To Whom it May Concern:

For years I have suffered with back pain due to my obesity. When I would talk with my doctors, they would all tell me to lose weight, then I would feel better. I lived with the pain and limitations because all my attempts to lose weight throughout the years had failed. I finally found a solution to my obesity and lost 140 pounds. The weight loss though gave me a massive amount of redundant skin. This redundant skin in my upper & lower abdomen, puts a tremendous amount of stress on my lower back. I also suffer from panniculitus, that beagn after my initial 100 pound weight loss in February 2003.

My primary care physician, Dr Susan Whitely,as well as her Physicians Assistant, Sally Hartzell, have included a letter stating all of the medical steps I have taken to prevent the recurring panniculitus. I also must bathe two times a day, using a hair dryer to thoroughly dry the fold of skin under my enormous pannus.I then must place two sanitary napkins under the area to keep it dry, if I do not I sweat causing a rash and a foul smell.

My primary care physician, Dr. Susan Whitely, suggested that losing the excess weight I was carrying would relieve the stress excess weight put on my back.. When losing the weight didn’t decrease the pain, she suggested I try physical therapy to strengthen the muscles. I did go through physical therapy and continue to do the exercises I was taught on a daily basis. I also must wear a full size girdle everyday to provide some support to the pannus and my lower back. If I do not wear a girdle I end up in debilatating pain by the afternoon. I have also included a letter from my gastric bypass surgeon and hernia surgeon, Dr Terry Simpson, this letter shows that I underwent repair of an incisional hernia on May 20, 2003 and that I now have a second incisional hernia. I must also wear my girdle to keep my pannus from pulling down on hernia, which causes signifigant pain.

I have included a letter from Dr. Susan Whitely as documentation and verification that my pain is real, and that she has worked with me to help me with my pain. She states that the requested surgery is medically necessary. For the past 13 months I have made a strong effort to keep an exercise routine, however, my routine is greatly hindered by the pain of a large pannus and always causes me to end my routine early. I have to keep exercising if I want to keep my weight down and if I want to keep my health. I can’t keep my weight off without exercise.With the recurring hernias I am also unable to perform all of the abdominal muscle strengthining exercises I was trying to include in my daily exercise routine. Sometimes when I am doing my brisk walking exercise after 25 minutes or so,I have tears running down my face because of the pain in my lower back. I take pain medicine, Diclofenac two times a day so I can function during the day.

The surgery I am requesting is definitely of a Reconstructive nature and NOT cosmetic. I am aware that the surgery leaves noticeable, permanent scars, according to the AMA’s description. I am not requesting this for cosmetic reasons.

Sincerely,

Here is another:

I am not requesting these surgeries for cosmetic reasons.  These surgeries are reconstructive following massive weight loss per the American Society of Plastic Surgeons and the American Medical Association.  This letter is in response to my denial for Abdominoplasty and Medial Thigh Lifts with Dr. John T. Louis. Your insurance company gave me approval on my Open Gastric Bypass on April 12, 2004. I am 5’2” tall and was over 340 at my highest weight and had a BMI of 62, which put me in the Super Morbidly Obese category. I am currently at a weight of 145 and have lost over 190lbs total. The bypass has enabled me to be a much healthier person for which I am very grateful. However many of the problems that have been associated with my Obesity still persist even after losing this massive amount of weight. I suffer from Depression, Fibromyalgia and chronic re-occurring upper and lower back pain. Unfortunately during the rapid weight loss and having destroyed the skin with my years of suffering from obesity, I have been left with a 10-15lb mass of skin hanging from hip bone to hip bone. The reason I am requesting this abdominoplasty and thigh lift is to be able to move without constant pain from the tugging and pulling on my back and the constant skin infections as a result of this.

I now suffer from chronic consistent rashes under my Pannus area that are extremely painful and unhygienic. The area becomes extremely raw almost in a blistered scalded state and oozes a yellowish discharge that emits a foul odor. This discharge not only smells horrible it leaves a stain on my clothing as well. I have been self-medicating the area with Lotrimin, Tinactin, Gold Bond Powders, antibacterial soaps as well as many other home and over the counter remedies. Nothing that I have done has been able to alleviate the problem. I have been to my primary care physician to get help with the situation and was given Ketoconazole 2% Cream 60 Grams, which helps but does not get rid of these infections. I wear a soft sock under the area to help with the rubbing and friction but this is not very effective either. These eruptions normally will last anywhere from 3-7 days and return normally in about a week to two weeks (if I am lucky). I suffer with these infections under the Pannus area, the juncture of my thighs, my belly button, under arm pits, back of the knees and under my breast. I’ve tried blow drying the areas and using anti-perspirants to no avail. These infections have severely limited my desire to have personal contact with my husband. I just never feel clean and am very embarrassed from the odor. Not to mention the pain involved. Imagine what it must feel like to have your skin scalded with hot water on a consistent basis. It burns and is extremely sore. In the beginning it is very itchy also. I feel this almost all the time. It’s like being tortured by your own body. Nothing that will kill you but it can certainly work on your mind and your self esteem. As a person who is already diagnosed with clinical depression this only adds to that problem.

Before my RNY, I was limited to walking no more than just a few feet and was only able to do this with the assistance of a cane. I suffer with Degenerative Osteoarthritis with major damage to my knee joints that will need to be replaced in the near future. The huge mass of hanging skin from the Pannus now makes me over compensate when I walk and puts extra stress on my lower back and legs. Exercising and walking can be an uncomfortable problem as the pull and tug of extra skin flapping with each movement. I do wear support panty hose as well as stomach and thigh girdles to help support the extra skin

I hope you will look into my case with a new sense of urgency as the problems that I have are a direct result of my disease of Obesity. I feel that if I had been diagnosed with cancer and my breast had to be taken you would have no problems approving reconstructive surgery. These issues that I suffer from are no less debilitating than if I had Cancer. This 10-15 lb mass of hanging skin is no less of an issue than if I had a cyst that was growing from my abdomen. I do not want to be a failure in my fight to live a relatively normal life. After reviewing the following information that you have posted on your website I cannot understand why you have chosen to deny my rights to have these procedures as I suffer with more than the requirements that you have presented.

• The panniculus hangs to or below the level of the pubis
AND
• The patient’s medical record documents that the hanging panniculus causes skin irritation or infection (resulting in pain, ulceration, superpubic intertrigo, monilial infestation, or panniculitis that is chronic, persistent, and refractory to medical treatment for at least a 3 month period. Examples of agents that may be used for conservative treatment are antifungal, antibacterial, or moisture-absorbing agents; topically applied skin barriers; and supportive garments.

I am currently scheduled to have a breast reduction (for which you approved) with Dr. Louis on December 5, 2005 and would like to have this procedure done at the same time. My hope is that you will review expeditiously this letter, my primary care physician’s letter, as well as the photos and other documentation that I have provided for your consideration and reconsider your decision as I do meet the qualifications as outlined in your policy. This letter is my attempt at helping you to understand who I am and see my case with a new sense as to why this surgery is such an important issue in my fight against Obesity.

Very Truly Yours,

And the last one

To whom it may concern,