It's about the first of May 2005. I want my life back. I've been lucky to be healthy, strong, and active up to now despite obesity since childhood and morbid obesity for the last 25 years. But I'm starting to fall apart and I don't like it a little bit. I want to be strong and active and nothing I've tried so far has worked for more than a short time.

Around mid-May: I have been reading at the main boards for a couple of weeks now and had just about decided to ditch the whole idea of WLS. I was appalled to see how many people were struggling with regain within a couple of years out and many of them are making GREAT sacrifices (super restricted, starvation level calorie intake, obsessive exercise). This doesn't make sense! If they have malabsorption and are even eating normal calories, shouldn't they be losing weight? This all makes my head hurt. All anyone could tell me was that what maintenance would depend on is living the restricted diet and exerise lifestyle forever. Well, excuse me, but I have tried to live that way, remember? I don't mind living healthy but I resent living deprived, and certainly don't want to be violently punished every time I eat a little something that should be considered "normal" for non-obese persons. Then Ms. Batt suggested that I check out the DS board. WOW I had no idea there was so much difference.

First of June: DH is a nurse and the gastric bypass doc here in town (RNY only but apparently "learning" DS) told him a bunch of stuff about DS that was very disturbing. I shared that here and came away thinking, "That guy isn't going to touch me with a ten foot pole!" He's probably ok about RNY but I know for sure now that I am now having WLS if it means RNY.

I started mentioning that I have chosen DS and have been blasted at almost every turn. On an insurance list where I posed an ins question about DS, the group moderator called my very character into question and said that the only reason I would want DS is because I didn't really want to change my eating habits because I am unwilling to be permanently restricted from things that people should normally be able to eat. I'm getting the same exact flak from the yahoo groups for WLS surgery in Arkansas, too. It's like if you want to live, work out, and eat NORMALLY then you're just trying to cheat. If we're not going to be fat, then we SHOULD have to suffer for it. Hell I'm suffering now but at least I'm not miserably deprived. Whatever happened to the idea of normal or balance? Why is it required that we may only have either/or?

Mid June - We always have a week at the lake starting around the first Sunday in June and I haven't done anything to check up on the new ins. Frankly, I don't even know where to start but my annual appt w/PCP is June 16 so I'll ask her about it then and take it from there. She agreed last year to be supportive.

I'm worried. There are so many barriers and obstacles. I've never been much of a hoop-jumper - tenacity isn't my strongest suit (that ADD thing again.) I don't want to be miserably disappointed. I have a very strong faith in Jehovah God and have decided to give it all to Him. If this is something that He wants to use to heal me, then He's perfectly capable of making it happen. If this is just a wild hair of my own, I'm sure I wouldn't be happy even if I got it. But man it is SO hard to let go when you see a glimmer of hope.

Well that appt has come and gone. I thought my weight was 265 but it's 273 and I think that's about 11 lbs more than last year. She's clueless about DS. Never even heard of it and I could sense a bit of a pull back when I started explaining it. Nevertheless, she left the room saying, "just find out what to do next and let us know." Sat June 18 - I got a bug and started looking around for a DS surgeon. We're in western Ark and they are not coming out of the woodwork here, that's for sure!

The first of the year DH had a job change and the new ins went into effect on June 1. The old job's ins was Blue Cross and it had a written exclusion. The new ins book (Beech Stree) talks long and hard about what they don't do to support weight loss, but then gives specifics as to what they pay for surgical treatment of morbid obesity.

I had NO idea even where to start, and got great help from the great DS board members here, who told me to choose a doc or two first. It kind of came down geographically between Anthone in Omaha and Dr. Warden outside New Orleans. Omaha might be a smidge closer. When I actually sat down to work on this thing, the roadblocks started falling like flies. Reports from AR and all of the surrounding states by Beech Street clients were almost all approved, and most of the approved ones were done on basic proof of medical necessity. Nobody reported jumping through hoops. Most of the ones who were denied at first were ok'd on first appeal letter. But only one DS. I'd feel better if there were several.

I decided to just start with those two then fan out to see if there was someone who takes my insurance. I could hardly believe my ears when I called the ins co and found out That Dr. Warden is in network- and so is the hospital where he does DS! Money was one of the major hurdles - ins has to pay for this IN NETWORK and if it doesn't, it's a deal breaker. It might not be for everyone but if you could see my checkbook, you'd understand. Here this hurdle has possibly come crashing down. Actually, that's not the real time line - Sunday I was reading web page where it says that they now do GBP at Omega Hospital, and it's not on our ins. But when I called and talked to the patient advocate, I found out that Dr. W likes to do DS at Fairview, which IS on our ins. Ok OK OK I can't stand not to say it.. PRAISE THE LORD! Waiting to hear back from Danielle. I'm so tickled to have cell phone - we're leaving for a 4 day camping weekend tomorrow and I'd just hate to have to choose between that and missing her call!

