I was so upset yesterday that I couldn't really form my post into a comprehensive blog, so you got the succinct ten points. But I went home, wallowed in my misery, ate pizza, ice cream, and cried, and now I'm a little better. At least better enough to explain what all happened at my appointment yesterday.
So my lovely PA, Erica comes in first to give me warning about what is about to happen with Dr. Y. I guess I haven't made any secret about the fact that I prefer her presence to him anyday, on my blog, in the office, or otherwise. I guess they thought hearing it from her first would soften the blow.
So Dr. Y comes in and right away begins telling me why he wants me to have RNY surgery (gastric bypass) instead of VSG (the sleeve). He keeps going on and on about how we might as well knock it out of the park and get it right the second time around instead of needing a third surgery. I couldn't take it anymore when he said "I just don't believe you will be any more successful with the sleeve than you have been with the band".
Was he insinuating I have not been successful with my band?!
So that's when I couldn't take anymore and chimed in. I told him as much as I was trying to respect him and let him say his piece, I would rather keep my band than have RNY. Please don't get me wrong, I am not against RNY. This is a very personal choice, and each person has the right to make their own choice about which surgery, but RNY is NOT for me.
I think I offended a WLS friend that I text with daily yesterday when talking about this. It's just that as a medical researcher, I tend to look at things in terms of "overall outcome". Basically that means, at the end of my life, how will this have effected me. The answer here is "I don't know" because I intend, unless there are unforseen circumstances, to hopefully live another 50 years. What would happen to my body after 50 years of malnourishment? I don't know, and neither do the doctors.
Not to mention, there are much greater risks for a patient at a BMI of 35 having RNY as opposed to a patient with a BMI of 50. That is when I said, and my BMI as of this morning was 34.8. It just is not worth the added risk to me. My outcome is not to do 'better' than I have with the band. It is to do the same without the bimonthly adjustments.
I guess that's why Dr. Y "got it".
So... Now that I've gotten him on-board with VSG, we start to discuss that procedure, or should I say PROCEDURES.
Dr. Y then begins to explain that new research is showing that revision from LapBand to VSG is more risky than VSG to RNY or even straight up initial VSG because the band has caused scar tissue to form around the stomach. When the band is removed, they also have to remove all of that scar tissue before performing the VSG surgery. He prefers to do this in two steps. First, remove band and scar tissue. Let me heal for 3 months, then do the VSG.
An all in one procedure has greater risks of internal bleeding, sleeve leaks, and even death due to a longer operation (blood clots, etc.) So he prefers the two procedure approach.
Nope. Not happening. This doctor probably hates me, because I let him know exactly how I feel about everything and why. I told him I understand that the risks are greater, HOWEVER what happens if he removes my band now and 3 months later after I'm healed, the insurance denies my VSG request because my BMI isn't high enough.
Good, Dr. Y agrees. My procedure will be an all-in-one.
But that brings up another issue. The chances of getting approval at this point are kind of slim-to-none. At a BMI of 35, insurance requires two co-morbidities. What are my co-morbidities? None. Never had any. I'm healthy as a (fat) horse.
Let's face it-- as Dr. Y put it, revision is for people who have not been successful with their first surgery. How is he supposed to claim I've been unsuccessful when I'm consistently, even now, still dropping weight? I mean, I weighed in yesterday 3 pounds less than when I saw them 2.5 weeks ago. But he said he's going to put on his "Johnny Cochran hat" and do his best to get this to happen.
The other "hurdle" here is that BCBS is now requiring patients provide 6 months of weight history, and they have not had any luck using adjustment records for that, so I may have to START that 6 months now. That is absolut horsecrap to me, considering they have 19+ months of weight history for me.
Overall, I went in with my research, notes, policy info so upbeat and sure it was all going to work out, and Dr. Y and his staff just really didn't seem hopeful. I'm trying really hard not to lose hope and just giving it 'what is meant to be will be'.
All I can do now is just make sure I don't lose any weight between now and whenever they submit to insurance... whether that be next month or 6 months from now. I have some small weights I'll stuff in my purse for the next weigh in though. I think I can fit about 15 pounds in my purse.
Then after writing this post I kept thinking and I'm not even sure I want to go through all of this when I'm still losing weight. They mentioned death due to the all-in-one type procedure so many times yesterday. Maybe I will just have my port replaced to hopefully stop the leak. I'm not sure anymore.