Tuesday, August 26, 2014

Unlimited wardrobe?!

Losing weight can be EXPENSIVE when it comes to replacing clothes.  I'm sure it comes as no surprise that NOTHING I owned pre-surgery fits now after losing 100+ pounds.

I've bagged my clothes and donated them many times, and replaced them with hand-me-downs and loads of purchased items, only to turn around and donate those.  I always thought a clothing swap would be an awesome idea, but I just don't know enough people around to do that with.

This morning I discovered Gwynnie Bee and signed up immediately, especially after realizing the first month is FREE!!  (and you can cancle at any time in those first 30 days to avoid being charged for the second month). 

You can choose 1, 2, or 3 items to be sent to you at a time, but those can be swapped out at any time, as often as you'd like.  I chose 3 items of course.  (after the free trial, you can choose up to 10 for various prices).  Shipping is free, and if you damage an item, that's okay- you aren't charged.  I can't wait to get my first shipment so that I can model some items for you and tell you what I think of the experience!

You all should go check out Gwynnie Bee... first month is free, so what do you have to lose!?  Sizes 10-32 available :)  Have fun shopping!  I put 16 things in my cart already and have hardly looked through the site.

Here's just a little look into my "closet"....obviously we know I love dresses.....

Monday, August 25, 2014

Food addicion and the Brain

Have you ever stopped to consider how food addiction is different than any other thought you have?  I know some people like to think that they eat 'mindlessly', but I completely disagree.

There are only 5 things the brain is capable of processing in 'real time'.  Five.

Sight.
Sound.
Touch.
Taste.
Smell.

EVERYTHING else our brain processes is based on the past.  We aren't capable of processing non-sensory information in real time.  For example, you're doing a math problem-- that isn't real time.  It is all based on thoughts you've had before, things you've learned before.

You're having a really bad day, feeling crappy, stressed, upset, etc.  All of those thoughts and feeling are based on something that happened five minutes ago, yesterday, last week.  A reminder of how you felt when something simlar happened before.

So when you're experiencing sensory input, that is real time information, and it has the capability to block out almost any and every other type of input.  So... bad day... let me grab that ice cream.  The brain processing associated with taste can block out (according to reseachers) almost 80% of any other intellectual processing.

Of course, we're not all food addicts based on coping skills, but if you think about it, food addiction is a VERY efficient way of coping, based on how the human brain works.  Now... how to change it is the struggle.

It's unfortunate that candles and music aren't nearly as effective for me.

Friday, August 22, 2014

I'm ready!

My head is in upcoming surgery land.

I can't focus on much of anything other than surgery.

My mind is swimming with vitamins, and to-dos, and what ifs....

I'm excited and nervous and ready to start over.  I need a fresh start with this weight loss thing.  I've been stuck around 250 FOREVER!  I was feeling a little bit of a failure over that for a while, but I have to remember that I've lost 100 pounds (+/- 5 depending on the day) and that's not something to sneeze at!

But I get a new start, and that's exciting and scary all at the same time.  Before getting the band, I watched the procedure online.  I tried to watch RNY online and couldn't do it.  I may try again before surgery, or I may leave well enough alone.

25 more days.

Wednesday, August 13, 2014

I have a date....

I was banded on September 17, 2012.

I can't help sensing that it is a good sign that my surgeon randomly chose September 17, 2014 as my revision date.  I will have my lap band removed and be revised to RNY gastric bypass on my 2-year bandiversary.

I did get approved for the sleeve when they reversed my decision, however I have thought about it A LOT.  My surgeon feels strongly that RNY is the best option for me due to the amount of weight I still have to lose and my acid reflux, so I should listen to him.  I didn't listen to him initially, which is why I'm in the situation I'm currently in. 

For the band I will not grieve, RNY will be my reprieve.

Tuesday, August 12, 2014

APPROVED!!!!

I will have a surgery date in the morning!  OMG, I am so ecstatic!

Monday, August 11, 2014

Thoughts on the Lap Band... and regrets

When I first started "thinking about" weight loss surgery, I wish I'd done more research.  But I'm the kind of person that once I get something in my head, I am all in.  I don't test the water with my toes, I dive in head first.  Someone told me that I couldn't succeed with the band, and damn it, I was going to prove to her that I could.  Except I'm not sure how that worked out for me really.  I worked the band, and it worked for me.  Until something happened.  We call it a leak, but there is really no 'proof' of a leak.  If you've been following for a while, then you know what all has gone on, so there's no reason to re-hash that part.

