Wednesday, April 2, 2014

More on Revision

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.

RNY

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".

Excuse me?!

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".

VSG

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.
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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.

16 comments:

  1. P.S. I know I have at LEAST 2 band-->VSG readers. Any thoughts on this 2 procedure revision vs. all-in-one approach?!

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  2. sorry you are dealing with all this girl. I am here for you

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  3. Do you follow Dawnya at Evolution of a Black Butterfly? She had a revision about a year ago and is super happy with the decisoin.
    I say keep doing your best to lose weight and just throw those ankle weights on when you have to!

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    1. Thanks I just looked her up and actually sent her an email! Much appreciated :)

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  4. I hope that whatever is the best course for you works out. Maybe port revision is the way to go. you've been super successfull with your band--and if you don't have a leak, then you would be able to keep you restriction and not need adjustments all the time like you currently have. just a thought. but I'll be praying it all works out for the best!

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    1. Dr. Yoo doesn't believe there is such thing as a slow band leak and that I'm imagining it all, and replacing my port wont help.

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  5. Holler, I could have written your post minus your rnishap. First I have bcbs & my doc was able to count 2 mos of visits in my 6 mos diet. Second, I had to "diet" while staying close BMI 35. I lost & gained same 2-3 pounds,. My doc said he did have to repair scaring around my esophagus but he said that was only a few minutes more work on his part & not for me to worry.

    I had 2 things, sleep apnea (wink) & family history of diabetes (I do not have diabetes) my mom & sis do. Perhaps your Doc can use family history. I have never heard of anyone who have gone to sleep test & Not having diagnosed as having sleep apnea. I think it's rubber stamped like the psych test.

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  6. Also, the hoops took me 2 years...ridiculous

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  7. Mine was done all the same time. To be honest, I doubt I would have gone back for the sleeve if he didn't do it all in one.

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  8. I had to laugh out loud at "fat horse". ME TOO. Believe it or not, at 40 years of age and 301 pounds, I had NO co-morbidities. Thank God. Under my insurance however, I qualified for surgery on BMI alone because it was so high.

    However, my cousin was kind of at the same place as you. Does your policy consider osteoarthritis a co-morbidity? That's what she listed and everything went through with the insurance. Best of luck and I am keeping my fingers crossed for you. :)

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  9. Ugh. I'm sorry you have to deal with all of this. This decision is definitely not easy. I hope that you and your doctor can get everything sorted so that you have your revision (or port replacement, whichever you decide) as quickly as possible!

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  10. Keep fighting for what you need girl! I know you can get it done they way you want. Sounds like a new doc might be in order.

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  11. My blood pressure has been high my last few visits, so I may be able to claim hypertension as a comorbidity. I was also pre-diabetic prior to surgery and have a family history of diabetes (mother and all 4 grandparents).

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  12. I feel very frustrated for you.

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  13. Wow, I totally understand all of your frustration! You definitely know what you're talking about and you know what you want.. that's incredible! I have an appointment with my surgeon on Tuesday after not going there since August.. I have been struggling with my band (I was banded 2/6/13) and have majority of the 47lbs I was down at month 3. I don't think it really does what it should for me.. I never feel full or satisfied, I have cravings constantly, and I feel like I've become more of a bulimic rather than a bariatric patient. I secretly e-mailed his office to see what the protocol is for lapband reversal to the sleeve is. My mom is completely against it, but in my heart, I don't think the lapband was a strong enough tool for me. I know you and I have different reasons for wanting to switch to VSG, but this entry was so insightful! Thank you for sharing your story! I look forward to reading more of your journey! Good luck with everything!! Catch ya on instagram!

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