Janeene_Gregory
My sugery status above refers to my husband's surgery status.
I am here for my fiance and what we're going through. He weighs approximately 650 + pounds. We have been denied our first referral. Now we are gathering his medical history for an appeal. Any help we can get will be appreciated.
Here's the link to his OH profile: http://www.obesityhelp.com/morbidobesity/profile.phtml?N=G1015209886
04/12/04 : Well we wrote out letters of appeal and PacifiCare overturned the Medical Group's denial. YEAHHHHH!!!!!!!!!!! I faxed the reversal over to New Dimensions this morning for my fiance and now we're just waiting for her to call us back so we can make his first appointment for the consult. I'm so excited and at the same time terrified.
I went to visit a friend this past weekend who had the surgery in Nov 2002. Things went terribly wrong for her and she never left the hospital. She's lost almost all her hearing. She's completely disabled at this point and only came home for the first time about two months ago. She's five years younger than me. My other friend and I took her out to lunch for her birthday (in a wheelchair) and the waitress commented how nice it was that we took our mother out to dinner. Like I said, she's YOUNGER than us. She just looks terrible. So I'm so torn. I know this surgery will save my fiance's life. I also know it can go terribly wrong.
Anyway, once we have his first appointment, I'll update this further.
04/28/04:
First I should update this to say that on 04/17/04 I no longer have a fiance I'm supporting here................I have a husband! We were married in Las Vegas.
We've now gone to his orientation, met with the psychotherapist (never could spell that word), met with Dr. LaPorte yesterday and had several pictures taken. They are submitting to the Medical Group now because they not only want authorization to do his gastric bypass but they want to remove his "apron" in a second surgery during one hospital stay. Next week we will go to the Nutrition Class and on May 17th we will go to the Doctor's talk.
I guess at this point we're just waiting for a response from the Medical Group to his surgeon and to know whether they will require him to see a cardiologist because he's over 400 pounds. Dr. La Porte seemed to think we may not have to do that because Dave (Harley) is only 35 and has no heart problems.
Once we have a response from the MG I'll update this again.
06/07/04- I haven't updated since our second denial. We have done everything asked of us for my hubby's surgery. Orientation, consults, therapist, doctor's talk. Then the medical group denied him AGAIN for the same reason they denied the first time when we requested the consultation. PacifiCare overturned that denial. So here we go again. Tomorrow morning I will drive down to Smart Dimensions and they have his medical records, pictures, a new letter from the surgeon and the therapist. We have the letter over turning their first denial. We were very lucky to have someone from here, obesity help, who started out at a weight higher than my hubby's who is writing his own letter to go with our appeal. My hubby is writing his letter. And then I'll write a letter. So hopefully by tomorrow or Wednesday, we will have this in the appeals process again.
I just don't know how they can deny him with a BMI of 93.5.
I have made the mistake of reading some of the memorial pages here recently. I sat there, at work, crying. Dave (Harley) is my best friend. He's my love. He's my lover. He's my sounding board. He's my defender. He's my hero. He's my everything. The thought of ever losing him..........it just can't happen. So, here I am, working away to help him get this approved, terrified all the while.
Anyway, I'll update again once we get our response on this appeal.
06/08/04- Appeal has officially been submitted. The waiting game begins again.
07/15/04-Time for another update. Last Friday we found out PacifiCare overturned the denial for the Gastric Bypass. Needless to say, we were very excited.
Come to find out the Surgeon's office submitted separately for the panni-ectomy (you know what I'm talking about). They submitted to the Medical Group in May and NEVER followed up on this! They told my hubby that they were sure it was being looked at and to wait a week. I said NO WAY! I called them (since I work for the insurance co) and told them that Medical Groups are not allowed to take that long to approve or deny a referral. They called again and guess what? The Medical Group is claiming they never received the referral for the second surgery. The Surgeon's office faxed everything over and now we wait again. Only this time, not so patiently.
I'm having my hubby call every day, maybe even twice a day. If we don't get a response within a week. I'm going to call and you can bet, head will be a-rollin then. I don't want to make this office angry, but everyone dropped the ball on this one and I'm tired of waiting.
Shoot, when he was first denied for the Gastric Bypass, they told us they were going to appeal to the Medical Group. For us to just wait and let them handle it. Even though I knew what the procedure was for our insurance co when something is denied, I held back out of respect for the surgeon's office. Well, the denial was upheld and the Surgeon's office never called to tell us! We never would have known if we hadn't called. So now, we're going to be on this every single day. Patience my...............never mind. LOL
07/19/04--We got the call today, they've approved the panniculectomy! They're going to schedule the gastric bypass, then schedule the panniculectomy for two to three weeks before the bypass. We should have surgery dates sometime tomorrow!
07/20/04--We have an appointment with the Plastic Surgeon on August 11th for the panniculectomy consultation.. Once we see him, we should be able to schedule the surgeries. I'm so excited for my hubby.
