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My Friday nutritionist visit showed another nice drop.  I went down 3 pounds, but the breakdown was most impressive.  Down 4.5 pounds of fat, and added muscle.  

Sadly though, I'm sick again.  I had half a day off to do my initial cardiologist consult as part of my pre op testing.  But I wound up cancelling it and going to see my doctor.  My breathing was so bad they told me I'd have to be hospitalized if a breathing treatment didn't open me up.  I made it but barely.  

So then I had to take 3 days off work I really don't have to spend.  A week later I'm still coughing.  I gave up the antibiotics because they were making me nauseous and sick.  Hershey Kisses, the doctor said, would cut the taste but after 3 bags of them I felt that was enough and stopped the pills.  I feel better today without them.  My gut muscles are sore as hell from all the coughing.  

This month I should complete my cardiologist stuff and my psych eval.  Then in early September I'll have my final visit before they can submit my case to Cigna.  Sadly I hear their turnaround is about 3 weeks which would put me dangerously close to my sister's wedding which is now scheduled for October 27th.  So I'm trying to get used to the idea that it's going to be early November before surgery.  

I guess my family will be able to say goodbye to the fat me at the reception.

My surgeon's office is adding staff.  We get a new nutritionist soon with better and more accessible hours, thank God.  To be honest I wasn't that thrilled with the first one.  

It's downhill from here.  The numbers just keep getting smaller...

Well here I am, half way through my medically supervised weight loss program.  I'm going to be done in September!  If my approval and the surgery schedule cooperates I should be getting my RNY late October-early November.   I have to wait at least until after October 13 because my sister is getting married that day.  

According to my original weigh in at Dr. Davidson's office I have now lost a total of 16 pounds!  Now I think his scale weighs heavy and I know I was wearing winter clothing.  According to my home scale it's probably only 10 pounds but geez, compared to my past failures 10 pounds is a sucess.  

Now I know what my sister is thinking.  "If she's lost 10 pounds on her own, maybe she'll keep going and not have the surgery".  My sister is not ill informed or mean, just scared of surgery in general.  

But the one thing she doesn't realize is that without the surgery those 16 pounds will find their way back to me.  I'm being pretty restrictive with my diet and the ONLY reason I'm sticking with it right now is because I know if I want this surgery I gotta do this.  I was so freakin hungry Thursday and Friday that if I didn't have that surgery motivating me I would have stopped at McDonalds and ordered a couple combo meals.  

I have a finish line in sight.  I'm driven to reach it.  

My sister wants to be with me the day of my surgery.  I don't want to have it before her wedding because I think it would be too hard to help her with preparations AND make this huge life change.  One big life change at a time, thank you very much.   When she's back from her honeymoon, which won't be a long one, I can have the surgery. 

The reception will be small and our entire family won't be there.  I've offered to throw them a big party in late spring to invite the entire family.  That way they can meet Kenny and see the new me.  

Work is a continued source of stress.  The new ownership took control this week and immediately screwed up the email and time entry system.  Not knowing what comes next is rough.  But the insurance is good and I get a special open enrollment period that even allows me to change the contributions to my medical savings account.  Sweet.  Got my hair done today and my dry cleaning is back so I'm ready for when the new division president shows up Monday.  

As long as I don't lose my job and the insurance.  That scares me more than anything.  I've GOT to get this surgery.  I would be so shattered to lose both my job AND my chance to turn life around.  I'm doing my best not to fixate on that and just plow ahead to be the best employee and best person I can be. 

This month I have to get my psych eval and see my primary doc for a thyroid check.  It's about time I do that anyhow.  I just ordered a new supply of Synthroid but I've been real tired lately.  It could be the diet or it could be my meds need adjusting.  I also have some "issues" I'd like to explore with the psychiatrist anyhow. 

But I'm moving forward.  How about that?

I was reading an article today about why highly creative people have problems with substance abuse.  This article caught my eye because I'm a very creative person in the entertainment field.  

The article referenced the works of a Polish psychiatrist named Kazimierz Dabrowski who has a theory that gifted and talented people may experience increased mental excitability, depressions, states of anxiety, inhibitions and ambivilances, all symptoms which the phsychiatrist tends to label psychoneurotic.  

It went on to suggest that the reason so many intense and sensitive people  self medicate  is to dampen the internal and external condemnations of those symptoms that Dabrowski and others say can indicate a capacity for achieving higher levels of personal development.  

