moore972003

Send Message

Block

Add Friend

Hey everybody!!! 

I got back last night from my meeting with Dr. Anthone.  Boy, were you all right, what a wonderful person he is!  In the middle of my consultation, his nurse came in and told him his mother was on the phone.  He looked at me and said, "Would you mind if I take a minute to talk to my mom?"  How sweet is that?  I smiled and said, "I insist!" 

He was only gone a minute.  Did I mention he was right on schedule with my appointment?  I expected to have to wait an hour or more like every other doctor I've ever been to. 

And everyone in his office was so nice!  When I was getting ready to watch a video of a seminar in my room, Rachael Ray was on the tv and had men modeling underwear on her show.  The girl putting in my video called everyone else in the office to come check out the guys!  We were all standing there oohing and aahing for like 5 minutes.  What a great bunch of ladies!  Just really down to earth and fun, like a group of girlfriends rather than busy, crabby office staff with something better to do than talk to me.

So back to my appt.  Walter said something the other day about Dr. A saying with his previous Nissen, he may have to convert him to an rny, and wouldn't know for sure until he got in there.  Well, to my surprise he told me the same thing!  His explanation is that if there is way too much scar tissue at the top of the stomach, there would be no way to cut down the stomach, he would have to cut more off of the bottom, including the pyloris.  He said this would be a hybrid, but more like an rny pouch.  The intestinal part will still be like a normal DS.  He said there is like a 20% chance of this.  He could tell I wasn't exactly thrilled with that, so he said, "I am going to fight for it!  I want you to have your DS.  And I know the first thing you are going to ask me when you wake up is 'Do I have a DS' and I really want to tell you 'Yes!'"  I told him I was confident with whatever he felt he needed to do and that I had researched this possibility and discovered that there are studies showing they think "dumping" may have more to do with the intestinal portion bypassed rather than the removal of the pyloric valve.  He seemed impressed that I was informed with my situation.

He answered every question I had very thoroughly and never treated me like he was in a hurry.  He sat back and listened.  At the end of my meeting with him, he was putting some papers together and stopped, looked at me and said, "Don't worry, Mandy, I am going to take really good care of you."  I believe that moment was the first time in this whole messy process that I actually felt very comfortable with my decision to have surgery.  I felt like I WAS doing the right thing instead of questioning myself.

So besides the fact I travelled 16 hours by myself in a car in a 36 hour period singing Christmas carols.... alone.... did I mention I was the only one in the car?  Oy!  Besides that, I am thrilled I went!  I can't say enough about the whole experience.

Thanks to everyone that recommended I go see him!

Well, I've been denied for the second and last time.  I have no more appeals.  However, my husband's company is self funded.  This means they actually pay their own medical bills.  Highmark just basically gives them a plan and does their paperwork.  So, our third step is to file a grievance with his union and try to convince his company to override the insurance's decision.  I'm not real confident that this is going to work.  But I am keeping my fingers crossed.  If this doesn't work, I may have something else up my sleeve.....

Here's a great list of all different kinds of foods and their protein values.  Thanks Anne!

 

FOOD---PORTION---PROTEIN

Almonds
dry roasted unblanched---1oz---5 grams
Planters---1oz---6 grams
Almond meal---1oz---11 grams

Beef
brisket braised---3oz---21 grams
chuck pot roast---3oz---23 grams
corned beef brisket---3oz---15 grams
corned beef canned---3oz---10 grams
eye round roasted---3oz---24 grams
filet broiled---3oz---21 grams
flank broiled---3oz---22 grams
ground broiled---3oz---22 grams
ground fried---3oz---21 grams
porterhouse steak---3oz---21 grams
roast beef med---2oz---12 grams
shortribs braised---3oz---18 grams

Bread
chapattis as prep w/fat---1 (2 1/2oz)---6 grams
cornstick---1 (1.3oz)---2 grams
Cracked wheat---1 slice---2 grams
Focaccia rosemary---3.5oz---6 grams
French---1oz---3 grams
Irish Soda---2oz---4 grams
Italian---1oz---3 grams
Oat bran---1 slice---3 grams
Paratha---4.4oz 1 piece---10 grams
Pita---1 reg 2oz---5 grams
pumpernickel---1 slice---3 grams
rye---1 slice---3 grams
seven grain---1 slice---3 grams
sourdough---1 slice---3 grams
Thomas English muffin---1---4grams
white---1 slice---2 grams
whole wheat---1 slice---3 grams