June 27 - Danielle- Dr. W's patient advocate- called today, but I didn't get to talk to her. I'd given her DH's cell number before we left to go camping just in case my phone didn't ring. I hate checking messages and don't have voice mail - this wasn't a call I wanted to miss! Anyway, she told him that Beech Street ins doesn't cover the surgery. Now, he's only the sounding board on this; I'm doing all of the legwork and he doesn't even know the right questions to ask. It specifies in our book that they will cover $$$ amt for surgery to correct morbid obesity. He didn't ask her if they told her that they don't cover the surgery or if they don't cover *DS* surgery. And furthermore, there is someone on the insurance reports section who had DS, so now we have a hurdle. Where to from here? Guess I'll fax her a copy of the book pages where it talks about that and see what happens from there.

July 6- Well it took forever to find the insurance book and then get the pages faxed, but we did this morning and Danielle called right away to say that it looks like there is a written exclusion. I asked her if we could pursue it on grounds of treating co-morbidities, and we launched into a new conversation.

As of now, DH is the only one with anything that could be considered life-threatening co-morbidities because he has an official diagnosis of obstructive sleep apnea AND he's already had the snore surgery. In addition, I know that his sugar is wonky but he wouldn't get it checked - it's been high when we checked it here too many times. Not sure about his BP - the new standards of a diastolic being over 80 will probably help there. Those, apparently, are the "big three." She is right now in a test case for a man with apnea and they are trying to get him approved on the basis of this being an all-else-has-failed treatment for the sleep apnea.

Actually, this could work in our favor. There is a $25K cap on any treatment for the purpose of weight loss. Possibly doable for the surgery but if any little thing went wrong a few days in the ICU could ruin us with only $25K of coverage. He is a nurse, and works for a company that leases space on a hospital floor where long-term ICU pts, esp. those that they are trying to wean off of vents, go. They have an RNY pt right now who has been there for over 2 mos - all because the staple gun misfired. You can't blame anyone for that, but it goes to prove that sometimes things happen.

As for me, things will be much harder. I don't have any of those three 'life-threatening' diagnosis although I have a host of weight-related complaints. Last month my bp was 126/88, and with the new lower standards for acceptable bp I might be able to get something going there. She said that there is usually a requirement that you be on 2 bp meds for it to count so I'll just have to address that with the PCP. She also said GET THAT SLEEP STUDY. I snore like a logger even when I'm not really asleep, I can be still-aware dozing or even in deep concentration but relaxed and start in. Nobody has to tell me I snore, but DH says that sometimes I do hold my breath. Not a lot, but only a sleep study will determine the extent.

She doesn't seem to think that the history of clinical depression/suicidal thoughts will be of any too much help - just on the principle of 'throw everything you can think of in there.' She also recommended that I ask about going back on anti-depressants instead of using all of the coping mechanisms I've learned in 15 years of dealing with this. And, considering two things: 1)that the first line of coping is putting up with it, and 2) that and the rest of them are only working so-so these days, that might not be the worst thing I could do.

So now, next step is to make the dr. appts. I am praying that you are all wishing me luck and all things bigger than luck. I'm trying to stay positive that all of this is not a sign of defeat, just a bumpy road to victory.

First of July - If you can believe this, we forgot that DH has Crohn's disease. I mean we really forgot! He was diagnosed almost 15 years ago after some complaints. He took some meds and then he was good to go - never had more trouble with it. We'd prayed for and believe in divine healing, so we just made the assumption that he was healed and went on our merry ways.

Then last year when he turned 50, the doc insisted on another colonoscopy. I had so totally forgotten about it that I was stunned when the doc came in and talked to me and said that the Crohn's was still there exactly like it had been before.

Recently, in a casual conversation with someone else, she mentioned that wls is contraindicated in Crohn's pts. Well blow me down. More and more research - apparently VG is a possibility and so is lap band. Lap band - ugh. We knew that it was not right for us at the beginning of this journey. Now, I consider it probably better than RNY, but only in the most marginal sense. VG on the other hand.... now you know, it just might be possible for the VG to do the portion control and it work beautifully. If it did, wouldn't that be great?? Weight control with NO malabsorption?