I'm talented and creative and Lord knows I'm sensitive.  Food is most definitely a substance to be abused.  Once I get my letter from the psychologist that says I'm approved for surgery I think I'll bring that up.  LOL

I had been waiting for this consultation for a long time.  Today I finally got to talk to the people who have come so highly recommended to do my surgery.  

I must say I'm a little let down.  

I didn't meet "THE" surgeon, but I met another of his partners.  When he asked if I knew what the procedure entailed I think I was too detailed in my answer.  He knew I'd done my homework.  I did tell him about Dr. #3 and said I wanted to know more about this program, especially the after care.  

He said frankly that it was good, but not that good but they were working on it.  I thought that was an odd response.  He also told me that Drs. #3 and #4 had done about the same number of lap RNYs.

When I met with the program director she was nice and we started to go over the paperwork I had filled out.  When we got to diet and exercise I told her about seeing Dr. #3 and starting his program, but wanting to see them as well.  At this point she closed her book and just said "Well, what do you want to know?"  

It was kinda snooty actually.  It was like the wall came down.  When she noticed someone had written the surgeon's name on my appointment card she got agitated and told me I wouldn't see him until I was 5 months into my medically supervised program.   I was told how busy they were and how many people they had come in the program every month and how he does all these other surgeries...he's obviously a superstar.  

The bottom line is I expect the surgeon to have a cold attitude, but not his staff.  I had tried smiling and lightening the mood when I was with the nurse, his fellow surgeon and this program director.  NONE of them were what I'd call warm.  Especially when they learned I'd been to other programs.  

Then there's the issue of how busy they are.  Their doctor for the medically supervised program wouldn't be able to see me til late July.  That means I wouldn't see the surgeon until December.  Figure the insurance gets approved in January then they work me into his heavy schedule so then we're looking at mid-March!  

At work it appears the company that has purchased us will take over in June.  I know from talking to their HR department that I'll be covered on their insurance.  But  what concerns me are the future plans.  Will I be a part of it?  I feel the need to get my body taken care of quickly.  The clock is ticking.  If I'm let go I at least want this surgery first.  Can't do it without insurance.  If I am a part of the future with this new company I want to be in the best physical shape possible so I can perform.  

I briefed hubby on the meeting and he was pretty mad.  Perhaps it's a good thing he didn't go with me.  He may have torn into someone.  He agrees with my decision.  

The winning contestant to revitalize my life is contestant number #3,  Dr. James Davidson at Dallas Presbyterian.  He's a lucky guy.   He gets to save a really wonderful person.

By this time next week I should have my choice of surgeon nailed down.  

I had my first nutritionist visit Friday.  It went well and I like the lady running the meeting.  My sister went with me and she was impressed too.  I felt like I got some good direction and goals that I can reach.  

Monday I visit surgeon #4.   He's the last one before I make my decision to stay with #3 or go with #4.  My fear is #4 is so much in demand it takes a while for the surgery to get scheduled.  I'd like this done by the end of the year.  

I am concerned about my job.  A new company is taking over and I'm just anxious that they'll want me to be part of the future.  The lady I talked to at the new company HR department told me I could call on her if I needed any help with getting the paperwork and approval from Cigna.  That was pretty awesome.   

Mostly I'm hormonal and having bad emotional PMS this month.  Today has been a two xanax kind of day.  I have lots of reasons to be proud of my work, but my emotions are in a place where I feel tremendously inadequate.  I hope to pull out of it by tomorrow.  

Pesky little quackers.  You never know what they're going to do. 

One of the reasons I was so upset about Baylor wasting my time is that the company I work for is being purchased.  This sale is taking forever to be approved by different government agencies.  Once the sale is complete I'm hazy whether or not I'm keeping my same insurance coverage.   Nobody seems able to answer that question yet.  

However, today I did speak with someone in HR at the new company.  I called after reading an outline of the new benefits package.  The health insurance offers are largely the same and I can remain on Cigna POS.  But what I needed to know was "Does your company have an exclusion for weight loss surgery?"  

The answer :  no.  There's no exclusion and she specifically said they cover WLS.  

