Introducing myself, a bit too long, pre-op

I’ve been reading posts on this Forum for some time and decided that it might be a good idea to introduce myself.

 

I am 62 years old and I’ve been obese for most of those years.  I had given up on diets because I always failed at them.  My weight went up to 295 pounds. (BMI 39)  I have type II diabetes, sleep apnea, hypertension, reflux, arthritis, and lots of problems with being FAT.  When I started on insulin (5 different meds for diabetes) I got very discouraged with myself.

 

In January I read newspaper articles about the lap band reversing type II Diabetes and spoke to my endocrinologist and PCP about lap band.  They both were supportive of lap band, and for some reason discouraging about RNY.

 

I went to a seminar at Lehigh Valley Hospital in Allentown in March.  Chose that hospital and Dr. Boorse at the advise of my endocrinologist.  Started their required six month pre surgical program in April, and now I’m 4 ½ months in.  I have my first surgical consult with Dr. Boorse September 2.  I think I’d like to talk to him about VSG, but I’ve already been discouraged by his office who tell me that most insurances don’t cover it.

 

The biggest problem I’ve had so far is that I’ve lost too much weight in the pre surgical program.  They told me to try to eat 2000 calories a day, and to get lots of exercise.   I’ve sometimes been able to do that and at one point my weight went down to 261 (The day I had my exercise evaluation at LVH).  If I get below 258, I’m not going to be eligible for surgery. That would take my BMI below 35. I freaked out.  Started going way off my diet, and started to feel ashamed of myself, out of control and creepy.  I’m trying to figure out how to keep my weight steady, and not be out of control.  So far I don’t really have a clue as to how to do it.  I’m going in Tuesday for a meeting with the therapist who is part of the LVH bariatrics program, and I’ve started reading Judith Beck’s book on cognitive therapy of diet and eating.

 

I wanted to introduce myself to you guys because I’ve really enjoyed reading posts here and feel that the honesty, intelligence, common sense, and humor that I’ve seen suits my temperament.  I may burden you with more information as I go along.

 

Thanks,

 

Henry

You're not a burden. Is it just just about the BMI. What about co morbis. Don't yuou still have those and would n't they still qualify you.

Welcome to our happy dysfunctional family. Here you will find lots of support oplus an occasional kick in the butt when you need it.

Welcome Henry.   Glad to have you join us.  Great bunch of guys here, and as you have noticed, lots of good info.    Looking forward to hearing more from you as you progress.
Steve

Thanks,

The Doc's office says that if you don't have comorbidities, 40 BMI is the cut off for insurance, with them, the cut off is 35. 

The fact that I started above 39 and have been above 35 for over ten to fifteen years seems to be irrelevant.

I'll know more after visiting with Dr. Boorse himself.

Henry

You know, you can't possibly be the first person who skates near the edge of the insurance/BMI cut-off, but all the time I see posts like yours from people who are legitimately struggling not to suddenly find themselves disqualified for surgery because of their own pre-op efforts.

I never had to wrestle with this, since my BMI was above 50 pre-op, but if it were me, I'd ask the surgeon at your upcoming consult how exactly you're expected to handle this.  Other surgical practices with perhaps less picky insurance companies just manage to use the weight/BMI as of the patient's initial presentation to the practice, so there's no chance of becoming "disqualified" if you originally "qualified".  I don't see how any other interpretation of the rules would make sense!

/Steve

Hello Henry,

Some advice from another 62 year old guy: Don't despair and don't give up. Your doc can work with you to help show the ins, company that you are a legit candidate for surgery--and that your pre-op discipline makes you an excellent bet for great long-term benefits.

As for keeping your weight steady, what about adding a protein shake or something every few days to keep the calorie count high enough to keep you in the qualified range? Or if you want to be bold, a bag of chips or something? Just be careful.

Good luck.

Please continue to post here regardless of whether you qualify for any WLS.  Rather than just taking your doctor's word as to whether your ins would cover WLS if you have a lower BMI with many comorbiditiies, contact the ins co directly.  considering your many comorbidities and the extent to which they affect you, it may be more cost efficient for them to allow the WLS than face more medical costs and probable surgeries. 

Welcome aboard Henry!!  I;m sure your Doc will be able to assist with the qualification issue. Like Steve said, if you originally qualified and are in prep for the surgery, they should understand that this is just a part of preparation for your new, healthier lifestyle.  Good luck, don't give up, and keep posting here!!

This is probably bad advice but when I was pre-op I didn't want the insurance company to have any reason to disqualify me for surgery so I ate about 4000 calories a day for about 3 months just to make damn well sure I was fat enough to have surgery. I know that's probably bad but I was allowed to have surgery and I've now lost more weight than I could've possibly done without the surgery! But if I were in your shoes (and I was about 6 months ago so I'm pretty sure I know what I'm talking about) I would make sure I ate enough to keep that weight up!

Welcome to the board Henry. Don't be a stranger and keep us posted on your progress.