Pittsburgh Banders

[Band_Groupie 3]

Young- Thanks (about the blog LOL)...one gal told me that's what she read as she was recuperating...cracked me up! Glad you got to talk to the anesthesia dept. already and don't leave the hospital without some anti-nausea pills! Best wishes tomorrow; I'm sure it will all go smoothly! BTW- Your daughter is very brave...you must be really proud of her!

Doc- Your time is coming! Here's hoping it's November! Keep in touch!

Lifting- I can't say the wait went fast (sorry, 6 mo. only goes fast if you're in a coma), but at least the holidays will keep you busy and those last months do go quickly. Keep busy collecting recipes and making lists of thigs you'll need...keep us posted on your progress and keep reading everything here...I can't tell you how much it helped me.

[shassy 0]

from my experience, many bypass patients gain the weight back....if you use the band as a tool AND change your eating and exercise habits the BAND works! good luck!

[Band_Groupie 3]

Hi Shassy my old friend! Just had to say WOW!!! 4 pounds below goal already and over 100 lost!!! You've done an amazing job!!! Take a bow!

[Liftingchic 0]

Lifting- I can't say the wait went fast (sorry, 6 mo. only goes fast if you're in a coma), but at least the holidays will keep you busy and those last months do go quickly. Keep busy collecting recipes and making lists of thigs you'll need...keep us posted on your progress and keep reading everything here...I can't tell you how much it helped me.

Thanks :scared2: I think the 6 months will go fast.. I am young and busy so the 6 months I think will fly for me....

I have been reading alot! Started my food diary Wednesday cant say i have been good on the diet its hard to go from eating what ever you want to healthly .. I am not sure if the insurance makes you be 6month of the 1200 cals or what.. Just nervous...:tt1:

[Band_Groupie 3]

Lifting- Your doc should be able to give you a form to use for the 6 mo. Just know that it almost always needs to include; date, current weight, your diet plan/calories, and an exercise plan (that last one foils some people) and your doc's/pcp's signature. I couldn't lose much weight during my 6 mo. 'diet' as I was already a low BMI. It will certainly benefit you later if you can lose some before. Good Luck! -BG

[Liftingchic 0]

Lifting- Your doc should be able to give you a form to use for the 6 mo. Just know that it almost always needs to include; date, current weight, your diet plan/calories, and an exercise plan (that last one foils some people) and your doc's/pcp's signature. I couldn't lose much weight during my 6 mo. 'diet' as I was already a low BMI. It will certainly benefit you later if you can lose some before. Good Luck! -BG

yeah they did, I meant, I was wondering if the insurance wont approve it if you havent stuck to the 1200 cal diet for 6 months.. I have Highmark PPO blue insurance...

The doctors office didnt explain it very well, maybe so they dont set you up to fail i guess.. I think 1200 diet is unreasonable :scared2:

[Band_Groupie 3]

YAY! You're in luck! According to my surgeon's insurance expert Highmark is the easiest one to deal with and the best to get approval from. It's what I have (H. PPO Blue). Now, saying that, everyone's rider can be different depending on what your company negotiated with them (I was able to get our policy online...and you should definitely have a copy of yours so you have all the requirements infront of you).

Just make sure you don't gain anything (not even a pound) and that you don't fall below the 40 BMI at any time before approval. Most places want you NOT to succeed with the diet...meaning you only lose a few pounds (I think I lost 8 total). So just because they give you a strict diet, doesn't mean you have to follow it (unless you need that to help you lose a few pounds). Some surgeon's have their own goals...meaning if you're a high BMI they may make you lose a certain amount before surgery. Mine does not.

With Highmark you need 6 VISITS to the doc, meaning 6 forms to fill in. This will make the length 5 months long, not 6 since they count your initial visit when you start as #1 (more good news, right?!). As soon as you get that 6th form they can send it all in. Don't go more than a month between visits.

I sweated the PCP letter and actually simple was better. Everything was sent in and I got my approval within 48 hours.