I don't know about their sick leave policy though.  Where I'm at now its really easy.  Once you're on sick leave for 5 days short term disability automatically kicks in.  I don't have to use vacation time.  I don't lose any pay.   I can get my RNY and be out for 2 weeks like the doctor recommends.  I think that will be very helpful.  

This week I'm doing a trial run of the pre op diet.  Two shakes and a Lean Cuisine.  (Okay so add to the day's total a handful of Cheese Its.  I'm weak.)  I'm practicing.  

I'd like to up my physical activity but my damn knees and my ankle have been bothering me a lot the last 2 weeks.  I went outside and did a little yardwork Saturday and it nearly killed me.  My back is all stiff and cramped.  If I can get in a mall walk this week I'll be happy.  I wish I knew of a water aerobics place close by where I'd feel comfortable in my present skin.  I need to research that.  

Damn.  That's another duck....

Okay, I think I'm on the right track this time.  The wheels are turning and a plan is coming together.  

Went to a seminar at Dr. James Davidson's office at Dallas Presby Friday.  I was fairly pleased.   He seems more than capable of doing a successful surgery and has done a lot of them.  I think his presentation was the most in-depth I've seen yet.  The office staff was efficient and friendly and made me feel at ease.  

But something is bothering me and I don't really know what it is.  I can't quite put my finger on it.  I'm really hung up on this whole "6 month medically supervised weight loss" thing I have to do in order to satisfy my insurance company requirements.  They were making it seem so easy to complete and it seems a whole lot cheaper than I was expecting.  

I think I need to make up a checklist of what is required of me and then add in there the expected cost.  Perhaps if I organize it better so I can get my head around it I would be more comfortable.   We also have a couple other questions we need to have answered by their insurance lady.

Now the doctor wants me to lose 30 pounds before he does the surgery.  He says he has all his patients lose some ahead of time to shrink the size of the liver that he has to work around when doing the surgery.  Okay, that seems reasonable enough.  He's never lost a patient before so he obviously knows what he's doing. 

Still, I also have an appointment with UTSW at the end of April.  My gut instinct, along with the opinions of others, is saying that's the place to go.  So I'm thinking if I start with the 6 month program now with Davidson's group, I can transfer over.  I just can't make a full on committment to go with Davidson until I talk to UTSW.  But I also don't want to wait another month and a half.  

Yes, sometimes I can become as rigid as a brick wall but I really do believe in the mantra of "just roll with it".  So since my last entry I've been trying to do just that.  I just had to shake my fist at the wind a little.  

A wonderful gentleman contacted me after I posted in the forums here about my insurance predicament.  He's given me some wonderful advice that has certainly heartened me.  I will not forget that kindness.  

For now I'm in a bit of a holding pattern.  I have a seminar scheduled with a surgeon next week and a second program I also hope to hear back from next week.  But I'm not content to just sit here and wait.  

I've managed to eat breakfast for two weeks now.  That's a big deal cause I'm a notorious breakfast skipper.  My husband is also a meal skipper but he also calls himself the "breakfast guy".  But instead of waffles he's mixing up protein shakes.  

I'm going to start inputting some stuff into FitDay.com so I can keep track of things better.  

I just feel like I have to do something everyday.  I need to feel like I'm moving forward.  When I just float I get cranky.  I realized this week that the last time I went through a big life change I experienced the same thing.  When I was planning my wedding I had to do something everyday, even if it was just researching or organizing or running an errand.  It was a kind of nervous compulsion.  

What's encouraging is that the marriage was absolutely the right thing to do.   I know this is too.  And just like with marriage, sometimes you just gotta roll with it. 

I'm really surprised anyone gets to the point of having weight loss surgery.  All I can figure is those who've done it are either pretty motivated or desperate.  

I discovered in October 2006 my insurance company finally started covering weight loss surgery.  So I began by meeting with my  PCP.  She was all for the surgery and recommended a couple programs.  

I went to a sales seminar at Baylor Plano with Dr. Nick Nicholson in early December.  I went in thinking I wanted the band, but came out with the realization that a laproscopic RNY was the better option.   Even better, the whole thing seemed SO EASY!  Well, not easy in terms of losing weight but so easy in terms of negotiating the insurance.  

I had contacted Cigna to find out what their requirements were...they want me to do a 6 month medically supervised weight loss program.  Weigh in with a doctor, see a dietician, see a shrink, get some exercise and if I hadn't lost 10% of my body weight in 6 months they would okay the surgery.  