But there are days where I have bursts of anger.  Anger that I did EVERYTHING I was told to do, and now I am going through this anyway.

Days that I am angry that I thought I could have the band removed if I ever needed to and it would be like surgery never happened.  I am an intelligent female, why didn't it occur to me that the band would cause scar tissue in the stomach?!

Days that I am pissed that I didn't listen to my doctors when they did explicitly tell me that someone with 180 pounds to lose would do better with gastric bypass.

Why didn't I consider those things then?

Well, I didn't consider them then because I thought as long as I followed the rules, I would be successful.  I did follow the rules.  I worked my ass off.  I shouldn't be dealing with all this shit now begging for insurance approval.

But here I am.  I guess life isn't fair.  I've always known that and I shouldn't expect it to be.  Still, I can't help feeling a little bitter at times that I am struggling now after all the hard work I've put in.  I know there is no point in feeling bitter, it is really out of my hands until I get the next decision from my personal appeal.  After that, I will either be scheduling surgery or gearing up for a battle again.  I hope it is the former.

I'm not sure I have the emotional capacity to keep pushing forward.  I say that, but I know if I have to, I will find it.

Thursday, August 7, 2014

Optimistic

Just a quick update that I'm feeling very optimistic about my most recent appeal.

Yesterday I got the letter from BCBS acknowledging receipt of my appeal.  It included in it the name and telephone number of the person handling my case.

So this morning I called her and in my sweetest voice I told her that I was concerned because I couldn't find documentation of an ER visit from March 2013 but BCBS was my insurance company then.  She located it, but stated that she had looked through my case and I had "more than enough" documentation and this one ER visit wouldn't make a huge difference.

She took my phone number and said she would be in touch if there was anything she needed.

It very much sounded like she is going to approve me. 

24 more days to wait for an answer....

Friday, August 1, 2014

My Personal Appeal to BCBS

For my 300th post today, I want to share with you all my appeal to my insurance company, which I will be sending to them today:



To whom it may concern:

Please accept this letter as supporting evidence for an appeal to BCBSNC’s decision to deny coverage for revision of bariatric surgery from my current Lap Band to roux en Y Gastric Bypass.  It is my understanding, based on your letter of denial dated 02June2014 (initial submission) and again 22July2014 (peer-to-peer review between Dr. Jin Yoo and Dr. Lawrence Woo), that this procedure has been denied because “there is no perioperative or late complication of previous bariatric surgery per coverage policy AND there is insufficient serial records that there has been post-operative compliance with diet after the previous bariatric procedure, 9/17/12”. 

In summary, I refute that there has been no perioperative or late complication of previous bariatric surgery, as I have been diagnosed and received treatment for GERD only post-lap band placement.  Other post-operative complications include polyphagia, dysphagia, excessive aggressive lap band adjustments, and failure to reach a healthy weight through no fault of my own.  I also refute that there are insufficient serial records to demonstrate post-operative compliance.  I have submitted 30+ records of adjustment/clinic visits.  However, despite this, my weight loss alone of over 100 pounds should demonstrate irrefutable proof of compliance.  The rest of this letter will serve to explain the medical necessity for revision surgery and disprove the reason for denial from BCBSNC.

As you know, my Lap Band procedure was performed on 17September2012.  My highest documented weight in the months leading to surgery was 344.4 lbs., and my weight on the day of surgery was 327 lbs.  In the months following surgery, I followed my post-op liquid diet fastidiously, transitioned to soft foods, kept my diet between 1000-1200 calories and protein between 60-100g by tracking my food intake on the myfitnesspal phone app and slowly began exercising.  Over the first 18 months, my lowest weight was 238 lbs.  The first months were not easy but the tool was perfect initially.  The Lap Band helped me control my hunger and as I lost weight, it became easier to exercise.  I did not realize how uncomfortable I had become in my body until I began to feel better.

Around March 2013, I began to have problems with my band.  One day it would feel like I could eat as if I didn’t have surgery and then the next day I would experience severe dysphagia causing me to get sick just from drinking water.  There were certain triggers that I knew would cause the dysphagia and make the band feel tight, for example: allergies, stress, and menstruation.  Other times the sources of the tightness and dysphagia were unexplainable.  This complication lead to frequent visits to the have my band filled and unfilled.  In addition to clinic visits for unfills, I went to the Emergency Room at Durham Regional Hospital in April 2013 for an unfill of my band due to dysphagia.  I was unable to swallow my own saliva by the time I arrived at the ER that day.