Let me know if you have any more questions about Highmark PPO Blue. -BG

*This next part is in case someone else has a lower category BMI and finds this post; you can disregard:

If you're well over your needed BMI requirement then disregard this (but I'm giving details in case someone else with Highmark finds this and is in my same boat); For mine, one requirement was a BMI over 40 or a BMI of 35-39.9 with a comorbidity (with medication for it, I have hypertension). I was in the latter category and could NOT fall below the 35 BMI until after approval (if you're in the higher category then do not fall below the 40 BMI). My PCP used a step-down calorie plan...I think she started with 1500 cals. My PCP also understood that I couldn't lose much weight during the 6 mo. (she scolded me one month for losing 4 pounds LOL). By the end of the 6 mo. we were down to 1200 cals (there was NO specific cal. requirement on the Highmark policy). You can NOT gain weight (not even a pound) during the diet, but you do not have to lose much at all (I lost I think 8 pounds total...I actually lost a few pounds more, but I'm good at eating/drinking before going for a weigh in, wearing jeans, etc.). I did not diet at all, just made sure I was not gaining at all. Insurance is such a big game it's stupid. Here I am with medical problems that can be helped with weight loss and I couldn't lose much on their diet, but as my insur. expert at the doc's said "If you diet well and fall below the 35 BMI, then you wouldn't need surgery, now would you?" They're not legally allowed to tell you not to lose much, but if you listen carefully they do. Just ask the ins. expert you have what would happen if you fall below your min. BMI.

Edited August 8, 2009 by Band_Groupie

[Liftingchic 0]

YAY! You're in luck! According to my surgeon's insurance expert Highmark is the easiest one to deal with and the best to get approval from. It's what I have (H. PPO Blue). Now, saying that, everyone's rider can be different depending on what your company negotiated with them (I was able to get our policy online...and you should definitely have a copy of yours so you have all the requirements infront of you).

Just make sure you don't gain anything (not even a pound) and that you don't fall below the 40 BMI at any time before approval. Most places want you NOT to succeed with the diet...meaning you only lose a few pounds (I think I lost 8 total). So just because they give you a strict diet, doesn't mean you have to follow it (unless you need that to help you lose a few pounds). Some surgeon's have their own goals...meaning if you're a high BMI they may make you lose a certain amount before surgery. Mine does not.

With Highmark you need 6 VISITS to the doc, meaning 6 forms to fill in. This will make the length 5 months long, not 6 since they count your initial visit when you start as #1 (more good news, right?!). As soon as you get that 6th form they can send it all in. Don't go more than a month between visits.

I sweated the PCP letter and actually simple was better. Everything was sent in and I got my approval within 48 hours.

Let me know if you have any more questions about Highmark PPO Blue. -BG

*This next part is in case someone else has a lower category BMI and finds this post; you can disregard:

If you're well over your needed BMI requirement then disregard this (but I'm giving details in case someone else with Highmark finds this and is in my same boat); For mine, one requirement was a BMI over 40 or a BMI of 35-39.9 with a comorbidity (with medication for it, I have hypertension). I was in the latter category and could NOT fall below the 35 BMI until after approval (if you're in the higher category then do not fall below the 40 BMI). My PCP used a step-down calorie plan...I think she started with 1500 cals. My PCP also understood that I couldn't lose much weight during the 6 mo. (she scolded me one month for losing 4 pounds LOL). By the end of the 6 mo. we were down to 1200 cals (there was NO specific cal. requirement on the Highmark policy). You can NOT gain weight (not even a pound) during the diet, but you do not have to lose much at all (I lost I think 8 pounds total...I actually lost a few pounds more, but I'm good at eating/drinking before going for a weigh in, wearing jeans, etc.). I did not diet at all, just made sure I was not gaining at all. Insurance is such a big game it's stupid. Here I am with medical problems that can be helped with weight loss and I couldn't lose much on their diet, but as my insur. expert at the doc's said "If you diet well and fall below the 35 BMI, then you wouldn't need surgery, now would you?" They're not legally allowed to tell you not to lose much, but if you listen carefully they do. Just ask the ins. expert you have what would happen if you fall below your min. BMI.

Thanks for clearing that up.. I scheduled a pcp appt sept 2 but i am going to try to get one before august is over so it counts...

I wondered also did highmark pay for all your PCP visits? I am afraid they might count it like a sports phyiscal or something (not medical needed or whatever)

[Band_Groupie 3]

Yeah, start in Aug. and you'll be done by the end of the year...Happy New Year to you!!

I believe the PCP visits were covered, but I'll try to check this. Make sure you don't combine the visits with anything else as they get 'coded' to the insurance company a certain way (I believe as a weight loss visit). I saw one gal here who was almost done with her 6 mo., got sick and combined a sick visit with the weight loss vist and she got denied and had to begin again. Don't know that Highmark is that strict, but better safe...

[Liftingchic 0]

Thanks so much for your help!

