Clara B.

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Well, I met with the HR person at work. She is absolutely certain the company covers WLS, because she's dealt with this in the past. She was flabbergasted to see that there's an exclusion, and she thought she'd be able to find the rider that overwrites the exclusion in the insurance handbook, but she couldn't find it. She made some phone calls to the insurance company, and got conflicting information from the two people she talked to. She thanked me for bringing the exclusion to her attention, because no one else ever has. 

Now I understand what people have been talking about regarding the complexities of insurance plans. Actually, this isn't actually complex at all, but it seems like a matter of uncrossed Ts to me. 

 I finally called Care First.

The lady told me VSG is absolutely covered, yada yada. She was very sweet and nice, but then said my company's benefits contract does not cover it.

Poop. 

What to do now? I was all set to meet with the great doctors at Johns Hopkins and have this done the right way. 

Mexico???

Well, I dug up Care First's policy on VSG. As of March 2008, it is considered "medically necessary" as a standalone procedure, not investigational. I hope that means Care First Preferred PPO covers it, not just people nwith BMIs over 50.

The CPT code is 43659 - Laparoscopic

Still getting up gumption to call insurnace.

I sent off my patient data sheets today to Hopkins!

I educated myself thoroughly on DS, and even though it seemed like the surgery for me, something nagged in the back of my mind - maybe it's a bit radical for someone like me with a relatively low BMI. But I know LapBand and RNY are not for me. DS is becoming the gold standard for long-term success. I hadn't really thought of the forth option - VSG - because on the Hopkins website it describes it as only for super morbidly obese patients. Well, I'm glad for my own research and scientific background, because once I started digging up the literature on this, it became clear that VSG is the surgery for me. Yes, there's no long term data past five years, but the five year data that exists is extremely promising. And for someone like me, getting to my target weight - the average for my height, should be very attainable. What I don't know yet, and this is the big if, is whether or not Care First will approve it. They cover the surgery for "carefully selected" patients. Which mostly means super morbidly obese patients. But --- there's no compelling reason it should only cover these folks. Some studies of VSG refer to its efficacy for both groups. And it makes the most common sense - a more physiological procedure that has an excellent effect on ghrelin production. I'm not sure the lap band can offer that - since the whole stomach is preserved, but I will have to ask the surgeon.

I am comiling the studies to help make my case. When it comes to insurance, I need to have all the ammo I can get, although I don't think it will be a huge deal if I were just wanting a lap band, but this is a bit different.

I need to call the insurance company. I have trepidation over making calls like this - will the person on the other end of the phone listen and be helpful or clueless? I have a whole pile of appointments I need to make, for more than just WLS, and this is just one of them. But I have the CPT codes and a list of questions, so that should help.

I finished filling out my patient data packet. Really pretty easy. I will mail it tomorrow. One more thing done. Check!

Tomorrow, I will see if my therapist can start talking to me about food issues and diet every week - we usually do this a bit, so it should be in my notes going back a few months, but we should step it up for insurances' sake. Also, once I have a surgeon consult date, I should meet with Dr. Rashbaum again (my Primary Care doc) and talk to him about a "diet/exercise" plan. Of course I know how to eat, but we should put something on paper and follow it.

Current exercise-
started Meetup group for people and theirn dogs before work. So far, I've had 5 meetups over the past week, about 45 minutes to 1 hour and 15 minutes in trails in the park. I also walk the dog every day, and doing pilates. Signed up for a pilates equipment series for all of September. Would like to go swing and contra dancing, but the late nights have kind of kept me away. It's so hard to get up the next day.

I think the Cymbalta might be working wonders on my mood. Even when I'm in terrible pain, I've been in good spirits. I've n ever taken an antidepressant that actually helped my mood(!) The jury is still out on my pain, but my doc wants to up my dose and see what the effect of that is. Good plan.

I was asked to join a band this week. I am so excited. This is exactly what I wanted for myself, and look, I got it!I am a good musician! My fibromyalgia and bum shoulder have kept me from practicing much of the past 10 years, but the little practicing I have done has gotten me noticed and I am actually kind of good. It's hard to play! Really hard, sometimes, and sometimes it's easy, depending on whether I'm in pain or not.