The discomfort from my band began to get worse when I started experiencing reflux.  I did not have issues with acid reflux prior to surgery, but I began to realize the reflux could be the reason for my band feeling ‘tighter’, or for food/water coming back up after eating or drinking.  I have been taking Nexium OTC to help control the discomfort but it is not always successful and I still find myself coping with the discomfort frequently.  On 03July2013, I woke up unable to drink water in the morning.  I thought this feeling would pass; it is often difficult for me to drink anything in the morning without vomiting since having my Lap Band placed, so this has become a new normal for me.  Later in the day I could not eat, drink a protein shake, or even keep water down without it coming back up within a few seconds of swallowing.  This continued until 08July2014 when I went to Dr. Yoo’s office to have a complete unfill of my Lap Band.  I was so relieved after having the band loosened to be able to drink water again and eat, however the problems didn’t end as I was admitted to Duke Regional Hospital on 13July2014 for pain in my chest which was diagnosed as GERD.  It was the most painful experience to date dealing with my band.

In addition to the physical pain associated with the band, I have experienced excessive hunger.  I was first put on Phentermine to help the hunger, but this is not a long-term solution due to health risks associated with Phentermine.  I began to have more aggressive fills, which somewhat helped the hunger, but irritated the reflux.  It seemed to be the only way to control the hunger and continue losing weight or even maintain my weight loss, so I thought I would cope with the reflux.  However, the reflux has become intolerable over the last few months.  Due to the pain and dysphagia, I have gotten fewer Lap Band adjustments (once every 4 weeks, which is normal for the average patient but not enough to control my polyphagia) and my weight has drastically increased.  This morning I weighed 260.2—a 22 pound increase from April 2014 when the reflux began to get worse and I began seeking fewer adjustments to help control the reflux problems.

It is incredibly frustrating that after being such a compliant patient with food, working out diligently, joining a running group and running three 5k races, joining two gyms (Burn Bootcamp in Durham, NC and East Coast Boxing in Cary, NC) that I am still struggling with my weight and pain associated with this band.  I have worked incredibly hard over the last 22 months, and the idea of gaining the weight back that I have lost causes me more emotional turmoil than someone who has never been morbidly obese can possibly understand.  I lose sleep over it.  I go to therapy to talk about how to deal with it and the depression, anxiety, and anger that accompany struggling with this experience.

I have a lengthy family history of obesity and diseases associated with obesity.  My paternal grandmother was so obese that her weight prevented her from walking.   I am terrified of meeting the same fate.  With a family history of obesity, I know the future health complications that I face if I don’t get my weight within a healthy range.  For example, all four of my grandparents and my mother suffer (or suffered prior to death) from diabetes.  My paternal grandmother lost a kidney due to complications of diabetes.  I have a family history of heart disease, hypertension, and sleep apnea.  I am trying so hard to get this under control while I am young, before I have a chance for these obesity related diseases to develop.  That’s why I had the initial Lap Band surgery, and I am not ready to give up on myself or on my health! 

At this point, I strongly believe that surgery to remove the band is unavoidable to cure my current complications--reflux and dysphagia, and I do not want to lose the progress I’ve gained by completely losing any form of a Weight Loss Surgery tool.  The desire to achieve a healthy weight is why I have requested revision to RNY gastric bypass in addition to the fact that gastric bypass is the best surgery option to help my acid reflux.  At 260 lbs., I am not close to a weight that any doctor would consider healthy for a 26 year old 5’8” female.  I know I am at risk of developing the prior mentioned complications due to my current weight, much less if I gain any due to these continued issues with my Lap Band.