End of July - well, I'd decided I'd hit a brick wall. That $25K cap on what our ins will pay (assuming we could fight them into paying it for WLS) was a scary thing. It would leave us $10K in debt for each of us. We are swimming in debt and, at ages 51 and 45, have no retirement set back. I have prayed and prayed about this, and while I don't sense any definite NO yet about wls, I do sense it about accruing debt. I'd tried and tried to find extra ins coverage to buy, to no avail. My taking a job doesn't seem to be the answer. I can barely stay on my feet a half day and then I have to crawl around sometimes. I don't have any special skills that would get me a sitting type job, and anyway then the back problems come into play. Finally, who knows, when you take a job, if the company has an exclusion? I've tried to make some discreet inquiries from people who have wls as to where they work, but that's not working out. If you take a job, odds are better that when the ins thing comes up, you'll find an exclusion. I can suck up 90+ days of suffering if I know that, at the end, there will be a policy available that will meet the need. But I can't do it on the off chance.

Then someone suggest another possibility - VG might be cheaper, and it might be available through the local doc where we might get some professional discounts to help out. DH works with the wls surgeon at the hospital (RNY only) is going to ask him about all of it - the Crohn's issue, VG, and, as a last resort, lap band. I tend to think that it shouldn't be too hard to find someone to do VG. After all, isn't it similar to some stomach cancer surgeries? If this doc will do it, then we have a good chance of getting the price under the $25K limit. Of course, we'd still have to fight them to get them to pay for surgery in the first place.

OK more good news!!! Someone wrote and suggested that I look into Ark Rehab Services. She had hers paid by FL rehab and she looked at the manual for ARS and said that they look very similar.

Tomorrow morning I'll be calling to get an appt - also to get dr's appts to start the diet and get serious about documenting co-morbs. They require 1 year but I have reason to believe they'll accept past diet efforts - still, no reason not to get going on that and maybe my clothes will fit the rest of the summer at least.

The biggest challenge will be their restriction of a BMI of 55 - mine is 47 and I literally think I might be an invalid if I gained another 50lbs to satisfy this. However, the insurance list at OH has 3 people whose BMIs were under 55, so there might be hope.

Once that is done, I'll still have to challenge for out of state surgery to get DS. If I lose that, then I will DEFINITELY work on VG. With DH's Crohn's disease, he's probably limited to, at best, VG. Since that is similar to operations done to remove stomach cancer, I am hoping it will be much easier to find a doc in state that they will approve.


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November 26, 2005-

Wow I need to keep a better eye on the profile. So much has happened since the last entry.

I did get approved for AR Rehab. However, the counselor is very VERY much against WLS. They've paid for a lot of RNY surgeries and haven't had good long-term results for their money. Duh. That's why I'm choosing DS. Besides, apparently the clients haven't gotten good counseling about the image problems that come with hanging skin; that seemed to be a huge deal to her even though I'm not worried about it. I have skin issues already, and am hoping that insurance coverage will deal with them when the time comes. This is SO not my problem at this junction.

And, as things worked out, there is a VERY different road ahead than I'd even thought to picture, much less saw myself on. The Rehab is all about getting disabled people to work. They make a 2-way effort at that - restoration (dealing with the physical and possible mental disabilites) and vocational rehabilitation - training.

Understand, for the last 27 years I have been a wife and a mother. I've been glad to do this - it really is exactly what I wanted. But my last child graduated high school this past summer. So my husband and I have been sort of rethinking what life would be like. We LOVE to camp, and he has a job where he works either 3 or 4 12-hour days a week, so it gives us time to spend several days at a time in a campground. Additionally, he's been thinking of taking on a position as a traveling nurse, where you sign a contract for several months at a time to work in a certain area. We'd take the camper and live there during that time.

Of course, our weight and health issues loom over things. We've both developed bp troubles for the first time. He's also developed sugar issues that are not quite diabetes, but the handwriting is nevertheless on the wall, right?

At that first meeting, I told her that my overall concern is about MAKING it to retirement and then not being broke when we get there. We haven't been good with our finances through the years, and now, at 51 and 45, we REALLY need to get on it. Of course, if we're crippled or dead, we could retire rich and we still wouldn't be able to do what we dream of doing.

This set the tone for what I'm hoping for rehab. Upon leaving the initial visit, I was thinking in terms of getting them to help me lose enough weight that I can work a full time job. I don't have a lot of marketable skills that don't involve some pretty serious labor - even standing at a checkout would be misery. MAYBE they would even help me get some certification in some office systems to help my marketability. I hadn't really intended to go back to work as a lifestyle, just get a job with insurance that would get our WLS's.

After I was accepted into the program, she wanted to talk about my 'career' goals. OK...I'd heard that fed. government ins covers WLS and there are two federal sites here, a national cemetary and a national historic site. I'm a master gardener, and if I could get work as a groundskeeper I might like it well enough to keep doing it. I also really love history and lecturing and think that a job as a park interpreter would be something I could have fun with. Of course, I didn't tell her that what I was really thinking was almost exclusively about something temporary that would get us to our goal of getting our health back.

