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Very well put. and your opening statement is absolutely correct... I will have to remember this!
On the surface, it should be approved, as typically a revision such as this is treated the same as a virgin WLS - you need a minimum BMI of 40, or 35 with comorbidities. Some policies may only require one comorbidity while others may require two or more. The other main roadblock is that some policies limit patients to one WLS procedure per lifetime, so that eliminates revisions (at least for weight problems; resolving complications puts it into a different category.) Also, some policies may limit the DS to higher BMIs, such as 50 or 60 and above.
Another wrinkle is that some policies may not approve a two stage DS - this is usually a throwback to when the VSG was still "experimental/investigational" and some people were using the 2 step DS as a backdoor way of getting a VSG (go in for the VSG stage and never show up for the second "switch" part.)
You can check the policy bulletin that covers your specific policy's bariatric benefit online and that should tell you what you need to know about its limitations. You can also call your company's customer service line and ask, but they don't always get things right. If you already have your surgeon lined up, they should have an insurance coordinator in their office who understands "insurance-ese" and can interpret the policy for you.
1st support group/seminar - 8/03 (has it been that long?)
Wife's DS - 5/05 w Dr. Robert Rabkin VSG on 5/9/11 by Dr. John Rabkin
I am trying to get approved for 2nd stage DS. Had an upper GI done which showed no issues. My BMI is 36.5 with comorbidities. What are my chances of getting approved? I have BCBS of FL.
Good morning Bob and congrats on the initial weight loss. My guess from your various posts is that, believe it or not, you're probably not eating enough food. The DS is different than any other WLS and you have to treat it differently, especially in your head. Not sure how much more weight you want to lose but you're at a different stage now. Sometimes a plateau needs a kick start. Up your protein. How much are you getting? at least 100 grams? If your DS was done correctly, fat is your friend, not your foe. You should only be absorbing about 50% of the fat you consume. You say you normally eat less than 40 carbs per day. Are you including EVERYTHING you eat?
Personally I think you're not eating enough for the DS. Start writing down everything you eat to really see exactly what you're eating and what might be causing your stall.
Yes you need to change your eating habits - FOR THE REST OF YOUR LIFE. This is not a diet - this is your life. I eat sweets, I eat bad carbs, but I also eat tons of protein, eat good carbs, drink lots of water. If I notice my weight is creeping up (and I'm talking a few pounds) I honestly look at what I'm eating and what's causing the weight gain - 99.99% of the time it's bad carbs, period - and that's 17 years post-op. My DS still works as long as I pay attention to it.
I agree 100 percent with this. I will be 15 years out this November and this describes me exactly. I have been within 7 pounds of my goal weight of 155 for about 13 of the past 15 years. Protein! Protein! Protein! then Fat! Fat! and then carbs.
Water is huge and exercise is crutial. Take Care!
A two step process was a real possibility for me when I had the DS. I was over 500 when the process started ( eval, etc) and the Doctor said if I didn't lose 50 lbs before I was ready to schedule he would do the first step VSG and then the switch as the 2nd part after I had lost some of the weight from the VSG.
I made it down to 464 and they did both steps in the same operation for which I was really grateful since I was pretty freaked out about going under the knife the first time without contemplating a 2nd trip.
Having gone through the whole thing I do think I would have done both stages if that was necessary.
Pete
HW 552 CW 198 SW 464 4/15/13 - Lap DS by Dr. Philip Schauer - Cleveland Clinic.
The old saying...."you are what you eat" is incorrect" ....."you are what you absorb"
Because the intestinal bypass is too great, the body can not ever absorb as it did before surgery. Everything we put in our mouth has a potential of being malabsorbed, including RXs. Some RXs are well known (ie Vit D2 as it is RX in oil formulation and we malabsorb that at about 85%). I had a thyroidectomy after my DS, I don't malabsorb my thyroid RX, but that too is dependent on many factors....are you on T4 only monotherapy? Do you take the one that is know to have the least amount of absorption issues? Extended release due to the longer time in the intestinal tract for a DSer most likely would cause issues with absorption as it would potenitally be expelled before the RX was absorbed due to the short lenght of the small bowel. If you are taking something that is ER then more would have to be used (ie K citrate only comes in ER)
Everything you take via your mouth should be evaluated......RX or OTC, supplements etc.....
If you have a specific question for me, PM me or I will not see it, as I don't check responses on the forums and don't have anything forwarded to my email.
It is a little more subtle than that, as what you describe is more of a revision from an unsuccessful VSG rather than a preplanned staged DS. When discussing this with my surgeon - the prospect of a "plan B" revision if I didn't do well enough with the VSG alone - he explained that the two stage DS works best if you do the second stage before any substantial regain occurs (just like if it was planned that way.) But this is tough to do, as the patient is unlikely to throw in the towel and go for the completion surgery simply because their weight loss has stopped, or they are "afraid" of regaining, Further, insurance usually doesn't cooperate as they typically want to see the usual 35/40 BMI level before approving a revision (if they do so at all.)
Another factor of the "success" level is that the two stage DS is usually only done on the very high BMI patients, who are unlikely to see as high of an excess weight loss (with any procedure, including a single stage DS) as more "moderately" obese patients. A further wrinkle is that with a fully planned DS, the sleeved stomach is usually larger (typically a 56-60 Fr bougie rather than a 32-40 for a VSG) so that works better as a "team" with the malabsorption and has less chances of side effects such as severe GERD.)
So, as we typically see in the WLS world, revisions overall don't work as well as virgin WLS procedures, but I haven't seen much to support the notion that a planned two stage DS is any more or less effective than a single stage DS, given the same patient cir****tances.
1st support group/seminar - 8/03 (has it been that long?)
Wife's DS - 5/05 w Dr. Robert Rabkin VSG on 5/9/11 by Dr. John Rabkin
The DS is technically a two-stage surgery. First step is the sleeve (VSG) and then the switch is shortening the intestines to provide malabsoption.
This is a great general description from Columbia University's website:
Bilio-pancreatic diversion with duodenal switch (also called Duodenal switch, or BPD-DS) is a complex procedure that induces weight loss by a sleeve gastrectomy and intestinal bypass. This approach results in decreased absorption of food. With this procedure, the surgeon removes approximately 60-70 percent of the stomach so that the stomach takes the shape of a tube (sleeve gastrectomy). The lower intestine is then divided much further downstream than with gastric bypass so that two thirds or more of the intestine is bypassed, leaving only a few feet of intestine where food and digestive enzymes meet. This is the intestinal bypass portion of the operation. The name duodenal switch comes from the fact that in this operation the intestinal bypass starts at the duodenum. The first part of the intestine, the duodenum, is divided and attached to the lower portion of the small intestine, the ileum.
Janet in Leesburg
DS 2/25/03
Hazem Elariny
-175
Some surgeons do the second stage when a VSG patient does not lose enough with their sleeve alone. A "virgin" DS is normally more successful than when it is done in stages.
Real life begins where your comfort zone ends
As far as I have ever seen, it is the second half of the DS, if the procedure was done as a two step process. Occasionally, in cases where they don't want to have the patient under anesthesia too long, either because of extreme obesity or other health issues, they will first do the sleeve gastrectomy part of the DS, and then after a few months and the patient has lost some of their excess weight, is stronger and healthier, they will go in and do the switch part - the intestinal rerouting - to complete the job. It isn't done as much as it used to be as the surgeons have gotten better at handling very high BMI patients, but we do still see it occasionally.
1st support group/seminar - 8/03 (has it been that long?)
Wife's DS - 5/05 w Dr. Robert Rabkin VSG on 5/9/11 by Dr. John Rabkin
