Aimee F.

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So I went in today to see my PCP. She was really terrific, and said she would do anything she could to support me. I was sooo happy with her.

She said she would send in whatever I needed, and that I should talk to their referral coordinator to get the scoop on what to send in to get the referral. She said it would be very hard because I am not only asking for bariatric surgery, but a specific type of surgery and surgeon.

I had brought with me the CALIFORNIA DEPARTMENT OF MANAGED HEALTH CARE "Review of Weight Loss Prior to Bariatric Surgery" study which shows that weight loss prior to surgery was unnecessary, along with a couple of articles.

The coordinator was very impressed that I those materials and she said she didn't see why it wouldn't get approved.

So I wrote the letter and have all the documents including several journal articles from PubMed talking about the DS.

Now I have to submit and wait! and be patient!  Hopefully I will get the authorization before my scheduled appointment with Dr. Crookes. :)

http://www.nyp.org/news/hospital/diabetes-surgery-program.html


http://www.sciencedaily.com/releases/2008/03/080305113659.htm

While I was digging around for some more articles on DS to send to family, I came across a few "medical tourism" websites that tout having surgeries done in foreign countries.  I'll admit that I was intrigued.  I was most impressed with Costa Rica, which has the best medical system in Latin America.   The cost of the surgery there is about $12,000.  That doesn't include travel expenses though, or lodging for my family who would want to come.  (No way would I leave my kids alone for 2 weeks!)

Then I started researching Mexico - there is a renown doctor doing DS there, and the cost is about the same as Costa Rica.  The issue with Costa Rica is that the surgeons don't have as much experience, I don't think.  I haven't gotten any information from them yet.

So, I posted on the main board about Costa Rica and/or medical tourism, and got some interesting replies.  The gist of one of the posters was to encourage me to poke my insurance in the butt by getting an attorney.

I'm feeling kind of, I don't know, passive/agressive about my doctor.  I supposed I should just go see her and tell her she is full of Sh*T for making me lose 30 pounds.  But then I still see the issue with getting the DS - no one in the area does it.  Only 2-3 docs in the LA area actually do it.

My alternate plan is to try to switch IPAs to one that contracts with USC.  I found a doc in the BlueCross directory who is a professor at USC and has offices at the USC campus.  I emailed her to find out if the BC IPA she is with refers to USC Bariatrics, and what her IPA rules are for bariatric referrals - ie, do I have to go through 6 more months, or can they do a direct referral etc.

My concerns with doing this are #1) will BC let me switch IPAs like that - they have rules about switching doctors; #2)  I will have to use my business address since that is within the 35 mile geographic radius; #3) while I'm going through this, for every appointment (related to the surgery or not - even if I"m sick) I will have to drive to USC, which is easily 45 minutes to 1.5 hours, depending on the time of day.

I think I will call BC this morning and find out about the process for appealing my referral for bariatric surgery.  And find out how I can get the DS.  I know it's covered by BC, it's just getting to a doc that does it that's the problem.

In the months that have passed since I updated, I had a sleep study done.  I don't have apnea, which I knew, but had to have the test.

My IPA requires 6 months of physician-supervised dieting before they will green-light.  I started that in Sept, and lost 5 pounds between Sept and Oct.  Well, I haven't been back. 

When I started this, I was not treating my diabetes at all, and so I had lost about 15-20 pounds off my normal weight.  So, when I started treating my diabetes (which always has to include insulin), I gained.  And gained.  And then we had the holidays. And I gained some more.

I just don't see how on earth I can lose the weight they want me to!  My doctor told me I had to lose 30 pounds.  That is insane - if I could lose the weight, I wouldn't need the surgery.

In January, I went to the USC Bariatric Surgery informational session.  I love Dr. Crookes.  I have decided to do the DS surgery on a cash basis.  It will probably cost about $25000.  That doesn't include pre-op testing, post-op appts or anything.  That's just the surgery and the hospital stay.  Hopefully we can afford it.

So, I have my first appt with Dr. Crookes on 4/14/08. 

My doctor's office called this morning and said they have been faxing back and forth with the referral department, and it turns out I need to fill out a sleep questionnaire to see if I have sleep apnea.  I know I don't, as my husband has an extreme case of it.

Anyway, I was just excited to hear that my referral was being processed!

Yay!

Being the super sleuth that I am, I thought that Dr. Suh in Corona would be my doctor, since he is contracted (according to the Blue Cross website) with my IPA.  I emailed his patient coordinator to find out what the scoop was, and she told me that actually my medical group refers to Dr. Krahn at Western Bariatrics.  So, at least now I know who I will probably get!

The other thing she said was that the medical group has to authorize the referral, and the doc doesn't do a direct referral.  So I am hoping that this doesn't mean I don't get held up!  (Or have to switch groups.)

It doesn't look like Dr. Krahn does DS surgery though, although it is discussed on his website.  

We shall see.  It's only been a week since I went to the doc and she agreed to put in the referral, but it feels like its taking forever!

So I posted a question on the general boards about diabetes and a very nice poster recommended the Duodenal Switch surgery as an option since it has a better "cure" rate with diabetes than the typical RNY.  

I checked with the Blue Cross insurance policy online and it says it's covered - the only problem is finding a BC surgeon who can do it!  Accoding to his OH record, Dr. LePort in Fountain Valley does it, but when I went to his website he doesn't mention it at all.

I am now super obsessed with getting this done...

I've thought about this surgery for years, but a recent article about it really propelled me into action.  Apparently, gastric bypass can cure diabetes even in people who are not siginificantly overweight.   

I've been overweight my whole life, but it's the diabetes thing that really scares me.  I was diagnosed with PCOS in 1997 and then with diabetes in 1999.  I have terrible control, even though I use an insulin pump, and know that it will eventually get me.  

I want to be around for my two children, and I want to participate fully in their lives.  I don't want them to be ashamed of me, and I don't want them to suffer from other kids' meanness for my sake.

What really, really scares me is blindness.  Not being able to see my kids faces as they grow up scares the crap out of me.  

My eating is a problem - the issue is that I need to control my carb intake, but I just can't make myself do it.  If I just treat for the carbs I take in, I gain weight.  I was up over 230 for a while.  So I need to treat my diabetes but also control my carb intake.

So if I can't do this, why do I think that I would be able to manage the lifestyle change that surgery would entail.

That's a good question and one I'm trying to answer for myself.  One thing everyone says around here is that the pouch is a tool.  I think that if I could only have a way to control my appetite and my intake, I would be able to do it.  

What worries me is the long haul and the ability to keep it off and not go back to the bad way of life.  

All in all, our eating isn't too unhealthy.  We have been eating a lot of fast food, but the majority of our meals are relatively healthy.   My kids are not overweight, and we encourage them to only eat as much as they need - none of the "clean your plate" rules I had when I was growing up.

If I could just get a jumpstart, then maybe I can get my life and weight back under control.