Miss Lori O.
1/2/06-On Christmas Eve I received a letter from my medical group (St. Mary Choice Medical Group) saying that they could not approve my request for bariatric surgery until a committee reviewed my medical records and tests submitted by Dr. Krahn's office. They also said that they would give me an answer within 45 days. I am sooooooo frustrated with the process. I just sat and cried for two hours. My husband was very supportive and told me not to worry, they'll approve it. I think he has more faith in the system than I do. One of the things that really makes me mad is that I have seen people get approved for the surgery when they have no co-morbidities and here I am taking a mouth full of pills everyday and it has taken over two years to get to this point! I am very fearful that they will deny me. Guess you can tell I am having a down day!! Hopefully I'll have good news next time I post! =-)
1/4/06
Today I was notified that my medical group has denied my surgery request. They said they want me to pursue MORE weight management options with my PCP. Funny because when I had to appeal the consult request (they denied that too!) I provided them with lots of weight management proof and paperwork and it was acceptable to them then. I immediately filed an appeal with Healthnet this afternoon and am praying for the best. I have received several words of encouragement from many of you and am so appreciatiative of them. It's comforting to know that you all understand because you are going through the same thing. My thoughts now are that if Healthnet denies the request then the universe is trying to tell me something! Guess I'll cross that bridge when I come to it!
1/11/06
Well, called HealthNet today to make sure they received my appeal/grievance paperwork. Took forever just to get someone on the line. The caseworker (Ruthie) was kind of rude and said that their nurse has the information and once she reviews it she will forward to the medical director for final review before a decision is made. According to her, I won't find out anything until the last week of January. I hope and pray that after all this waiting something good will come of it!!
11/04/06
It's been a long time since I've logged on. At the end of January I was denied the surgery. They said I needed to re-establish a relationship with my new doctor (who HealthNet assigned me to and which I did not ask for!!) and try to loose weight by conservative measures. What a joke! I jumped through the hoops for them and did exactly as they asked. I then filed an appeal with HealthNet directly. They denied my appeal and said they agreed with the medical group. Of course I was devastated, upset, depressed, etc. My family and I were moving to Utah and this was the only thing keeping me in California. If I was able to stay a little longer in California I would have filed with the State as well.
So, now nine months later I am going to try to establish myself here in Utah with a doctor and go through the process again. Hopefully this time will go better. I currently have BCBS of Georgia (PPO) through my husbands work and am hoping that I can get through the process a little more quickly. I saved all my records, letters, weightloss documentation, etc. so hopefully this will help.
1/1/07-RECAP: My journey started as an overweight child and teenager. I have always had a weight problem and this was only amplified after I went through two pregnancies and gained even more weight. Jump to 2003. I was diagnosed with high blood pressure, joint pain and beginnings of arthritis by my physician at my yearly physical. I saw myself going down the road that my mother is on (and that my grandmother went through before dying) with obesity, high BP, mini-strokes, congestive heart failure, poor circulation, sleep apnea, etc. and was terrified for the first time in my life that I could die at a young age. I was exhausted all the time and really just felt like crap. I felf like my husband and children were suffering because I could not give them what they deserved. Two of my friends had gone through WLS and were doing well so thought I would speak to my physician about it. After doing 8 months of monthly weight monitoring with my physican which included keeping a food and exercise journal, I was able to have a psych consult . In the midst of all this, my insurance company changed me to another PCP. My new PCP was able to get me a consult appointment with a bariatric surgeon (only after being denied first). The ball really started to roll after that (so I thought!) and was told by the surgeon that I was a great candidate for WLS. I did all the labs, tests, etc. that were required before submitting to my medical group for approval. After weeks of waiting, I was denied by the medical group. So I filed an appeal with my insurance company which was also denied. I was devastated by the outcome but since my husband and I were moving to Utah, I decided to forget about all this for a while. That was in March 2006, in April 2006 I started going to MD Diet in Ogden to try to once again loose weight. I followed a low carb diet, eating lots of protein and healthy fruits and veggies. The result was going from 277 to 230. My blood pressure was at an all time low (waa-hoo!) and I was feeling much better. Of course all good things must come to an end...I've gained about 20lbs. back and my blood pressure has skyrocketed again. I feel crappy again and have pretty much decided that the surgery must happen for me to reclaim my health.