And I'm scared to death too.
08/02/04~~ Another bump in the road. The plastic surgeon that the Medical Group referred us to called to say they don't do panniculectomies. Amazes me that a Medical Group denies us a doctor who works with our Gastric Bypass surgeon, send us to their surgeon and doesn't even know he doesn't do this surgery?
GRRRR
Anyhoo, they submitted another rush referral to have the original plastic surgeon approved. Dave also needs to have a gallbladder ultrsound, chest x-ray, upper and lower GI, blood work, see a cardiologist, and pulominary specialist. Once all this is done and cleared and once we have approval for the plastic surgeon, we can set surgery dates.
This has been hard. I don't hold up very well sometimes and I feel really bad about that. I feel like I'm taking things out on my hubby and I don't mean to. All I can say is it's hard jumping through all these hoops. It's hard watching my hubby struggling to even walk to all these appointments. I hate that he has to go through all this. I worry about him. I'm scared. It's just hard. I don't know else to put it.
08/05/04~~Got a call from the surgeon's office. I think she got the final approval faxed because she wanted to know what date (possibly two days) would be good to schedule the gallbladder ultrsound, chest x-ray, upper and lower GI, blood work, cardiologist, pulominary specialist, and (I think) appt with plastic surgeon. I told her ANYTIME!!!! So she's supposed to call me back with the date or dates. I'm exhausted.
09/03/04~~Hard to believe it's almost been a month since my last post. Things sure do move in slow motion. Dave has had all his preop work done. Everyone signed off for his surgery. Everything came back ok. His heart is a little large and his oxygen a little low, but they say that's normal for someone of his size.
I do want to comment on how insensitive some doctors are. The pulminoligist we saw said there was something on his left lung, but because Dave was so large, he couldn't do a C-SCAN. He then looked at Dave and said "So, are you ready to bite the bullet?"
Dave, thank goodness, got mad and told him why he was ready for all this. I cried. And after all that, the doctor signed off for Dave to have the surgery anyway.
Talbert has approved a doctor at UCLA to perform the panniculectomy. Once again though, you can't get a call back from these people. I've discovered that everyone tells you it will be a couple days.......whatever the latest thing you're waiting for is, but weeks can go by before anything is taken care of. It's so frustrating.
I finally told Dave to ask for this person at UCLA's supervisor. Then, of course, he had a call back in ten minutes. The call he was promised for the past week. They scheduled him for October 25 for his consult with the plastic surgeon. At first they said Nov 29th! (good grief)
At this point we have resigned ourselves to the fact that the gastric bypass will probably not happen until sometime next year (2005).
The cardiologist told Dave that if he doesn't have this surgery, he won't live to be 40. By the time it gets done, we will have spent well over a year getting there and he will be close to 37. I'm trying my best to keep positive, but this can be so hard sometimes.
10/15/04~Time to update now that things have calmed down a bit. On September 26, 2004-Sunday, my hubby Dave got sick very very suddenly. He went from joking with and folding laundry to vomitting and a fever of 104. I started to get the car, but he said he didn't think he could even walk about to the car.
I called 911, which was one of our biggest fears because, well at a little over 600 pounds who wants to have to have the paramedics come out, try to fit on that little gurnie, and then be lifted into an ambulance. But they did it...very nice bunch of guys at that.
The gave me the wrong directions to the hospital (even though we requested to go to our contracted hospital). Then I got the right directions to the hospital they said he would be taken to. Got there and no hubby. Called 911 again only to find out they took him somewhere else. I finally find him.
They have him on IV antiobiotics, but the doctor says he's never anything like this before, which I found VERY hard to believe. They did NOTHING. He has lymphedema in his left left and they left us sitting there for over 7 hours trying to arrange a transfer to our hospital. He couldn't lay in the beds, too small, very uncomfortable. So I watched his leg turn red, get hot and fill up with fluid. I actually had to go in and find this doctor to come talk to us and let us know what was going on.
Finally we got him settled about 9:30 pm at Orange Coast Memorial in a bed made for large people and a wonderful staff. He had two infected sores on his pannis, which also has lymphedema. It took several days and trying different antiobiotics to finally get his fever down. He was able to come home the following Thursday.
He needs these surgeries so bad. We see the Plastic Surgeon at UCLA in just over a week, Oct. 25th. Just praying they'll do the panniculectomy. Will update then.
OH!! I almost forgot. When he entered the hospital, they weighed him. His highest weight was 652. He weighed in at 617 and when he left the hospital it was 605. Great news!!
10/26/04~I can't even put into words what I'm feeling.
When Dave had all the preop work done in July, the Medical Group called us and said "we have someone to do the panniculectomy!!! you'll have to go to UCLA, but he'll do it."
