No Sleeve for me, need two knees - not happy- long

Hi - had a band in 2004 - had it removed in 2007 - insurance wouldn't cover revision - tried going on my own - gained weight back (only lost 30 lbs with band) and recently have been inquiring about VSG.  WLS is excluded from my insurance coverage by my husband's employer - I called anyway and was told - that chance of any successful appeal is zero.  All of my physicians - orthopedist (need both knees replaced), nephrologist (only have one kidney due to cancer), pulmonologist (have sleep apnea), endocrinologist (have diabetes), cardiologist (high BP), urologist (frequent bladder infections), gynecologist (had hyst due to pre cancer condition), gastroenterologist (have reflux), and any other dr I have been to - thinks WLS would be most beneficial for me.  My BMI is 48 and I am 60 yo.  So I checked around - I live in NE Ohio - the price range for the sleeve is 18600-25000.  Can't go to Mexico (long story). I haven't worked in 10 years,  Husband is in early stages of dementia and has diabetes - so I am his caretaker - needless to say I don't have the cash to pay or access to borrow it.  So I am extremely disappointed!!!!!!
I have almost no mobility - hard to grocery shop,or  go to grandchildren's events, take care of teh house and my husband and I am in a lot of pain.  I am so nervous about having the knees replaced that I keep putting it off - I so fear the pain and recovery.  I know my weight will make it extremely difficult and I wonder if I can do it.  I just know losing weight would help all of my health issues.
So if you have stayed through all this -
1) Anyone have knees replacements while obese and how was your recovery?
2)  Any other suggestions on how to improve my situation.

Bariatric surgeon's office told me to wait til Medicare covers me - that's 5 years - I think I will be dead by then.

Medicare covers it - can you get declared disabled NOW so you can get Medicare sooner?  Can you take a loan against your house, or your husband's 401(k) if he has one?  An early disbursement of 401(k) can under some cir****tances not incur penalties.

If you didn't have an erosion with your band, you could send an email to [email protected] to see if they can help you with pricing for a VSG - or better for you would be a DS! - if you can go right away.

And you should appeal your denial anyway - you never know if the law will change, or if your insurance will.  And perhaps you can get it covered as the only treatment available for your comorbidities, including your knees - I've heard that some orthopedic surgeons will not replace knees if the patient is MO.  And you could argue that in your case, delay could mean death, or becoming too sick to endure surgery.

From  http://www.insure.com/articles/healthinsurance/weight-loss-s urgery.html (2010 article - don't know if it is still accurate):

"Only six states mandate that treatment for morbid obesity be covered by group health plans: Georgia, Illinois, Indiana, Maryland, New Hampshire and Virginia. These mandates apply only to group plans, and even then not to group plans offered by self-funded companies. That’s where large employers take on their own financial risk of covering employee claims, and you probably won’t know if your employer is self-funded unless you ask."

Anyone still think universal health care is unAmerican?

 I am also in Ohio...

I had my knees replaced 2 years ago at age 43 and I weighed about 430 lbs, making my BMI at the time 78+. Since I had both knees done at the same time, I went into a rehab facility for 3 weeks. I won't tell you that the recovery was easy, because it wasn't. BUT...the pain after surgery was better than the pain I had in my knees prior to surgery. Carrying 430 lbs on a 5'2 frame was no easy task!

The recovery was slow, but the pain was not terrible.(They gave me pain medicine and made sure I got my meds before each bout of PT. ) It was less painful than I imagined it would be, considering I had physical therapy twice a day, 6 days a week (whether I wanted to or not..lol) To complicate matters, I also have spinal fusions with hardware, so that made doing some of the physical therapy a tad more challenging.

I have seen others post on here saying that their insurance had a WLS exclusion that was in place per the employer and had that changed through the company's HR people. Have you looked into that? Did you speak to the HR person at your husband's job?

I too am trying to raise a little $$ to get the surgery I REALLY need  instead of the one I am scheduled for..You said that you are not able to borrow it, maybe there is an insurance policy or 401k to borrow against?  I wish I could be more helpful. Maybe someone more helpful will respond to you..in the meantime....

ETA..Was it the insurance company who told you that there was a zero chance of winning an appeal? If so, I would still try because I would think that would be their standard response...besides, nothing ventured, nothing gained

Thank you so much for answering - good for you that you were brave enougfh to have both done at the same time.  I want to do that too but I am having a hard time finding a surgeon who will do both at the same time because of my size.  Not to be too personal but one of the things that concerns me the most - personal hygiene during recovery.  It's hard now - can't imagine taking care of toileting the recovery weeks.  Was that an issue for you?  I was hoping not to have to go to a rehab facility - due to my husband's problems but I really won't have anyone at home to help with him or my needs so I may not have a choice.  My husband is not diabled - just has memory problems - so taking his insulin can be an issue as well as hypoglycemia.  How are you doing now with your knees?

