Hi everyone new to the forum I was turned down because my bmi was 56 and it has to to be 55 my dr is doing appeal any advice about the surgery will help me.  

Hi Jayzeos,

Welcome to the forum.  I hope your appeal goes thru.  Why did your insurance turn you down for being 56?  Is this too high for them or your doc?  Sending good vibes your way... Hope things get turned around for you in the New Year.

Happy New Year

Caroline

When I began my BMI was 58.5 and the surgeon wouldn't consider WLS until I lost weight. Due to my age (58) and co-morbidities, he felt there was too much risk involved.

I saw a dietician, followed the eating plan, lost some weight, began walking every day and had surgery over 2 years ago. Sorry but I can't recall the exact plan but it was low fat, high protein and smaller portions. You may want to see a dietician for help.

Since then I have lost over 200 pounds and my BMI is 21. Well worth the extra effort to be considered for surgery.

Good luck.
Annette

Between 56 and 55 isnt that much of a difference and is probably 10lbs or less. I dont know about insurances having a BMI limit, although many doctors do have a BMI limit.

If you need to, just lose the 10lbs or whatever. Dont even stress it, just take some colon cleansers and eat light for a few days and youll easily lose enough.

Hi
My doctor will do surgery on a BMI of 70 as his highest limit.  I think it depends on the doctor  and the insurance that you have.  But it is not hard to get your BMI down a point or two.  I lost 10 pounds and it was already down a point.  Best of luck to you.
Joanne

Hi James,

Getting turned down for something you really hope for has got to be discouraging!  Don't give up though, being patient & persistent will result in you getting what you need for yourself.

With a starting BMI of 56, have you considered the DS as a surgery option?  Long-term studies show that it will be your best chance of losing your excess weight -- AND keeping it off!  I don't recognize your surgeon's name, so assume that the DS is not even an option with this doctor.  While you await your appeal, you could take this time to review some other options for surgery & a different surgeon.  Come over to the DS forum and read about why people are so happy with this surgery choice: 
www.obesityhelp.com/forums/DS/

Here is a link for a great online resource:  www.dsfacts.com
Almost daily someone researching surgery options asks why people decided on the DS, here is a thread from just today to read over:  www.obesityhelp.com/forums/ds/a,messageboard/action,replies/board_id,5357/cat_id,4957/topic_id,3822771/

On this thread, you will find the following information that a fellow DSer put together on considering your surgery choices:

RNY compared to the DS

RNY – expected weight loss

• 50-65% expected excess weight loss (percentage varies in opinion – this is the most commonly seen estimate)
  • Results may vary
• Regain
  • Possible regain: more prevalent after 5 years
  • 50-100% regain of weight has been recorded
  • Results may vary
  • Must follow “pouch rules" in an attempt to not regain

DS – expected weight loss

• 85% expected excess weight loss
  • Results may vary
• Regain
  • Studies show little to no regain (20-40 pounds recorded)
  • Results may vary
  • Highest success rate over 10 year study (78% avg. Excess Weight Loss – EWL)

 RNY – have a stoma (stomach made into a pouch – size of an egg)

