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I had my psyche test, settled on Dr. Ellner after attending her seminar in Anchorage, gotten the LONG list of to-dos from her office, and TOLD MY PARENTS (by far the most difficult thing on my list).  
This week I have my PCP (Dr. Cooney) appt.  I expect a physical, EKG, and bloodwork.  I still need to do fasting bloodwork (Maybe the next morning).  I may need to do a 3 hour glucose tollerance test and maybe an upper GI.  I will know after the results of my bloodwork.  I also have a phone consultation with Dr. Ellner on Monday.  She'll let me know about the upper GI based on my medical history I submitted.  (I was brutally honest so she would have no surprises)
I am about 1/2 way through the total list of things to do for insurance and Dr. Ellner.  I will have 90% done by the end of the week.

After the seminar, I asked myself why should I put it off.  I decided to try to get everything done and submitted to insurance ASAP so I can have the surgery Nov. 13.  I will need to be in San Diego for about 10 days then I'll have Thanksgiving to rest.  I'll try to go to work the following Monday or maybe Tues.-we'll see how I feel.  I can be pretty sedentary at work.  Then I will work for 4 weeks before it is Christmas break aka 2 weeks of rest if needed.

9/22/07
I have narrowed my surgeon choices to 2:  Dr. Julie Ellner or Dr. Wittgrove.  Both come highly recommended by my Dr.  Unfortunately neither are "preferred providers" for my insurance (EBMS).  This means I will need to pay more out of pocket expenses as well as travel and hotel.  Both doctors will be in AK in Oct. for informational seminars and I have reserved my seat.  
I have attended a WLS support group in Anchorage in early Sept.  All were patients of Ellner or Wittgrove.  Everyone was so wonderful to answer my MANY questions!  Next time I will be more of a listener! ha ha
I contacted my insurance company to find out the specifics of their requirements.  They sent a list with the following:

Procedures, Gastric Surgery for Morbid Obesity 
Documentation of ALL the following Preoperative Indications (all information needs to be dated within the last 6 months): 
□1. Please provide the specific proposed bariatric procedure being performed along with ICD9 or CPT codes 
□2.  Is this an Adjustable Gastric Banding Procedure?

 □3. Is this in or out patient?

 □4.  BMI:               Height:                        Weight:

BMI of 40 or greater (approximately 100# over standard actuarial tables) OR 
  BMI of 35 with significant comorbidities which may include but not limited to: 
     *Pickwickian syndrome 
      *Poorly controlled or uncontrolled diabetes 
    *Refractory gastroesophageal reflux disease 
     *the obesity interferes with daily function to the extent that performance is significantly curtailed (i.e. impeding job loss or job loss with documented disability). 
       *The obesity causes incapacity physical tama as documented by the medical history records including x-ray finding and other diagnostic rest results.

 

*There is significant respiratory insufficiency documented by respiratory function studies blood gasses, etc.

 

 

*High blood pressure requiring treatment.

 

 

*Coronary heart disease

 

 

*Sleep Apnea

 

 

                *Degenerative arthritis of weight-bearing joints.

 

                *Hyperlipidemia

 

 

The comorbilities need to be documented in the record or letter of medical necessity.

 

 

□5.  The condition of morbid obesity must be at least 5 years duration.  Documentation of repeated failure of multiple (greater than 3) rigorous attempts to lose weight prior to the request for surgery.  Documentation should include the name and length of the programs and how long the patient attended each program.

 

 

□6.  There must be a letter of support of the surgery from the PCP or physician who is currently providing care of the member and familiar with his/her attempts at weight reduction, health history and current health status including issues related to obesity.

 

 

□7.  Documentation of laboratory studies completed within the last six months including:

 

 

                *No thyroid dysfunction, to include TSH

 

 

*No liver or renal disease which would be a contradiction to the surgical procedure, to include ALT, AST, BUN, and Creatinine.

 

 

□8.  No clinical evidence of cardiac disease and a normal EKG.  Please provide a copy of the EKG results.  If abnormal, patient will need cardiac clearance.

 

 

□9.  An appropriate provider other than the surgeon must conduct evaluation as to the psychological capacity of the patient to undergo such a procedure.  A psychiatrist, psychologist or Licensed Professional Counselor must complete this evaluation.  In addition, a statement documenting that there has been no history of an eating disorder (i.e. bulimia, anorexia) and a history of alcohol or substance abuse will not be considered unless the patient has completed a recognized rehabilitation program and is certified to be substance free.

 □10.  Documentation that the patient has been advised of the surgical risk of the procedure, possible long-term complications following surgery including the possibility of death.

I will share the list with Dr. Cooney in mid Oct. when I have my next appt.  I also have my psyche test Oct. 10th.

I have also looked at my schedule.  My only 2 options for surgery is right before Christmas or in May at the end of the school year.  Christmas would be PERFECT-My folks will be up so there would be extra help for my recovery time.  Summer would be okay, but the yard work will be a problem (I know that I won't have the money to pay someone since I will be paying the out of pocket money for the surgery).  Dr. Ellner and Dr. Wittgrove would require me to stay down in CA for 10 days.
Bye for now.
-MTT

8/7/07

Time to stop lurking and start asking questions!  

I am still in the "questions" stage of my journey.  I have a Dr. appt to chat about my weight loss surgery options with my internal medicine Dr. (Cooney) in early Sept.  
I called my insurance to see if they will pay, and they said yes if you are over 40 BMI or have additional problems (basically if it is a health risk and not for vanity).  I am lucky to have few additional problems, but I am at least 50 BMI (eek!).
I am fighting the "if I could be stronger I could lose weight without surgery" guilt.  I have noticed a lot of answers about that on the forum which has helped me.  The idea that WLS is a TOOL and not a cure all is a new idea for me to chew on.
I had success with Weight Watchers (75# gone) UNTIL I stopped following the program (75#+ returned).  I have so much to lose (at least 190#)that I just got frustrated, life got busier, and I was bored eating the same food over and over (my fault, not WW).  After reading the boards, I think I will need to continue with WW or some kind of support group to get those last pounds off.
I am worried about complications.  I am a single mom with young children.  I need to weigh the risks with the benefits.  I think the key to this problem is to be careful to pick the right surgon.