Tuesday, July 22, 2014

Peer to Peer

Imagine that... I email the doctor about the administrator dropping the ball yet again, and I get the peer to peer scheduled pretty much immediately.

It happened today at noon.  Below is the email I received from Dr. Y afterward.  Cross your fingers!  Now we just wait.  I should have some kind of answer in the next 7 days.

Monday, July 21, 2014

A Modern Day WLS Fairytale

There once was a young girl who worked very hard to lose 110 pounds.  She worked out a few times a week, saw her WLS PA regularly, and --regardless of her food addiction-- tried really hard to eat the right things.

But one day, her Lap Band started leaking.  This elusive leak was hard to prove, but she was willing to fight the insurance company to magically turn her Lap Band into a Gastric Bypass.  She went through her pre-op appointments and waited on a reply from the insurance company.  Alas, they denied her.  Luckily for the girl, her PA was secretly a fairy godsister who was willing to do anything in her magical powers to help the girl.

Little did they know, there was a wicked wicked administrator in the office who didn't give a shit about the WLS patients in the office, even though she too, was once one of them.  She forgot to turn in paperwork, refused to answer emails to give status updates, lied about contacting the insurance company on multiple occasions.  It seems she was going to do nothing in her power to help.

To be continued..........

Friday, July 18, 2014

22 Month Bandiversary

Yesterday was my 22 month bandiversary.  I spent a lot of time thinking about how I've changed...and more importantly, how I haven't changed.

9 days with a COMPLETELY empty lapband will really tell a girl what that lapband has been doing for her.  Loose or not, there was SOME restriction there, because once it was completely empty, it was like I'd entered a whole new world.  A world of bread and pasta and eating and eating and eating.

Holy shit.  Revision needed or not, this band is doing SOMETHING for me.  I guess taking a vacation from my lapband was a good reminder that this band is just a tool.  It didn't change me.  If I don't use it to it's full potential, I can go right back to where I was 22 months ago.

I often convince myself I'm not that same fat girl anymore.

I'm better.  No I'm not.

I don't eat my feelings anymore.  I just do other things to suppress them.

I'm the same girl.  I have the same problems with food.  I just have a tool to help.

I don't want this band anymore, I want revision.  If I don't get the revision though, I will be happy that I have this, because it really has changed my life.

Monday, July 14, 2014

Straight from the BCBSNC Guidelines

I'm feeling frustrated, and like there's nothing I can do, so I just feel like copying some sections straight from the Surgery for Morbid Obesity Policy statement for BlueCross BlueShield of North Carolina website.  Basically, I'm going to argue my case with you all, for the hell of it.  I should mention that these guidelines are slated to change tomorrow...so this is all going to be somewhat irrelevant.

IV. Revision Bariatric Surgery -
A. Revision surgery to address perioperative or late complications of a bariatric procedure is considered medically necessary. These include, but are not limited to, staple-line failure, obstruction, stricture, erosion, non-absorption resulting in hypoglycemia or malnutrition, weight loss of 20% or more below ideal body weight, and band slippage that cannot be corrected with manipulation or adjustments.
[[HAS]]:  I hope Acid Reflux is a good enough 'late complication of bariatric procedure'.  My EGD on May 5 shows signs of reflux and I was admitted to the ER for a stomach spasm from reflux yesterday.  This could continue to happen if I don't have the revision.

B. Revision of a primary bariatric procedure that has failed due to dilation of the gastric pouch or dilation proximal to an adjustable gastric band (documented by upper gastrointestinal examination or endoscopy) is considered medically necessary if the initial procedure was successful in inducing weight loss prior to dilation, and the patient has been compliant with a prescribed nutrition and exercise program.
[[HAS]]:  I swear BCBSNC, I've been so freaking compliant.  I've tracked my food.  I've joined and actually WENT to gyms.  I've lost between 100-110 pounds depending on the day.  I'm doing everything I can, but I just had far too much to lose starting out to get to where I want to be now.  I'm currently requiring a Lap Band adjustment every two weeks in order to continue losing!

Patients with a BMI greater than or equal to 50 kg/m2 need a bariatric procedure to achieve greater weight loss. Thus, use of adjustable gastric banding, which results in less weight loss, should be most useful as one of the procedures used for patients with BMI less than 50 kg/m2.

[[HAS]]:  In conclusion, I should have never had Lap Band surgery by your guidelines.  My BMI was 50.8 at the time of surgery.  Please please please correct your error.

Sunday, July 13, 2014

Pain, Emergency Room, Acid Reflux....oh my!

