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HEY!  I got my weight documentation from NY today!  They called and asked if I wanted it faxed over and I have it!  It documents my weight on 3/13/2001 at 200 pounds!  The doc even noted twice on the form "obese".  Unfortunately, part of the form is blacked out like happens sometimes in faxes. I've been trying to reach them to get them to send me a clean copy in the mail, but at least I can move forward now!

I called CMMC and faxed in the required forms.  They will call me to make an appointment.  More waiting, but I knew how this goes when I started.  I'm just hoping to have surgery this year.

I'm on my way!!

Still waiting for that documentation to come in the mail from NY.  It'll be 2 weeks on Wednesday.  Once I have it, I'll make an appointment with the surgeon.  Waiting, waiting, waiting....argh...

Pretty sure I'm gaining some weight in the mean time.  My husband even said I look bigger to him as well.  I'll have to bite the bullet and weigh myself in the morning.  I can't let it get too bad, I have to think about my blood pressure.

I'm wondering how much time I'll have to take off work for all the appointments I'll need.  The 3-month diet Aetna requires means four appts each at the PCP, dietician, and exercise therapist so that's 12 appts right there!  I've written out a plan to get all those in on days when  my boss will be out of the office, and what's required at each appt (I'm an executive assistant and it's just easier to get time off when my boss is out).  Of course, this plan only works if that piece of paper comes in the mail from NY.  HURRY UP PEOPLE!  Waiting is killing me now.  And there's no saying if the doctors are available on those days but, hey, it made me feel like I was moving forward. Then there are the appts for the surgeon and the pre-op stuff, but I'm not as worried about that.  I guess it's the insurance requirements and the all the orchestration needed to meet them that is bugging me.  I wish that piece of paper would come in the mail so I could move on!

They say you need a week off work but since I sit at a desk all day I think a few days will be just fine.  I had my gallblader out in 2005 and took a week off for that and it was too long.

I've been thinking about goals.  I've done this a lot while on diets but never really made any of them!

- Lose the high blood pressure
- Have doctors stop telling me to lose weight
- 199 pounds (less than 200 again)
- 175 pounds (lowest weight in MS)
- 155 pounds (former weight - pretty happy there)
- 140 pounds (lowest adult weight)
- 130 pounds (goal! and loss of 102 pounds)

I wonder what I look like thin.  I have no idea since I've never been thin.  Do I have a small waist or thick?  Is my neck long?  Are my hips slim or wide?  Are my thighs narrow or plump?  Are my breasts small?  I can't tell...there's just too much fat in the way now.  Hope to find out someday soon tho! :)

OK, I got it to work but I have no idea what I did different this time!







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I'm memorizing and practicing The Band Rules already.  Especially #4:

1.  Do not drink with meals, or for an hour afterward. 
2.  Eat solid protein first, then veggies & fruit, then complex carbs. 
3.  Sip 64 oz of water per day.
4.  Eat slowly, tiny bites, and chew thoroughly.
5.  Stop eating as soon as you are satisfied.  Even one bite too much will result in discomfort.
6.  Avoid liquid calories.

Let’s talk about co-morbidities. I’ve got a few.  

First and worst is my high blood pressure. “High” according to Aetna begins at 140/90. Mine is running 153/98. Well, honestly that was a few pounds ago. My doctor would like to see it under 120/70. An elevated diastolic reading (bottom number) is closely linked to heart disease. Blood traveling under high pressure causes nicks and scrapes in the lining of the vessels. Your body responds by troweling over the injury. Over time that area of irritation get plastered over and over again, and eventually the whole thing breaks off as a blood clot and goes to your heart or brain and ZAPPO!!BAMMO!! You have a heart attack or stroke. I understand that this process is ongoing inside me every day.   

Spells. I’ve been having what I call “spells.” Out of nowhere my heart starts to pound, my vision narrows or darkens, I hear a long burring in my ears, I break out in a cold sweat and tremble all over. Only lasts about 30 seconds, not even probably. I can remember 3 “spells” since last summer. I forget all about them until I’m having another. They are not really scary…just sort of what the hell is this? One was in the local public library and it was totally surreal. My boss witnessed one just a week or so ago and he said I was visibly trembling and my face was sweaty but my skin was cold. And I was bright red – but I get that a lot. Doctor thinks it’s linked to my high blood pressure. Keeps telling me to lose some weight, that my body is obviously stressing out. I would have objected since I get tired of doctors immediately reacting to any problem I have with “Well, you’re fat. What’d you expect?” I would have objected except this never happened when my weight was more normal. True ‘nuff.  