I want to continue working hard to get to where I want my health to be.  I just feel that I shouldn’t have to either suffer with polyphagia, dysphagia or acid reflux in order to get there.   Even when I do not have my band tight, the reflux comes and goes.  The episode of reflux that sent me to the ER on 13July2014 was during a period that my band was completely unfilled.  So then, if I chose to keep my band tight because it appears I will have some form of reflux anyway, I require adjustments every two weeks.  That is a lot of time away from work and money to receive an adjustment bimonthly.  It is also a lot of exposure to radiation to receive an adjustment under fluoroscopy every two weeks, but since my aggressive fills require greater amounts of saline than a typical Lap Band patient, it would not be safe to do them without the fluoroscopy component.  The average Lap Band patient receives around 0.5 CC at an adjustment every 4-6 weeks, while I’ve continually needed anywhere between 1.0-2.0 CC saline at each adjustment every 2 weeks.  If we did the adjustment without the fluoroscopy machine and I received the usual 0.5 CC adjustment, it wouldn’t be nearly enough to help the polyphagia, and if Dr. Yoo were to give me 1.0-2.0 CC of saline without checking the adjustment under fluoroscopy, the chances of ending up with an overly tight band in the emergency room is much higher.  The only solution for my aggressive adjustments is for them to be performed bimonthly with the use of the fluoroscopy machine to ensure my band is tight enough to treat my polyphagia but not too tight. I often fear how that is affecting my reproductive organs and my future ability to have children at only 26 years old by continually exposing my body to radiation every other week under the fluoroscopy machine.

I have done everything Dr. Yoo has asked me to do to be a successful patient.  I’ve counted calories.  I’ve exercised on top of more exercise.  I’ve come in for my adjustment appointments at a rate that is TWICE the normal Lap Band patient.  It baffles me that BCBS can make the assertion that “there is insufficient serial records that there has been post-operative compliance with diet after the previous bariatric procedure”.  I would truly like to know how an individual loses 100+ pounds without compliance or how 30+ follow-up appointments in 22 months fails to provide sufficient serial records.  If this is NOT compliance, how then does BCBS define compliance?  I have a copy of the current Coverage for Bariatric Surgery policy, and nowhere does the policy define what compliance is or is not.  In addition to my records of follow-up visits and Lap Band adjustments, a letter was included from a nutritionist, Ellen Michal, stating that she had no nutritional concerns for me and Dr. Yoo vouched for my compliance in the peer-to-peer review.  I feel that BCBS is just looking for a reason to deny my case, and cannot find a valid reason, as ‘insufficient serial records that there has been post-operative compliance’ is certainly not legitimate.

When I changed jobs in March, I looked at my benefits information and realized pretty quickly that the insurance offered through my new company would not fulfill my needs as a bariatric surgery patient.  It was not a hard decision at the time to choose BCBS as my insurance provider, because BCBS was the company that made my initial weight loss surgery possible.  I even read through the benefits for bariatric coverage and came to the conclusion that BCBS would be the best option for me to correct the issues I have struggled with while having my Lap Band.  I had confidence that my health and wellbeing as a patient would be taken best care of with your company, but I am beginning to wonder if I was wrong.  I did not have a problem paying $332 per month for health insurance through BlueCross BlueShield, as opposed to the $42 per month for the insurance offered by my work, when I thought it was in the best interest of my health.  However, I no longer believe BCBSNC is putting what is in my best interest first. 

I have been obese my whole life, so perhaps I should be accustomed to being bullied about my weight.  But, the fact is that I am not used to it in a professional setting.  It is true that fat shaming is one of the last socially acceptable forms of discrimination, but it’s something that after losing over 100 pounds I am faced with much less frequently.  After receiving a denial for revision from Lap Band surgery to RNY gastric bypass, and then a denial from Dr. Yoo’s peer-to-peer review with Dr. Lawrence Wu with no credible explanation for the denial, it occurred to me that BlueCross BlueShield is practicing this form of bullying because the reason for alleges that I have been non-compliant, therefore the issues I am experiencing are through my own fault.  When I am told no, and the blame is placed on me, BCBSNC expects me to give up like I would’ve in middle school when I was picked on for being fat.  Two years ago at 344.4 lbs. and with a lot less self-confidence, I might have given up more easily, but today I realize my health and quality of life is worth fighting for.

Please take the appropriate action and reverse this decision in the best interest of my health in order to treat my GERD, polyphagia, and prevent future obesity related health complications. While I’ve been compliant and successful at losing 100+ lbs., I am still obese and I fear the repercussions of my obesity in combination with my poor family history.  I strongly feel that roux en Y is my only option to treat these medical problems.  This IS a medical necessity as I am having postoperative complications due to my Lap Band and am still obese.  If revised to RNY Gastric Bypass I will continue to be the hard working, very compliant patient that I have been since my initial weight loss surgery.  Please make my health a priority to your company.

Kind regards,