I woke up this morning to a pain in my upper abdomen that I have never felt in my life.  It went across my stomach at the exact area where my band sits right under my breasts and traveled slightly upward.  I could feel the pain under my chest so intensely that if I didn't know this lap band were in there, I would've thought I was having a heart attack.  I was crying and damn near screaming in pain and my skin had lost all of it's color, so I asked 4D to drive me to the emergency room.  By the time I arrived there, I had sweated so profusely from the pain that my hair looked like I'd just had a shower, I was drenched.

They took me back immediately.  I guess that's the good thing when you're in that amount of pain, they don't like you sitting in the waiting room laying on the floor yelling "Fuck fuck fuck". 

They checked for a slip.  No slip.

The final diagnosis was that I was having a stomach spasm caused by acid reflux.  They gave me something to drink which took the pain away almost immediately.  It had something in it that made my esophagus and stomach numb until the spasm stopped.

Hoping and praying it will help my revision case.  Dr. Y will be requesting the peer to peer review this coming week.

Tuesday, July 8, 2014

Off the Wagon

I'm a food addict.  If I was not sure about this fact before, it is now blatantly obvious.

21 months without bread.  Without pasta.  I stopped missing it.  Or I thought I had.  But oh man, did I find out I was wrong!

So as soon as I got my band unfilled yesterday, I had that chick-fil-@ chicken, egg, and cheese biscuit.  It could've been worse.  560 calories for breakfast after not eating for 5 days isn't the WORST thing a person could do.  I justified it by telling myself that at least it had 28 grams of protein.

I left work early because I can be more productive from home.  Stopped at cookout on my way home.... Barbeque sandwich with onion rings and hushpuppies.  What the hell, let's throw in a peanut butter banana milkshake for kicks.

I wasn't really hungry by night time, so I'd decided I probably wasn't going to eat dinner.  But around 7:00, 4D offered to make me dinner.  He's been boasting about his cooking skills, so of course I couldn't turn that down.  It was the most perfect combination of pasta, sun dried tomatoes, and cream sauce... sweet, spicy, and heavy garlic all in one.  It was one of the best meals I have had in the longest time, and I have plans to get him to make me a homemade pizza before I get this band tightened up again next week.

I waited until today to total all those calories up.

2224 calories.

And I don't even regret one of them.  There's a part of me that thinks I SHOULD, but I don't.  That's the bad part about it.  I want to go do it all again today.  Live it up a little for the 9 days I have "off" of the band.  If I get revision, I'll never have time "off" again.  I know this is the wrong way to look at it, but I'm loving every second.

Monday, July 7, 2014

Complete unfill

I got a complete unfill this morning.  It feels so good to be able to drink water without getting sick!

Know what else I did?  I ate a chicken, egg, and cheese biscuit.  Don't judge- I'd gone 5 days with zero food.  Unable to even choke down a protein shake.

So I'll stay unfilled for a week or so, since it's going to be a doozy at work this week, and then go back to tighten my band back up.  I won't lie, I'm looking forward to a week of "normal".  I'm sure my scale isn't though.

Sunday, July 6, 2014

Revision Update...another month gone

Let me just get this out of the way-- I'm having a HATE/HATE relationship with my band right now.  It just cannot decide what it wants to do!  I've had ZERO restriction for 9 months and suddenly now, what, I can't even drink a glass of water without a PB episode?

It's hormonal.  I was driving to my parents a few nights ago and felt so so crampy, and by the time I got there there was a tinge of blood (sorry, TMI).  And that's when this trouble with my band started.  Although the blood stopped, I guess the hormones are still there.  I haven't eaten solid food in 5 days now.

All I want is my revision!

And much to my dismay, the nurse at my doctor's office FORGOT to submit my appeal to my insurance company.  She FORGOT?!!!!
IT JUST SLIPPED HER FREAKING MIND...

I should mention that this woman is a fellow WLS patient and has been promising things she can't deliver for a couple of months.  Promising me that she's not going to let me get denied, and then denial came.  Then promising she was going to make sure they fought it with everything they had.  Well, I'd say my doctors have done everything they can, but when the administrator forgets to submit, that's a HUGE FREAKING PROBLEM.

So what now?!  I've wasted a month for NOTHING.  If you all have forgotten, I have until the end of 2014 to resolve this because I can't afford to continue paying $334/month for insurance to have "better" bariatric coverage.

So we're going straight to a Peer to Peer review between my doctor and the insurance.  Fingers crossed.  Tomorrow I'm going to go in for an "emergency unfill" because my  band is tight and it will be a stressful week at work.  My study is locking and I can't physically afford to continue depriving myself of healthy nutrition.  While I'm there, I intend to tell my doctor/PA that if RNY is my best chance of getting approval for revision due to the moderate reflux they saw on my last EGD, I will take it.  I will do whatever it takes at this point.  I need to do something.  I hate this band today.  I'm thankful for all of our hard work together but it's becoming really troublesome for me.