The letter I got back from Baylor Plano confirmed that.  However all the insurance requirements I had to take care of myself.   Sure they had a few recommended people for the diet and psychiatrist, but I had to go back to my PCP for the weigh ins and other paperwork.  

So I did.  In January she said "No, you have to find a place that does it all in one spot.  If the paperwork isn't done perfectly Cigna will reject it."  Furthermore she said all the requirements were a bunch of crap but there was little I could do about it.  She said, "You need to go to Big Baylor in Downtown Dallas.  Little Baylor in Plano just doesn't have their act together."  

So a couple weeks later I went to the second sales seminar.  And in my haste to get started on this I made an appointment with their dietician Jessilyn.  She said once I did the sales seminar I could meet with her and she'd get me started on the medically supervised weight loss part.  

Sounded like a great deal.  Especially since a friend of mine highly recommended Dr. Kuhn.  We liked him in the seminar too.  I even had my first meeting with Jessilyn and we set some goals.  Hot damn, I'm really on my way, I thought.  

Then the mail came.  

Not only did they tell me Dr. Kuhn wasn't on my Cigna POS plan but they told me Cigna required TWO medically supervised weight loss attempts.   

So I call Cigna.  They couldn't help me with the issue of Dr. Kuhn not taking Cigna POS, but they did tell me the requirements Big Baylor had written about were incorrect.  I only need ONE six month medically supervised weight loss program, with all the bells and whistles.  

I know Baylor is highly recommended but ya know, it sure woulda been handy to know about the Cigna POS issue THREE MONTHS AGO!!!  It's why I call it a sales seminar.  Just get 'em on the hook and see if you can reel 'em in.  It really wasn't helpful to me at all.  Turns out Big Baylor doesn't have their act together either.   At least not for people like me. 

So back to square one again.  I start digging through Cigna's website which isn't at all helpful in finding these specialized surgeons.  They have "Cigna Approved Bariatric Locations" but it's an incredibly short list and doesn't include all the doctors that accept POS.  You gotta wade through a poorly designed search function to do that and cross reference hospital websites and Google.  It's taken hours and hours of my time.   

Purely by accident I came across the name Dr. Hamn who practices in Plano Presbyterian.  I called his office and for the first time found someone helpful.  Not only did he take POS but they were familiar with the requirements and had a doctor in Frisco who knew exactly how to assemble the documents! 

I could do a six hour seminar by where I'd meet with the insurance people, the surgeon, and get a total overview and an appointment with this doctor.  

But then I find out Dr. Hamn only does the open RNY.  Crap.  His associate Dr. Cribbins has done the lap RNY but only "a handful".  Crap again.  I've had my lower abdomen cut open for a ruptured appendix and then again for a second infection.  It was horrible.  I'm not about to get my upper abdomen cut open.   Not willingly at least.  And I've researched enough about this procedure to know that you gotta find a doctor who's done a lot more than "a handful" of lap RNY's to be safe.  For as much as I liked their office, I just can't put my trust in those doctors.

So now I'm looking at Dr. James Davidson at Presbyterian Dallas and Dr. David Provost at UT Southwestern.  Ironically, the first seminar I ever went to about WLS was with a friend a few years ago who had the procedure.  Dr. Provost was the one who spoke.  (But my friend decided on Dr. Kuhn at Baylor instead.) 

It's incredibly frustrating, maddening and ridiculous the lengths we have to go to in order to find the care to fix ourselves.  Maybe I can help someone else by sharing my story.  

There are tons of resources for those who've had the surgery, but hardly any to help those who want it.   Even the surgery centers stand in your way!  My first advice to anyone will be "If they tell you in a chippy voice "Well first you have to attend our free seminar, it's how we get you in the system..hang up!"  

I will gladly pay a small fee and spend 6 hours in an office if it means I get to talk one on one with the surgeon and office staff to get a clear picture of what  to expect with the surgery, insurance, etc. by the time I walk out the door.  That's what I'll be doing with Dr. Davidson and Dr. Provost.  It's what I should have done back in November. 

But it is what it is...slogging through the quagmire.  I know in the end it'll all be worth it, but right now it's freakin annoying.  I hope somewhere along the way I can kick someone in the pants to streamline this process and make it easier for those who really want to do something about their obesity.