• Size: 2 oz
  • Stretch to average size of 6 oz in 2 years  (possible to stretch up to 9-10 oz)
  • You can eat more as time goes by
  • Average after 1 year is 1-1.5 cups of food
• No Endoscopes on blind stomach/remnant stomach that is bypassed
  • Doctor evaluation: cannot use an endoscope (to find ulcers and tumors)
  • RYGBP construction makes the large bypassed distal stomach inaccessible to standard non-invasive diagnostic modalities. Neither x-ray contrast studies nor endoscopy can assess this potentially important but hidden area.
• Stoma: pouch
  • Should not take Nonsteroidal Anti-Inflammatory drugs (NSAID).
• NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascription, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish
  • NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains.
  • Taking NSAIDs could develop into a bleeding ulcer and interfere with kidney function.
• Possible Problems
  • Ulcers (Some doctors recommend taking prilosec for 6 months to 1/2 years in an attempt to prevent the ulcers)
  • Possibility of a staple line failure
  • Noncompliance: simply do not lose enough (even with following the rules)
  • Vitamin Deficiencies
  • Narrowing/blockage of the stoma
  • Vomiting if food is not properly chewed or if food is eaten to quickly
  • Dumping syndrome, NIPHS, Hypoglycemia
    • No Valve (pyloric valve that opens and closes to let food enter intestines is bypassed) which means food empties directly into the small intestines and causes dumping and/or can cause NIPHS or Hypoglycemia
• Dumping: food (most commonly sugar but not necessarily “just" sugar) enters/dumps directly into small intestines and causes physical pain (some people believe this pain enforces good eating habits)
  • Dumping varies in degree of occurrence and discomfort
  • Dumping symptoms:
    • Nausea
    • Vomiting
    • Bloated stomach
    • Diarrhea
    • Excessive sweating
    • Increased bowel sounds
    • Dizziness
    • “Emotional" reactions
• NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction.  The change occurs on a cellular level, hard to diagnose.  Treatment: Removal of half the pancreas."
  • RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow.  Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food.  With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.  
  • NIPHS, Hypoglycemia is deadly if not corrected

 DS – whole stomach (size of banana)

• “Whole working stomach" - meaning the stomach’s outer curvature is removed as opposed to making a pouch/stoma.
  • Part of the stomach removed is where most of the hormone called Grehlin is produced.
  • Grehlin gives the sensation of hunger so by removing most of that section of the stomach a DSer is not as hungry as before.
• Whole working stomach: no blind stomach.  Endoscope can be used.
• Can take NSAIDs
• Do not need to take Prilosec to prevent ulcers.
• Valves are in tack: no Dumping Syndrome or NIPHS

 RNY – Eating

• Eat protein first
  • 60g of protein a day
• Recommended to chew food to liquid consistency (pureed, soft, thoroughly chewed)
  • This is more important for people early out (new pouch stomach will stretch out with time).
  • Food is thoroughly chewed to prevent blockage (the hole/path leaving the stomach and into the intestine is roughly the size of a dime).
  • To get food unstuck, patients drink meat tenderizer mixed with water.
• Low carbohydrates
  • Carbohydrates can slow weight loss and lead to possible regain
  • Avoid sugars in particular (to prevent dumping syndrome)
• Low fat
  • Foods high in fat may cause Dumping Syndrome
  • Fatty foods can lead to slow weight loss or possible regain
• 64 oz of water
  • Stop drinking within 15-30 minutes of a meal
  • Do not begin drinking after a meal for 1-1.5 hours
  • Some doctors do not encourage the use of a straw (pushes food too quickly through the stomach and can cause gas/discomfort)
• Water Loading
  • 15 minutes before the next meal, drink as much as possible as fast as possible. 
  • Water loading will not work if you haven’t been drinking over the last few hours.
  • You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
    • Disclaimer: this is a practice some people use to feel “full" and lose weight. Not a requirement.

DS – Eating

• Eat protein first
  • 80-100g of protein
  • DS patients can on average eat more food than any other type of weight loss surgery.
• Low carbohydrates
  • Carbohydrates can slow the weight loss and lead to possible regain
  • No dumping syndrome from eating sugar (or fat)
• Eat high in fat
  • DS only absorb 20% of fat (do not need to eat low fat)
    • If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or RNY absorbs ALL 20g. (this is just an example, measuring absorption is not an exact science)
    • When experiencing a “stall" (slowed weight loss/plateau) a DS patient commonly increases fat consumption to resolve
• 64 oz of water
  • Can drink with meals
  • Can use a straw

RNY – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins B12, iron, and zinc
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Gas
  • Constipation
  • Dumping in the form of loose stools
• Reversible procedure (Reversals of any surgery is very complicated)
  • Revision often performed instead of reversal
  • Revising to a different type of surgery is possible.