We waited THREE LONG MONTHS for this appointment. And the plastic surgeon doesn't even touch my husband. Says he doesn't do this before the gastric bypass. Only after. I'm empty. Got nothing left.
I do EVERYTHING for everyone. I work my ass off at work. My boys are causing me problems at home and I do SO MUCH for them. My ex is trying to sue me so he doesn't pay his child support anymore even though my oldest is going to college. I have my own pain.......a neuroma in my foot. But I can't stop for one second because I'm the only one continuing on these daily battles. I just don't want to do it anymore. I have nothing left.
11/17/04~ As always, so much has happened. We got a Case Manager at PacifiCare to help us because we were getting three different answers from different people. First we were told that the gastric bypass dr convinced the surgeon at UCLA to do the probcedure and that everything was going to be done at UCLA. We were waiting for the paperwork......nothing came. Then we were told this was never true. So back at square one.
The original surgeon that we wanted to do the panniculectomy wanted two assistants to help him and we're told that was originally denied with the Medical Group telling him they would only allow one. Finally, (we're told anyway) the gastric bypass surgeon has offered a second assistant at no cost. So, maybe, just maybe, we're getting somewhere.
The Medical Group approved Dave to go for the consult with the plastic surgeon Dr. La Porte works with. The appt coordinator was SO nice and got us an appointment in 5 days (she said he had nothing available till end of January 2005 at first). So Monday, we go see Dr. Elliott and hopefully (please please please) things will finally get scheduled.
02/10/06~~I guess not posting for over a year isn't very good, but things went so slowly. So many set backs. I'm afraid I got very discouraged.
We saw Dr. Elliott who had many reservations about doing the panniculectomy first. He wanted us to consult with a surgeon with UCI. We waited and waited. Eveyone was pointing to the other offices to follow-up on this.
Finally we heard that the surgeon Dr. Elliott wanted Dave to consult with at UCI was no longer there, so suddenly it seemed everything was at a stand still. PacifiCare once again interveined. Got us back to see Dr. LaPorte who agreed to go ahead and schedule the gastric bypass.
His hesitation in doing the GB first is that my husband's pannus probably weighs 50 to 75 pounds. This laying on his legs and stomach during a surgery may cut off circulation to his spine and legs. They're concerned this will cause permanent nerve damage and Dave may never walk again. But we were moving forward and so excited. This was summer of 2005.
But no.............not to happen.
Dr. LaPorte ran into Dr. Elliott and mentioned that Dave was going to get the GB but that he was very disappointed the panniculectomy couldn't be done first. In steps Dr. Elliott again. Evidentally there's a new surgeon at UCI. So here we go again.
Luckily the surgeon at UCI sees us very quickly. He says YES this surgery is very doable, high risk, but doable. He forwards his notes to Dr. Elliott and we wait.
Finally Dr. Elliott himself calls my husband. Our patience has paid off, he's going to do the Panniculectomy. Wow, this has been some roller coaster ride.
So as of today we have the panniculectomy scheduled for 04/17/06 (our 2nd wedding anniversary) and the Gastric Bypass for four weeks later on May 15. We're so excited now.
BTW........from Dave's top weight of 677 he's down 77 pounds!
I'll be much quicker with future updates.
03/16/06~Well, Dave's had all the preop tests done and passed everything with flying colors. All "we" have left at this point is the final appointment with his PCP, who is completely supportive of both surgeries and then the final appointment with the Plastic Surgone and then Bariatric Surgeon.
After almost two and a half years of jumping through their hoops, of having and losing hope, it's so hard to wrap my mind around the fact that this is really going to happen. One month from tomorrow (04/17/06) he will have the panniculectomy........nothing standing in our way any longer. Then on 05/15/06 he'll have the Gastric Bypass if all goes well with the first surgery.
Somehow every moment seems so precious with my husband now. I mean it always was before, but with the surgery so close at hand I want to hold on to him so tight. I want to savor every minute. I firmly believe everything is going to be fine. Still it's scary.
11/04/06
Again it's been way too long since I've updated. My journey here has been for my hubby. Here's his profile:
http://www.obesityhelp.com/morbidobesity/profile.phtml?N=G1015209886
After a two and a half year battle he finally got his panniculectomy on April 17th. They removed 95 pounds and this made a huge impact on his life............our lives.
On July 25th, 2006 he had the gastric bypass. With the exception of Atrial Fibrulation from the anesthesia everything went great.
Of course when they did the cardioversion to correct the AF his heart started just flapping and they had to call a Code Blue.
This has been a very long difficult process and the stress has taken it's toll. But we're on the other side now and so far he's doing great again. He's lost about 235 pounds total. About 121 of that since the gastric bypass. We're able to get out and go places now. He can drive and run errands for me. Complete life change. He's buying clothes in an actual store now instead of just online.
In January we're both going back to school. Life is busy, but very good. I'm so thankful for all this. It gave my husband back his life and I just want him to be happy.