I'm so excited about life right now. I'm actually funny, or so my best friend tells me - my improv classes have been paying off. I'm on my way to becoming a damned good musician. I found a good primary care doctor, thank goodness for that because the last one was a nightmare. And my fibro medicine may even be working. My morning dog walking meetup group is great. I have two reliable members who get me out of bed in the morning by showing up, the park is beautiful in the morning and not too hot. My mom's estate is closer to being closed, which means less headaches for me. The project for the zoo that I started before my mom died is 80% done. I might make a film about an amazing project in Borneo, I'm going to Mecca in October, that is, Cape Breton, Nova Scotia, the mecca of Scottish music in the new world. Holy Moly, life is good.

I have so much of what I want in life - a great job, a great boss, playing music, doing comedy, the world's cutest dog, the best best friend I could wish for, Jason, who is so different from me, but yet understands me better than anyone else on the planet. I don't have a lot of friends, but right now, it doesn't seem to matter. Like Frances says, the people who matter will show up.

On Wednesday, Jason and I left work at 2:30 and trudged up to Johns Hopkins for their informational seminar on WLS. It was kind of funny being the skinniest fat person in the room. I didn't learn too much new info. there, but it was nice to be in a real room with a real surgeon and real people who had it done. Personalized it for me a bit. There is still part of me that says I don't deserve this, people will think I'm too thin at 230 pounds to do this. People are so prejudiced against large people.Even one of my best friends and roommates. She thinks they're fat and lazy and have no self-control. Bu yet she admires me. There's a disconnect there, somewhere. I guess I'm not one of "them" because she knows me, and she knows how I've struggled with pain and losing my mother. Butr I wish she were more open-minded, and I don't really want to have to be the educator. But maybe it would be for the greater good. Not sure how I feel about Dr. Steele. She might have too much of a diet mentality for me. I don't like to be told what to do when I'm doing the absolute best I can under the circumstances. She's, like 5'3" and a petite little thing. But I have no doubt she's a very competent surgeon. I'm leaning toward Dr. Schweitzer, who is considered the best of the best, and is a little bit pudgy himself. Not sure why that little fact would make a difference to me, but it does. He's been there, or somewhere near there, anyway. Anyway, Jason and I drove around Baltimore getting lost afterwards and then found after an hour of driving and admiring the charming/scrappy little neighborhoods as well as the cemented up projects (no boards, cement!) we found Yabba Pot, a vegan restaurant that my Bal'more friend Neill had recommended. We had some wonderful food and some weird food. Like fake chicken that's the consistency of chicken, formed into drumsticks and thrown into curry. All that effort was wasted on me - they just tasted weird because they went for form over flavor. And I don't really like chicken that much in the first place, so faked chicken was not thrilling. But they made it from scratch, so you have to give them that. And the kale salad - not as good as I make it, but the only time I've seen it outside of my kitchen - was good. The seaweed salad was good too, and the carrot "tuna" was funny. It was really good, but oddly the consistency of tuna - through the clever use of celery and seaweed. Sounds weird, but tasty. I love this kind of food, especially when someone else prepares it! Not great food, but good food, and it feels VERY nourishing.

I had a sobering but completely inspiring call to Borneo last night. Here I am thinking of $25,000 surgery while my college classmate Kinari is in Borneo treating sick people who make $13 a month and have to become indebted to loan sharks to buy $10 medication for their children who have meningitis or TB or malaria. 150% interest, compunded MONTHLY. $10 is an inconceivable amount of money to people there. KInari says 20% of the people there have TB. A small cut can be deadly when you've never had a tetanus shot. Inconceivable to us here. And they live in one of the most important rainforests in the world - the lungs of the planet. But after the loan shark gets them, they are forced in to illegal logging in the National Park to pay it off. Kinari went there 15 years ago when we were in school to study orangutans, but she returned to the U.S. determined to get her M.D. so she could return to Borneo and help people. Becuase the health of people is so caonnected to the fate of the forests, she has started a program that trades healthcare for stopping illegal logging. It's amazing. Please visit the website and give them some money. www.healthinharmony.org. Kinari had a dream, and instead of getting swept up in the stress of modern life like many of us, she pursued that dream, and just did it, without looking back.