[young at heart 0]

Band_Groupie, I am now one week post-op and feel like...well you know what. I cannot drink all of the liquids they want me to drink. Breakfast was 1/2 cup skim milk with 1/2 pack of Carnation Inst. Breakfast. Wait one hr and do an 8 oz Protein Shake & low or no-calorie beverage try to get 2 cups Water in before lunch. Then after you 1/2c lunch yogurt you do the same routine as after breakfast. dinner 1/2 c low fat Soup and the liquid routine. If I didn't have this darn nausea from taking all of the cut up meds I take it may be better. Did you have any trouble at first with all the liquids they wanted you to consume. I've only been using the pain med at bed time. I do feel uncomfortable down around where the band must be and across above my waist where the rest of the incisions are but nothing I cannot tolerate. I jsut wanted to run that by you and see how you did with all of those liquids...Young At Heart

[Band_Groupie 3]

young- CONGRATULATIONS on your banding! Sounds like you've turned the corner if you're only using the pain meds at night (that's about where I was by a week).

I'd say by the end of the week that the liquids were getting easier, but I did have a hard time in the beginning. You're on a much more advanced diet then I was though (I had CLEAR (not full) liquids and skim milk only for 3 weeks. For the first 6 weeks the only thing you need to focus on is getting in the liquids...don't worry about Protein, losing weight or anything else but healing and liquids. You don't want to get dehydrated or you can cause all kinds of problems as you know.

Here are my suggestions...if you're eating anything thick (like the yogurt, you may want to thin it a little as even that is probably filling your pouch at this point). I found that the pills went down easier with a hot liquid (decaf peppermint tea helped me through this phase...not something I would normally pick, but it was suggested for settling the stomach and it did work for me). I also spaced my pills out through the day and didn't take the ones I absolutely didn't need daily (ie. Calcium supplements...stuff that can wait a few weeks until you feel better). Make sure you're taking each pill after you've had a few sips of something hot to open the stoma so it slips through. Even with all this I did struggle with the nausea a few times and had to take my anti-nausea meds once as I was starting to heave. As often as I could I would keep the glass/cup of liquid in my hand (like when you're just watching TV...it sounds stupid, but it reminds you to take a sip more often...I found that if I put it down that it took me much longer than it should to finish it (I'd take a few sips then put it down for awhile). It's a pain to keep sipping consistently, I know. I also kept track of my liquids on a piece of paper so I could see where I was...sounds stupid, but it was a little motivating to see it getting better each day. Also I would see if I was where I should be by lunchtime and if not I'd work a little harder at it for the next few hours. This helped me space the pills out also, since I was used to taking them all in the morning I needed to set a new temporary routine up.

By week three things finally started to loosen up a little and then I started getting hungry (started my Protein shakes a few days early, but you already have those). I think you'll find the stoma swelling will go down soon and then you'll be able to take bigger sips without it hurting.

Good luck and keep me posted on your progress! It's all worth it! -BG

[young at heart 0]

Hi Band_Groupie, Thanks for answering my post so soon. They just added milk, yogurt and cr Soups thiking it would be better to have a little more in there because of all the crushed up meds. After the first couple of days I did start staggering my meds & not taking the ones that I felt like you, were not that important right now. I am doing better with the Water and I really need to because it seems in the am I have so much gas and really loose bm's with a lot of water loss. By afternoon that quiets down. Even with my pain med Roxicet I only sleep until 4-4:30 then I get up & come out to the livingroon and get on the couch with my water bottle. My chest bothers me and I think that maybe I need the water for the band as it feels like it is dry down there. It is so funny the different feelings we have with our bands. My is a Realize Band. I am excited and so looking forward to healing and adding more foods. We had been talking about taking a trip to Fl towards the end of October but I am not sure if that is a good idea or not. Well I am off to get my pj's on so will write more another day....Young AT Heart

[Band_Groupie 3]

So glad you're doing better and getting more Water in. You'll be doing great soon and all this will be a blurrrrr. Take the trip. By the end of October you'll have already had at least one fill and be fully healed. The port area may still be a tiny bit sore at that point, but that's all. Have a great weekend! -BG

[young at heart 0]

Hi Band-Groupie, Had my 2 week visit to the Dr. yesterday and I am doing great. Everything is healed and I lost 15 lbs since surgery. I started eating pureed meats & veges today. I got a lot of different foods added for the next week. I had a scrambled egg and 1/4 c baby oatmeal for breakfast and thought I was in heaven....lol. Hope you are doing good. I go back in five weeks for my first fill. Will keep you posted.....Young At Heart