery by the time I have my first visit with the dietitian. This both delights and worries me, as I am not sure how they will take this information. I was told during the meeting with the senior doctor, that once I lost the weight, I would simply call up the clinic to tell them and I would get my surgery date some days later via email.

However, the emails I received from the clinic prior to these meetings thus far have confused me, as they don't seem to suggest the same thing. Here's the list of requirements that I am still supposed to meet besides the upcoming appointments I have listed above:

• Lose at least 8%-12% of what I weighed the first time I visited the clinic and maintain that weight loss until the day of surgery.
• I need to have regular conversations (via meetings with a dietitian at the clinic or telephone) with approx. 4 week intervals to discuss:
  • Agreements and goals for progress and weight loss
  • Dietary changes
  • Exercise
  • Smoking and drinking alcohol
  • Medical diseases

Then, it says: after 3-6 months, I am to have a status interview and then a team of specialists will assess whether I can be offered an operation. 🤔

I guess what I am confused about is that I thought I was already offered the operation, but just needed to lose the required weight before I could get a date! Furthermore, if I lose the weight before my first meeting with the dietitian, would I really need to have so many more meetings after that? Eh, I guess I will make that phone call once I reach my goal weight to find out where I go from there. I am hoping it's as easy as the senior doctor said it would be during our meeting!

Anyways, that's enough from me for now. I'm Steph! I recently joined the FB group and ended up finding my way onto the website. I look forward to writing with you all more in the future! Good luck, everyone! If anyone else has experienced a similar situation in the Scandinavian countries, I would love to hear what clarification you guys had gotten! And sorry if I sound totally spoiled -- I know the US insurance companies require a lot more in order to cover the operation! 🙈

[catwoman7 10,846]

a lot of us have to go through 3-6 months of "classes" where we learn about the stuff you mentioned - eating, exercise, etc. They prepare us for life post-surgery.

I lost maybe 30 lbs before my first meeting with the surgeon, and then another 30-ish lbs during the months I had classes. And then the team met to do the final approval for the "students" based on whether or not they'd completed the classes and met all the requirements. If so, it was sent off to the insurance company for final approval, and we got our date for the surgery. So yes, what you've been told is pretty common.

[BoredFatGirl 134]

5 minutes ago, catwoman7 said:

a lot of us have to go through 3-6 months of "classes" where we learn about the stuff you mentioned - eating, exercise, etc. They prepare us for life post-surgery.

I lost maybe 30 lbs before my first meeting with the surgeon, and then another 30-ish lbs during the months I had classes. And then the team met to do the final approval for the "students" based on whether or not they'd completed the classes and met all the requirements. If so, it was sent off to the insurance company for final approval, and we got our date for the surgery. So yes, what you've been told is pretty common.

Thanks for the reply, @Catwoman7. I know the requirements differ from each insurance provider and country, so I am still not 100% on it. I will give them a call soon, though! It can't hurt to have more meetings about how to live life post-op, though. It's definitely a serious change.

[catwoman7 10,846]

3 minutes ago, BoredFatGirl said:

It can't hurt to have more meetings about how to live life post-op, though. It's definitely a serious change.

yes - it really is! I felt having all those classes and gradually changing the way I ate really helped with the transition, though.

[BoredFatGirl 134]

3 minutes ago, MsMocie said:

Hello,

I am from Norway. Though I paid for my own surgery in the Baltics, I know a fair amout about the public system.

First off. For your PCOS, has anyone put you on metformin or glucophage? This is an essential part, even though one might not have diabetes. The medication releves the symptoms, lowers your blood sugar and reglates your appetite. Pls ask for this. I've read about patiens loosing kgs rapidly for a period of time due to the medication. For me it didn't give so much of a weight loss, but it solved many of my PCOS related issues, and shrunk my endometrium making my uterus more baby friendly.

I think your choice of surgery is exellenct due to your weight and weight history. I have the mini gastric bypass and I am very pleased about it. Surgeron recommend this for me, as sleeve was a poorer option for me and full bypass might have been to much for me as I was in good health before surgery.

The weight requriment is to make sure you are dedicated to changing your life. Far to many patients get a surgery and continue on with their bad habits, and the thruth is, the surgery is a waste if you do not the minimum to loose weight by your own. It also makes your surgery safer. Every kg you loose, shrink the liver, and they need to "flip it over" during surgery. That is easier with a normal size liver than a fatty liver.

It also comes to concern that you have sleep apnea. If you loose 8-12% the apnea will probably disaper and the risk of you not waking of after surgery is more og less eliminated. I think the reason why you got two answers on this one is beacuse of surgeon preferences and personal experience. In Norway they wanted me to loose 5%, in the Baltics they didn't say anything about the weight other than dieting for a week prior.

My recommandations. Get metformin. Make an effort to walk a 5k on a tread mill each day. I know, boring, but it strengthens your cardio vascular system, makes you breathe easiler and help loose the weight. I would usually stream a movie or series on my phone, attached ear phones and just walk until done. Cut back on red meat and junk, it gives you fatty liver, and drink plenty of Water (this helps you loose weight)

It was like pulling teeth to get my OB/GYN to prescribe me Metformin, as she said it wasn't meant for use outside of fertility and because of my weight, she couldn't give me the treatment. However, I found a ton of medical studies, kept pestering her, and she ended up caving. She gave me a 3 month supply of Metformin (which runs out next month, so we will have to discuss getting more soon.. Hopefully it won't be so hard for me this time).

I assume the Metformin is the reason for such rapid weight loss (besides going on a mostly-keto diet since starting it). However, not too much else has changed -- I haven't even had a period in over 130+ days at this point.

Thank you for the recommendations!! I was dancing for 30 mins a day to get my exercise in, but that has stopped since I came back from the states. I need to get back on it. It was a lot of fun and definitely got me to work up a sweat.

[BoredFatGirl 134]

2 minutes ago, MsMocie said:

For me it is like turning off and on a switch when it comes to my period. If I weigh more than a 100kg no period. Under that, clock-timed period. It has to with your hormones, and high weight keeps your insulin levels high, thus producing an imbalance in your hormones. It's like never ending cycle. Everything keeps everything else on brake or just shut off.

Have you checked that you are ovulating and have egg sacks by the way? I have them all the time, and pleased to know that in my mid thirdies I still produce eggs like no other.

My weight is still pretty high and I have had irregular periods for a long time (and has gotten worse with the additional weight). Maybe in another 33kg, I will start shooting blood all over the place like normal, though! 😂

As for ovulation and egg check, I don't think I have had it done. It's probably worth getting checked out when I talk to my OB/GYN again for the Metformin, though. Thank you!