I was blown away when she said that the park interpreter's job requires a bachelor's degree! To recite a script and show people around???? geeze! But guess what - they are willing to pay for that degree! A scholarship for a bachelor's degree practically dropped in my lap! UNBELIEVABLE!

It was such a different train of thought that I stopped her cold at one point and went off on a tangent of spending a few months getting certifications for office work. But I couldn't shake the the thought. Our local university offers a bachelor's in Historical Interpretation.

We also talked about the more immediate ideas of restoration - treating the physical disabilities. They are going to pay for a double ended program- a weight loss center similar to LA weight loss and a membership to Curves. I am really excited about these things.

At some point after the second meeting, I finally realized that I am a different person than the 19 year old whose immediate goal for the long term was to be a wife and a mother, with any work being incidental - just working for the money. Immediately after DS left home, I had a hard time with a feeling of loss of identity. But it went away and the fun plans that DH and I have for the future were fine.

But here is a chance to re-invent myself for the second half of life. I DO love history, and writing, and talking to people - even public speaking. Every person I told about it says that this sounds like a PERFECTLY suited job - practically tailored to me. It pays more than I thought it did, which, hey, is a plus! Plus it would have government retirement benefits - both in payout and insurance. I could really help our financial situation in both the long and short terms.

BUT - the overriding thing STILL is to make a way to get our surgeries. And with our health starting to swirl down the toilet, waiting 4 or 5 years is NOT an option.

However, two other things worked out: I found out that after I get some work tolerance built up, I can get a part-time job. I also discovered that there is a high probability that Home Depot's insurance covers WLS AND that they offer it to part-time employees.

Before we turn around, it will be spring and they will be desperate for help in the garden center. I'll have 5 months of dieting and exercise under my belt at that point - surely my work tolerance will be built up. Not to mention that I am so totally passionate about plants that I am willing to suffer to work with them LOL - every spring nearly kills me. Shoot, one of the reasons I want to lose weight is because I'm losing the ability to garden! As a certified Master Gardener and someone who works very well with the public, I feel that there is a good chance of getting on with them.

So now there is a new goal: For the moment, I'm following the diet program. It's a low-glycemic, low fat, high protein program. It's tolerable and I don't mind it at all. Same things with the Curves program. Then, when spring rolls around, I'll try to get on with Home Depot - hopefully p/t if I can still get insurance. (Lowe's offers ins to p/t people so it seems reasonable to hope that HoDe will.) Once I have been there long enought to get their insurance, we will IMMEDIATELY begin working on getting our surgeries. We'll both have MORE than six month's medically supervised diet/exercise already done and documented, so that's one holdup we won't have to worry about. We're already insured through DH's work, so 'previously existing' doesn't count.

Obviously I'm not going to try to lose a great amount of weight- I won't feel safe about being approved if I'm below 225. That might be a bit of an issue. The people I've talked to who went on this program lost a LOT of weight, and pretty quickly. So there's a balance to work out. It'd really suck if I went through all of this only to be turned down for not being heavy enough!

As far as which doctor, I'm leaning more toward changing to Anthone. He, Husted, and Warden are all about the same length drive away, and he really does seem to have the best record as well as the best insurance situation of the three. Of course, we'll just have to wait to see the policy to see how that part works out. DH's ins obviously will not pay (although I'm still going to fight them about it to get out our-of-pocket as low as possible). I may have to choose to go with someone in-network if it's possible and Husted isn't in-network with anyone.

Come August, with everything behind me, school will be starting and I'll be a student again! IMAGINE!

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Long time no see.  I quit at the boards here around Nov 2005 and didn't come back for a long time.  Ark Rehab paid for me to go to Curves and join a weight loss program that is similar to LA Weight Loss.  It wasn't that hard and I lost 45lbs from Nov. 2005 to Aug 2006. 

Feb 2006 I went to work for Home Depot in the garden dept.  It was fun!  I couldn't believe I was getting paid to do something I enjoyed so much.  But after 3 months I got to look at the ins for p/t people and found that it excludes WLS.  Les had developed diabetes in the meantime and now needs the surgery more than ever.  And me?  Even at 225lbs I was still really interested in a tool that would help me get and keep it off.   

As soon as I discovered the ins problem, I asked to be placed full time.  They didn't change me to full time till after Labor Day.  Then there was still a problem at the paperwork level...it was December before everything got done and I was able to sign up for the full-time insurance.  I had checked as soon as I found out the bad news about ins for p/t...ins for f/t did not have an exclusion.

At some point over the past six months, I had gravitated toward going with Dr. Anthone as our surgeon.  It just seemed to naturally fall into place.  Both he and Nebraska Methodist Hospital are in network.  The office staff is phenomenal.  Christie got our insurance papers all done for us.  UHC approved both of us on the first application. Our first consult was Dec 22.  We were approved and had a date by the end of Feb.