As far as checking with HR - that's who told me I had zero chance of appealing.  Actually the insurance company said they cover WLS but that the employer excluded it.  I am collecting letters from all my doctors stating that it is a medical necessity to have the WLS.  I'm going to try it - like you say - can't hurt.  The larger pressing issue is the knee problem - not sure I can wait for the months it takes to appeal.  There is no other means to borrow or finance but I appreciate your thinking.

Good luck on your surgery!!

ETA : My knees are much better, but because of my weight I have problems with the surounding muscles and I now I have issues with my hips and ankles:/

Personal hygiene during recovery was a little more difficult for the first few weeks. I couldn't shower for 2 weeks, but my fiance washed my hair backed up in a wheelchair to the sink and I washed up at the sink with a long handled sponge on a stick, sometimes he would help me. One thing I really disliked, was at the rehab, the physical therapist that dealt with personal care (hygiene, dressing and household activitie) want to SEE that you are able to wash yourself

As far as wiping after using the toilet, my fiance helped me when he was there, or I had a nurse help when i had a bowel movement for the first few days. 

There is a great bathroom helper and it only costs $9.99...I have tried a few different kinds, things that look like tongs, etc., and this works so great!! Here is the link for it:
http://www.drleonards.com/Support-Mobility/Canes-Helpers/Long-Reach-Comfort-Wipe/49779.cfm?clickSource=JUMP_SEARCH

Ouch!  I wish I had some real answers for you about how to get WLS, yet I don't have a clue.  It would be a total hardship for you to have to wait until Medicare covers it.

About the knee replacement...  I had one done in Aug.  I needed it years ago but my ortho surgeon refused due to my weight.  The weight will destroy the artifical joint just like it does a natural one and knee revisons are worse than the original, or said the surgeon.  It was very painful for me.  I'm not trying to discourage you, just let you know that I had a rough time.  I think it would have been more difficult if I were still obese.  (I lost 190 pounds before getting it done.)  I have seen it done on obese people and when I was doing my physical therapy, I was told that obese people have it rougher.

I truly wish I had more encouraging words for you.  But this place has people who are a lot smarter than I am, so I'm hoping you'll find a better answer than what I can provide. 

Best wishes for you in your search to improve your health and getting your life improved.

Just wondering how you are doing now with your knee - since you just had your surgery in Aug - sounds like the worst is over for you.  Do you need to have the other one done and if so - will you after what you have gone through.?  Are you glad you had it done? Since you had WLS - what kind of anesthesia did you have for the knee surgery and did you have any special considerations in teh hospital - did you go to a rehab facility?

Sorry - so many questions - I've had other major surgeries but nothing orthopedically that would require such a painful long recovery.

My knee is still pretty stiff, yet my surgeon is pleased with my progress.  I was "too healthy" to go to rehab, so I started outpatient PT one week after my surgery.  I still do exercises at home to get the strength back in my knee.  My other knee is not as bad, so of course I'm hoping it will never need surgery.  I've heard it is a rough surgery no matter what one weighs.  I know a rather thin man who said it was a lot rougher than he anticipated.  Right now I'm not exactly  glad I had it done, but I do anticipate it getting better.  I've heard it takes 3 months and I'm just a little over half through that 3 months.  I'm a bit of a baby so perhaps I'm not the best one to ask LOL; I sometimes wish I had general anesthesia for a routine dental cleaning.

My biggest worry about being in the hospital for knee surgery after my WLS surgery turned out to be a non-issue.  The nurses were great about reminding me to take my home vitamins and such that I need since  WLS.  They even stored my shakes and protein extras in a patient fridge.

It's been a series of little victories.  I needed help just getting in and out of bed, yet now it's no big deal.  I absolutely hated waking my husband up in the middle of the night so I could use the bathroom.  He was so patient and good about lifting my leg back into the bed and all that I needed him to do.  It definitely required what seemed like a lot of help in the beginning.

I was born and raised in OH so I'm always happy to help out a Buckeye.  Feel free to PM anytime, OK?

Is your husband still working while he is going thru the early stages of dementia? Is he going to retire due to his health? (I'm not trying to be nosey, there is a reason for asking). You say ya'll don't have extra money for your surgery, so if/when he retires ya'll will have less money? Then maybe when he retires you might be able to apply for Medicaid. Medicaid is based on income, so maybe you can qualify.  There is a Medicare forum on this site. Talk to them and see if they can offer any insight. I hope things work out for you.

No my husband has been retired for 8 years - he is 72.  We live on his pension and social security - have used most of our retirement funds due his health issues and mine.  We are able to pay for our monthly bills and have a small reserve for car repairs,etc.  We wouldn't qualify for Medicaid.  But thanks for your reply.