Stress incontinence. Oh, joy. This one has really gotten bad lately. I’ve been told I smell sometimes (by my overly-honest husband). It’s hard not to smell when you dribble in your britches 20 times a day. It’s definitely worse when my weight tops 200. Sometimes just turning in my chair at work will cause a gusher. I don’t have any control over it. I go thru a lot of pads and I’ve learned to keep a full box and a change of underpants in my desk at work. Embarrassment-wise this one is way up there. All of us fat people work very hard to make sure we don’t smell because everyone else expects us to. I’ve thought about bringing a washcloth to work, but the thought of trying to wash myself in front of co-workers in the ladies room turns me cold.  

Heartburn. Ouch! I never had this before except once when I was pregnant. It’s like chunks of hot lava in your throat. Burp ‘n burn, baby. I have it already today and it’s only 8:30 am.  

Plain ole’ PAIN. Joint pain – ankles, knees and hips, oh my. I used to walk quite a bit (I actually enjoy it) but I started to roll my ankles all the time. It’s pretty bad when you’re so fat you’re afraid to freaking walk for fear of getting hurt! My feet and ankles are always swollen and ache, ache, ache. My hip only bothers me occasionally but when it does it is sharp and urgent. Lower back pain. This is more of a tight, pulling feeling. Kind of like a headache in your back.  

Shortness of breath. I was sitting on a couch at an acquaintance’s home the other day and suddenly I couldn’t breathe. My beach-ball middle section was all crowded up into my chest by the sitting position. I couldn’t inflate my lungs. Very uncomfortable. When I lay flat I have a crushing sensation from all the weight pushing down. And I get out of breath now just getting dressed! And just forget anything involving bending…I am just too big in the middle. Worrisome since belly fat is supposed to be dangerous. This is another reason I cut back on my walking. I dread feeling like I can’t breathe.  

High Cholesterol. I’m sittin’ at 220 right now, or at least I was last year. Might be more now. My cholesterol has always run borderline high, though. Just genetics. Both my maternal grandparents died from heart disease; so did my paternal grandmother (at 44 years old). My father has heart disease. Bad genes, huh?  

Sleep disturbances. I used to hit the sack at 9 pm and be out like a light! I rarely sleep more than a few hours at a time now. A combination of shortness of breath and that crushing feeling. I’m not exhausted but kind of low-level dreamy a lot. I’d hate to have one of those CPAP machines. I know sleep apnea is very dangerous, but I honestly don’t think I have apnea. Although if I did it might help explain the spells…hmmmm.  

Loss of confidence. I hate to go out because I’m sometimes the fattest woman there. I don’t want to bring attention to myself  because I can’t stand how attention makes me feel (oh, god, they must be thinking I'm really fat because it's all I can think about!). I have gotten more reserved at work and my work has, frankly, suffered. I can’t concentrate like I used to. I just don’t have the energy. I don’t like to be touched because I can feel all my fat rolls under someone else’s hands. Especially hugs!! I hate hugging!!! I can feel all my fat when someone puts their arms around me. Ugh, it makes me shudder. I don’t like to be looked at. I wear lots of layers even though I’m not fooling anyone. Everyone can see I’m fat, I just don’t want anyone to see exactly how fat. I turn the air conditioning up high at work so I can wear a big bulky sweater.  Everyone else freezes so I say the AC is faulty.  I’m not a woman anymore. I don’t feel womanly or sexy. I’m not attractive anymore; men don’t bother with a second look. And sex? Well, I’ve never had a high sex drive. I think most fat women would agree that there is nothing like sex to reveal just how fat you are! It is the most humiliating and mortifying experience EVEREVEREVEREVER.

Thinking about being fat, wanting to not be fat anymore, takes up all my time, all my energy.  It's all I think about.  It's all I think about.  It's my most heartfelt wish and my biggest fear, my longest-held goal and my shining failure.  God, I don't want to be fat anymore.  God, can't I please not be fat anymore?!?!

Holy moly!

I may actually have a documented weight in 2001 that puts my BMI over 35 at that time.  I finally got hold of the company I worked for and wormed my way thru to the occupational health office.  They couldn't confirm they still had my pre-employment physical but took my name and are faxing me a release form.  I still don't believe it.  They'll have lost it or something.  I know my weight qualified then because BELIEVE me that I remember the way that doctor treated me.  But this seems to good to be true.  Maybe the insurance company won't take it.  It would mean I only have a weight in January of 2001 (I estimate 215 pounds) and a weight in December of 2008 at 202, plus my 2009 stuff.  Is that enough?  I don't know.

