I need your help!

candessg
on 12/6/12 1:38 pm - plymouth, MN

Hello All! 

Well since my last post I have had so much going on. My dr, thankfully, decided against reversing my surgery. We are trying to run tests and exhaust all other options before doing that. The problem is I am back on an army base with doctors who don't know what they are doing and don't listen to me. They fight me on everything.

So, here is where I can use some help.

I have found an actual army surgeon who performs the DS at Madigan Medical Center in Ft Lewis, WA. He has agreed to see me and follow my care. THIS IS A MAJOR BLESSING! The issue is that Tricare, my insurance company typically pays for travel expenses to specialists if they cannot give you the care they need at the base your family is assigned to. Especially since I am a part of the Exceptional Family Member Program. Because of my ongoing issues with liver problems and bowel intussusceptions I have had to spend thousands of dollars of my own money over the past few years to travel to see my surgeon. This should be covered by tricare because they cannot handle my care. they have covered some expenses, but very little. Now that I have found an actual army doctor who specializes in DS they are now refusing to cover any medical expenses by saying that this is a pre-existing condition caused by the doudenal switch. Now, the army does not pay to perfom the DS, but 4 years ago before having this surgery and before my husband joined I contacted Tricare and they said that they will provide follow up care if any complications arise. Now they are saying that my chronic bowel intussusceptions are a result of the DS and they will allow me the referral to see Dr. Martin because he is willing to see me, but they will not compassionately reassign my family to that area, nor will they pay any travel expenses. (either way I am going, but I am trying to get my family to be able to stay together and help get these costs paid for because the proper medical treatment cannot be provided at the current base I live on and my health has declined over the past 2 years because of negligent medical care. I have also gone into debt to seek care on my own)

My question is this. How many of you have suffered bowel intussuscpetions from this surgery? I have been on here numerous times and asked this before I have not heard from anyone else. I have heard that ANY stomach surgery can cause this because of scar tissue, though both times I have had surgery to remove the intussusceptions, and the 2 different surgeons who performed the surgies have said it was not caused by scar tissue and I don't have a hernia. The cause is unknown. So I am trying to figure out how they came to this conclusion and how they can even determine this when I have never seen a qualified medical expert to make a diagnosis. The doctors I have seen have told my PCM and my insurance company that they cannot help me and need to be seen by Mayo Clinic or a specialist who is more familiar with the DS procedure. 

I am basically looking for any supporting evidence to show that this is not a common problem with the DS.

Any advice, evidence, personal stories, web site links, ect would be greatly appreciated!

 

Thank you and God bless!

texasrigdiver
on 12/6/12 2:15 pm - TX
DS on 11/29/12

I hope everything works out for you on this, it must be pretty disappointing for you.

It seems like the most proof that this isn't caused strictly by DS alone is all the people who have had DS surgery but do not also have intussusceptions. So the question could be stated like this: everyone that has intussusceptions has had WLS but not everyone that has WLS has intussusceptions. Thats a false statement since CBI from WLS is not that common. What else are the causes of "CBI" (chronic Bowel Intussusceptions"?

I know nothing about the disease but a quick search on that thing called the internet tells me that CBI's in adults are are only secondary to bowel surgeries and there are a whole list of primary reasons for this in adults.I'm sure you've done more then a single search but I included one of the links from several articles I read.

I haven't had a lot of dealings with ins companies but an unintended complication from one surgery is still a complication that should be covered as far as from a treatment standpoint, right?

Good luck, I hope everything gets worked out. God Bless Military Families.

http://www.wjgnet.com/1007-9327/15/407.pdf

"...the sun is the same in a relative way but were older, shorter of breath, and one day closer to death..." Pink Floyd 

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candessg
on 12/6/12 2:57 pm - plymouth, MN

Thank you for the link you provided and your advice. I think it's absolutely ridiculous to assume that it's caused by the DS. There is really no supporting evidence for this. It also could have just happened because I was pregnant and the time and some women are prone to them during pregnancy, though also rare. My surgeon did not cut out that section because he felt the bowel was strong enough and I asked him to do whatever he could to save my daughter's life. Resectioning the bowel would have likely killed her. I believe it's more likely that it's recurring because the bowel is weakened and may initially may have been caused by the pregnancy itself considering I never had it before then. They are grasping at straws and making assumptions to get out of paying for travel and treatment, but they have not provided any supporting evidence. It's ridiculous. My husband has gone to war twice and he feels like he's getting slapped in the face. It's so sad really. Anyway, thank you so much for your input! Blessings!

(deactivated member)
on 12/6/12 4:57 pm
I am so sorry for what you are going through I got my ds in June at madrigal with doctor carter and he and his team have been amazing for me. Good luck with everything
(deactivated member)
on 12/6/12 4:58 pm
* madigan I am still learning the iPad
candessg
on 12/11/12 8:16 am - plymouth, MN

I heard Dr. Carter is awesome!! Congrats on your surgery and thank you!

MajorMom
on 12/6/12 5:54 pm - VA

You might want to try to reach Vitalady, Michelle, through her site. She is dealing with something similar concerning intussusceptions that are not WLS related. She's also in Wash state but may have been able to teach the docs trying to treat her. Perhaps Dr Martin can consult with her docs. If you can reach Michelle, let her know I sent you her way. 

Wishing you resolution to all this quickly.

--gina

 

5'1" -- HW 195/SW 187/GW 115 July 08/CW 121 Dec 2012
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candessg
on 12/11/12 8:18 am - plymouth, MN

I will definitely have to contact her! I think they may have found that cause..or we are close..they believe I have Endometriosis and in some cases it causes this in women. I hope this our answer so we can find a solution already!

Jaiart
on 12/6/12 7:47 pm - MI
I thought the new healthcare bill disallowed insurers from denying coverage based on "pre existing conditions."

 

Herman
on 12/7/12 9:34 am

I don't think that starts until 2014, and it may not be the same for tricare.

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