 DS – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins A, D, and iron
  • “Water soluble"/ “water miscible" / “dry" vitamins absorb best (in other words get vitamins that are not fat/oil based)
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Gas
  • Loose stool (Most common in the first few weeks of surgery. Generally food related)
• Reversible procedure
  • The intestinal bypass is reversible for those having absorption complications
    • revision: lengthening common channel (to stop losing weight and/or to absorb vitamins)
  • Stomach is obviously not reversible (part of stomach was removed)

 

RNY - Diabetes

• 85% cure rate
  • RNY can put diabetes in remission.
  • Diabetes may come back in two or three years--even if the
    patient maintains most of their weight loss.
  • Even a small amount of weight gain, long-term, can cause a diabetes
    relapse.

 DS – Diabetes

• 98 % cure rate for type II diabetes.

 

DS – Myth or Fact

The DS is only recommended for the super morbid obese (BMI over 60) = Myth / Not True

• To be eligble for ANY type of weight loss surgery, a person has to be 100 lbs. over weight or have a body mass index (BMI) of 40 or more.
• BMI’s under 40 have also been approved (usually require a comorbidy/health problem - an example is sleep apnea).

The DS is “experimental and investigational" = Myth / Not True

• Medicare approves the DS
• Many insurance companies are starting to cover the DS.
• DS has been performed since the 1970s

DSer will have a problem when they become old = Not True

• We wont need to eat as much when we are older b/c our bodies will adapt
• The little hair-like villa located in the intestines grows longer to adjust to the new digestive system (grows longer to increase absorbtion).

DSer’s gas stink = true

• The gas does smell. (This is true for the DS and RNY)
• There are products called air fresheners that a person can use.
• May take Flagyl or fish zole

DSers may need to wear a diaper = Myth / Not True

• That is silly

Skin color turns yellow or pallor = Myth / Not True

• Patients who follow their regular vitamin regime (keep up with blood work) do not turn pallor
• If someone looks pallor, they could have a vitamin deficiency.  This applies to any type of weight loss surgery. For both RNY and the DS.
• Vitamins and blood work must be monitored for life. For both RNY and the DS.

DSers will have a heart attack from all the fatty food they eat = Myth / Not True

• Cholesterol levels lower after having the DS. 
• 80% of the fatty food is not absorbed – the fatty food is healthier to eat as a DSer than a person without surgery.
• If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or a person with the RNY will absorb ALL 20g.  Good meal for the DSer. (this is just an example, measuring absorption is not an exact science)

Dsers don’t need to exercise = Myth / Not true

• DSer’s are aware of the benefits of exercise (body and soul).
• Exercise helps in losing weight and maintaining goal weight 

 *Possible issues are just that, “possible," and may or may not occur.  

Not every surgery will be covered by insurance. Good luck to everyone and thank you for reading my comparison chart. Hayley F.

I have my surgery on Jan 28; I had to get my BMI down to 50 below for NC State Health Plan. I had my primary care doctor give me Xenical to lose some weight, plus I take Furosemide and I took a laxative on the weekend to clean my self out. You would be surprise how much waste can add to your weight. I hit make target weigh, my doctor at UNC Health Care in Chapel Hill,
Dr Overby wouldn’t file the paperwork to the insurance company until I made the weight requirement. I was approved in 3 days. Your doctor should have waited until you hit the target weight, they do enough surgery to know what the insurance company will approve. You need to get your weight down before he does an appeal. Once you hit the target weight sent that information with the appeal. My method isn't the best way, but it worked for me. I lost 20 pounds in three week. I carry a lot of water weight. I also cutout bread, sodas, fried food the last two weeks and added more water. My only health issue is hbp  which is mild, so I wasn't at any  health risk. I didn't eat anything the morning before my weigh-in and I Exercise  hours before  to burn more calorie I was kinda weak, but I was determine to meet  the weight requirements. lol Good luck

Thank you for the feedback I was approved they sent in the wrong info about my weight so the journey is starting to begin please give any advice and stay in touch

I'm having my surgery on Jan 28 and UNC Hospital. Dr,Overby will be performing a band call Realize band. I will be there first patient to reveive this band and someone from the federal government will be in on the surgery.I'm excited. Let me know your surgery date. Do you have a myspace profile or tagged?