If they actually do provide my records, now I'm not sure how that changes things!  I guess I can make an appointment with my surgeon, get a consult, and maybe do the 3 month diet instead of the 6 month.  Whoa,  I could have surgery by the end of the year!  If they have it, I'll have to make an appointment with my PCP right away to get my co-morbidities further documented.  My BP is always elevated, but I want to get the other in the record as well.

It's a good thing we used Dave Ramsey's plan to get out of debt in 2008, because my deductible is $3,000.

More to come...they still haven't faxed over the release form...

Fax machine went off as soon as I typed that!  I filled it out and faxed it back.  Should I call and make sure they received it??  I guess so!  I called and they received it.  She said it would take 2 - 3 weeks to fill it since they take them in date order.  It's a big company in NYC.

Whoo hoo!!  I'm trying not to get too excited but I can't help it a little bit.

I'm thinking I'll wait until June, then start my Aetna-required 6 month diet.  It seems pretty straight forward.  It's simpler than the 3 month diet and I have to kill the time anyway.  I'll see my PCP in April so that I can get another weight and see if he wants to put me on any BP meds.  We'll also put our heads together and devise a plan for my 6 month diet.  I have to work with a dietician and I'd really like to work with one at CMMC where I'll have my surgery.  I'll have to call them and see if I can do that.  I guess I'll have to pay since I won't be able to get precert until January 2010 and my insurance does not cover dieticians or nutritionist.  Wonder how much it is...it's only 7 visits.  The 6 mos diet doesn't specify that I have to see an exercise professional, only that increased activity has to be included in the plan.

If I can get the diet done and they accept a weight for me in January, I should be able to get precert in January!  11 mos!

Got ahold of someone in medical records at my old OBGYN in NY...no quailifying weights there.  It was a long shot.  My only other option is the employment physical in 2001.  I know that weight was about 215-220 and definately qualifies, but I'm having trouble locating the doctor.  My part of the company was sold, and the old part no longer requires the physicals so a lot of barriers.  I know it was some occupational health office in NYC and the doctor was female but that's all I remember.

Attended the CMMC seminar.  It was fabulous!  They had a ton of before and after shots cycling on a big screen, a video, as well as a presentation by the bariatric nurse.  This seminar was more feel-good, they were still forthright with the dangers and requirements, but it was more upbeat.  You can tell they are excited about their own program.  The surgeons weren't available so I didn't get to meet them.  I was a little afriad of running into someone I know from the Optifast thing and I sure did - one of the nurses.  But she was great, gave me a hug and said I look great (ha!), asked if I was still running.  SLOWER, I said.  I'm not really, just walking.  And not even that much anymore.  She was warm and welcoming.  Yup, that whole thing musta been me.

Anyway, I like CMMC, they've got a lot of exprience there, they  are very close to my home, and it's a Center for Excellence.  Plus it's in network for my insurance and so is Dr. Cleveland.  So I'm going with them.

My husband asked me last night if I was sure  the 2 year BMI history meant 24 months...maybe they just meant 2 calendar years.  In other words, since I have weight in December of 2008, maybe I just need one in 2009.  And that's 2 years.  I got all excited and called Aetna this morning and asked.  I was told "I believe you'd need a weight in 2007, too."  Doesn't sound very definitive.  Their Obesity Surgery Clinical Policy Bulletin states "..for at least the last 2 years..."  Calendar years or 24 months?  I don't count that as resolved yet.  I did notice that the Policy is up for review on 2/12/09.  I'm going to call back and see what someone else over there says.

Later...

I called Aetna back and spoke to a perfect darling over there named Josh.  I'll be sure to ask for him in the future!  He told me he tends to remember people and their questions/issues so that's great.  He did some research and told me that the 2 year rule is not hard and fast.  They don't deny you because you are a few weeks or even a few months short of the 24 months.  He advised me to try to precert in the March/April/May timeframe of 2010.  And IF I can find a weight in the early 2000s, he told me to go ahead and try to precert this year!  So I'm still on a mission to find that.  I called my OBGYN from our first house in NY.  I have to mail them a letter to get my medical records.  As I remember, the doctor there was great but the staff sucks.  So we'll see what they say when they get my letter.  I'm also trying to track down an employment physical I was required to do in 2001.  I was really up there then.

So...new hope!

I've pretty much confirmed that I can't document a weight over the required BMI 35 for the last 2 years.  I was up there, I just can't PROVE it.  So I'm starting fresh, but with a PLAN.

My first documented weight above BMI 35 was with my PCP on December 4, 2008 - 202 lbs and BMI 35.7.  So that's my starting point.  I have another weight there on 2/10/09 at 211, BMI 37.3.  I'll go back this spring to document my co-morbidities (and get another weight while I'm at it...the more, the better).  I'm thinking he'll want to put me on blood pressure and maybe cholesterol meds.  I don't want to die of my co-morbidities before I can get the band!