5/4/07 - I went to the information class at St. Marks Hospital on 4/24. It was very informative and I really liked Dr. McKinlay. I filled out and mailed in all the forms on 5/2 and am hoping to be called for an appointment by the end of next week (the time table that the office gave me). The receptionist told me that they book their appointments about 1 1/2 - 2 weeks out so should have my consult by the end of the month. It's almost here!
5/15/07-Dr. McKinlay's office called me last week. I am scheduled for my pre-op and education class on 5/29. They said that they will schedule my surgery after I finish my appt so.....on 5/29 I'll know when my surgery is taking place! I can't believe it's happening! After all the crap I've gone through over the last few years I am finally going to have WLS!!!!
5/29/07-I have a date!!!! Today I attended a class and was scheduled for my lap rny on July 6th. Woooo-hoooooo!!!! I have to go to another class on 6/29 for nutritional quidelines and blood work then........it's time!!!! I can't wait to be a loser!!!!
6/30/07-I'm getting so nervous!! I had my nutrition class, hospital pre-reg and lab appointment yesterday. It was a really long day but glad it's done with. I have to do grocery shopping to get all my last minute items and am also in the thros of getting my daughter ready for camp. Oh joy!!!! Lot's to do so guess I will be a busy little beaver this weekend.
I've been talking to one of my dear friends about the WLS (she had it almost 2 years ago!) and she has given me much confidence that I'll be fine. All of a sudden I am worrying about the pain factor and so I go "Is it worse than the pain of childbirth???" and she's like "Hell NO!!!". LOL! So I guess if I made it through birthing two large headed babies than a few cuts on my stomach won't be so bad???
Not sure if I will be able to post again this week (my home computer took a dump!!) but will try to get on as soon as possible.
7/17/07-Well it's been 11 days since surgery and I'm back at work. Knock on wood-my recovery has been textbook. I didn't have hardly any pain, just discomfort with gas. Food wise I'm doing well. Learning to eat slower and trying to get in all my 64 oz each day. That I think is the most difficult thing, drinking the water. I find myself struggling just to get in 40 oz but I will perservere! I know that it will get easier and easier as time goes on.
On another note, I am obsessed with the food network. I find myself watching the shows and figuring out how I can turn a menu into low carb/low fat. I'm fantasizing about the good raw veggies and chicken I can eat. My husband says I'm torturing myself but really it's helping with the whole "my food choices will never be the same as before" thing and keeping me from feeling sad. I love food there is no denying that, I just have to learn to adapt the food I love to my new diet. Making things low in fat and low in carbs so I can be healthy!
Better get going for now!
8/12/07-Well I am over 1 month out from surgery and doing great. I'm down 38.5 lbs. now and looking forward to the next 38.5 lbs. The weightloss has slowed down now but it keeps on falling off slow and steady. I keep imagining how much I'll be down by Christmas (hoping for 75lbs gone by then!).
I started a new job a little over a week ago and am loving it. Only 30 hours a week with full benefits and the perfect schedule (7:15-2:15pm). I am in a tower of sorts and even though I am only on the second floor, I am only using the stairs. I usually go up and down several times a day so know that it is helping with my exercise. I can already feel a difference in my breathing and I don't want to puke after climbing the two flights!!! Wooo-hooooo!
Toodles!
9/05/07-Yesterday I had my 2month post-op visit. I am down 50.5 lbs!!! Wooo-hoooo! I've gone from a size 24 to an 18 and am hoping to at least get down to a size 12. But guess we'll wait and see. Everything else is going well. I'm still doing great and not having any issues surgery wise. My family and I will be going to Las Vegas in 1 1/2 weeks so hoping I lose a few more pounds before then.