I don't feel guilty about pursuing surgery, though. In order to do the most good for the world, I need to be healthy - in body and mind, and obesity is a particular challenge we have to face here in the first world. Kinari has had a very different life, but I'm not jealous of her.

You see, I spent over 10 years learning to accept myself just as I am and love that woman. I found out there's nothing wrong with being fat. But I thought that translated to "it's bad to want to lose weight, because you must accept yourself as you are." Well, now that I do, I can see that losing weight isn't a bad thing if it's done for the right reasons. Because you feel good about your life and want to improve your health and not because thin is better in any way. Super thin people die earlier than overweight people. So there. But I recognize now that there are medical conditions that, if addressed through weight loss, could significantly improve my life and help me life as long as possible, so I can do the most good for the world *^*

For this reason, I can't fathom doing a RNY gastric bypass. I respond better to positive reinforcement than negative reinforcement. I have no interest in dumping. I thought the DS was for me from all the research I've been doing (which includes digging up abstracts on all the recent papers I can find on DS and VSG)

A funny thing happened on the way to the forum - the Johns Hopkins information forum, that is. Jason and I were running late on the hour-long drive from D.C. to Baltimore. When we arrived, I had him jump out and ask the parking attendant where the center for Bariatric Surgery was. They told him the Burton building, so we headed over there and went inside. Something didn't seem quite right...so we asked a clueless guard behind the desk who probably couldn't guard anything to save his life. We kept repeating the word "Bariatric" and he looked at us blankly. Then he said this was Bariatrics. There were all these old people in wheelchairs and covered in blankets. I went over and looked at the dedication plaque for the building that was on the wall. Then I whispered to Jason, "this isn't bariatrics, it's geriatrics!" Oh dearie me. Fortunetely, Jason was able to roust some administrator lady, and she directed us to the right building after having to look it up for us. It was right next door. What a day!

Since I've been researching this, I'm amazed at how many smart, articulate, introspective people have gone through this. I had NO idea there was a community out there.

I'm in a really good place in my life, but things haven't always been this good. I've done a lot of work over the past 20 years to become who I am. I kind of thought people would do this out of desperation, but now I'm wondering if maybe it's a really good thing to be in such a strong place right now, after all, if I get surgery, it will take a lot of emotional strength.

I wonder if I'll show this to my dad. He's my "next of kin" but he doesn't know about my eating disorder, or if he does, he would never say anything. But I don't think he knows. Part of me wants his support. Part of me wants to tell him I'm getting gall bladder surgery instead. Why am I afraid of him knowing?

Writing all this stuff, I'm starting to think maybe I could tell people. Like my roommates. Like selected co-workers. But that will take trust, and the only people I trust to know right now are Jason and Paula. Laura is fat-o-phobic, but I think she would learn something from this, but do I want to be the teacher (oh, but YOU'RE no very fat, you just have big boobs. Her selective blindness to maintain feeling of superiority to ACTUAL fat people). People I would never tell: Michael (unsupportive ex-BF), anyone who's made a disparaging remark about fat people (except maybe Laura, who makes disparaging remarks about homeless people, etc., etc.)

If I ever do lose weight, I don't want anyone congratulating me like I've just won the Boston Marathon, or something. People get so looney when you lose weight, like you're a hero, but funny how they stay quiet if you've gained weight. I still have a chip on my shoulder about this. I don't want anyone saying: "You look great!" Because my cynically interior voice will respond: "You think I looked like shit before, you cad!"

Here's a conundrum. Let's say I lost weight and just happened to meet a nice boy AFTERWARDS instead of before. Would I ask him the probing qwuestion: "would you ever date anyone who's obese?" Would I break up with him if I got the answer I didn't want to hear. Truth be told, whoever I date needs to know about my struggle and accept me, support me, even admire what I've done and who I've become, and that's going to require a lot more of a conversation than whether he would date an obese person. Of course, I might not get surgery, might never lose weight, or I might meet someone before I lose weight. That would be a whole 'nother can of worms.

I have stayed up late researching this. It's the desire to know everything, to come in eyes wide-open. Maybe I'm a tad obsessive sometimes, but not that often, I think it balances out most of the time, although I could use more rest.