In March of 2010, about a year from now, I'll attend another seminar at CMMC with Dr. Cleveland and make an appointment for a consult.  I'll start my 6 mos diet that summer, complete it and submit for approval in December.  That gives me a 2 year weight history and my 6 mos diet and my documented co-morbidities.  My diet history is already laid out in a Word document I created.  So patience.  I'll wait.  And for the first time...for the next 18 mos I don't have to try to lose weight!!

I'll check in once in a while.

I'm attending my second Lap Band seminar this Thursday, February 19, 2009.  This one is  at Central Mississippi Medical Center with Dr. Cleveland.  I attended one a few weeks ago at River Oaks Hospital.  I liked the surgeon who presented and the nurse who assisted him.  She'd had surgery there 6 years ago but I believe it was the RNY, not the Lap Band.  I must say I did look her over and she seemed normal, healthy, and happy.  They were both very up front and honest about the surgery, it's benefits, dangers, and requirements.  They passed an information packet out that you had to fill out and bring with you if you made an appointment for a consult with their office.  At CMMC, they sent me the packet in the mail ahead of time.  Their package included information about how they help you deal with your insurance company, which I liked.  I also liked that they are a Bariatric Center of Excellence.  River Oaks is still working on that.

I do have a hard spot with CMMC in that I did their Optifast program last summer (2008) and I immediately failed at it.  I attended the seminar on that because I mistakenly thought it was some sort of WW with doctors!  When I found out it was a liquid diet I was disappointed.  I signed up anyway, even though I had was very skeptical that a liquid diet would work for me...only 800 calories a day!  They promised I would not be hungry.  Go figure.  Someone with my hunger issues on an 800 calorie diet when I couldn't make it on 1600.  But I'd never tried it and I thought I should try.  It was VERY EXPENSIVE.  But I was gaining weight and getting desparate to stop the upward climb.  They have to test your blood every 2 weeks to make sure you weren't dieing or anything.  I had headaches, felt weak, sick and naseous.  And I was freaking starving the whole time.  I made it, I think, about 8 weeks, maybe less.  I lost 12 pounds or so but gained 10 pounds the week I went off and then with my metabolism depressed because of the 800 calorie limit, I began soaring into the 190s then over 200 and up, up, up.  I complained of being hungry  and told them I was eating all the time and they labeled me a binge eater and sent me to a psychiatrist.  Now I don't mind that - I'd never seen a shrink and I thought maybe that would be a good idea.  I talked to her 3 times for $125 a pop.  She figured my parent's divorce when I was a child left me searching for comfort in food.  OK.  I kind of knew that.  Knowing why I'm fat doesn't help me change it, though.  I think everyone at some level knows why, the trick is changing the behavior.  I must add that the Optifast director did feel the program wasn't a good fit for me and refunded me about $700 without me asking, which is 1/5 of the cost of the program.  They really were very nice people, professional and compassionate.  The whole thing left me with kind of a bad taste though. Maybe it's just that fact that it was yet one more failure.

So back to CMMC I go. I'm worried they'll be like "Oh, not HER again. This program isn't right for her either."  Again, probably that's just a lack of confidence on my part.  I have gained about 30 pounds since I did the Optifast thing and I'm extremely jumpy around folks to whom it would be obvious that I've gained weight.  I do like that they are a Center for Excellence.  I hope to get a good feel for the surgeon.

I have Aetna and they do cover Lap Band surgery with the usual BMI, diet history, supervised weight loss, and weight history requirements.  I'm a little worried about the 2 year weight history.  I only have one weight recorded by a doctor (OBGYN) in 2007 and that was in December.  We moved cross country that year and I just didn't go (I tend to avoid doctors at all costs anyway, since I feel judged about my weight).  If I remember right my weight at that appointment was a pleasant surprise at 186, which would make my BMI then 32.9.  I must have lost a bit in the move.  Will they require that I was above a BMI of 35 for the entire last 2 years? 32.9 is still in the Obese category.  Also, will they require that it be a full 24 months?  If so and they accept the 32.9 BMI then I'm not eligible until December 2009.  Which is fine with me.  I'll do my supervised diet this summer/fall and put in for approval in December.  If the requirement is that I was above BMI 35 for an entire 24 months, then I'll have to wait until November 2010 since I saw my new PCP in November 2008 and my weight was 202 (BMI 35.8).  Maybe CMMC will be able to help me with these questions.  I guess I have made my decision.  I want the surgery!  Hooray, that felt good, and right!