Cheese
American---1oz---4 grams
bel paese---3 1/2oz---25 grams
blue---1oz---6 grams
brick---1oz---7 grams
brie---1oz---8 grams
camembert---1 wedge---8 grams
cheddar---1oz---7 grams
cheddar low fat---1oz---9 grams
Colby---1oz---7 grams
Colby low fat---1oz---9 grams
Edam---1oz---4 grams
Feta---1oz---7 grams
Fontina---1oz---7 grams
Gjetost---1oz---3 grams
Goat soft---1oz---5 grams
Gouda---1oz---7 grams
Gruyere---1oz---8 grams
Limburger---1oz---8 grams
Monterey---1oz---7grams
Mozzarella---1oz---6 grams
Mozzarella part skim---1oz---7 grams
Muenster---1oz---7 grams
Parmesan---1 tbsp---2 grams
Provolone---1oz---7 grams
Ricotta---1/2 cup---14 grams
Romano---1oz---9 grams
Roquefort---1oz---6 grams
Stilton blue---1.4oz---9 grams
Swiss---1oz---8 grams
Whey cheese---3.5 oz---15 grams

Chicken
breast & wing fried---2 pieces---36 grams
broiler/fryer breast w/skin roasted---1/2 breast(3.4oz)---29 grams
broiler/fryer breast w/skin stewed---1/2 breast(3.9oz)---30 grams
broiler/fryer breast w/o skin----1/2 breast(3oz)---27 grams
broiler/fryer drumstick w/skins, floured, fried---1.7oz---13 grams
broiler/fryer drumstick w/skins roasted---1.8oz---14 grams
broiler/fryer drumstick w/skins stewed---2oz---14 grams
broiler/fryer drumstick w/o skin fried---12 grams
broiler/fryer drumstick w/o skin stewed---1.6oz---13 grams
broiler/fryer skin roasted---from ½ chicken(2oz)---11 grams
broiler/fryer thigh w/skin, battered, fried---3oz---19 grams
broiler/fryer thigh w/skin, floured, fried---2.2oz---17 grams
broiler/fryer thigh w/skin stewed---2.4oz---17 grams
broiler/fryer thigh w/o skin fried---1.8oz---15 grams
broiler/fryer thigh w/o skin roasted---1.8oz---13 grams
broiler/fryer thigh w/o skin stewed---1.9oz---14 grams
broiler/fryer w/skin floured, fried---1/2 chicken (11oz)---90 grams
broiler/fryer w/skin roasted---1/2 chicken (10.5oz)---82 grams
broiler/fryer w/skin stewed---1/2 chicken (11.7oz)---82 grams
broiler/fryer wing w/skin battered, dipped, fried---1.7oz---10 grams
broiler/fryer wing w/skin floured, fried---1.1oz---8 grams
broiler/fryer wing w/skin roasted---1.2oz---9 grams
broiler/fryer wing w/skin stewed---1.4oz---9 grams
canned w/broth---I can (5oz)---31 grams
Cornish hen w/o skin roasted---1/2 hen (2oz)---13 grams
Cornish hen w/o skin roasted---1 hen (3.8oz)---25 grams
Cornish hen w/skin roasted---1/2 hen(4oz)---25 grams
Cornish hen w/skin roasted---1 hen(8oz)---51 grams
Drumstick breaded & fried---2 pieces (5.2)---30 grams
Oven roasted breast of chicken---2oz---11 grams
Thigh breaded & fried---2 pieces(5.2oz)---30 grams

Cottage Cheese
creamed---1 cup---26 grams
dry curd---1 cup---25 grams
lowfat 1%---1 cup---28 grams
lowfat 2%---1 cup---31 grams

Deli Meats/ Cold Cuts
bologna beef---1oz---4 grams
bologna pork---1oz---4 grams
braunschweiger pork---1oz---4 grams
headcheese pork---1oz---5 grams
liverwurst---1oz---4 grams
mortadella---1oz---5grams
pepperoni---1 slice---1 gram
salami---1 slice---4 grams
corned beef---1oz---5 grams
pastrami---1oz---5 grams
genoa---1oz---6 grams

Egg
cooked any style---1---6 grams

Ham* highest protein content per brand
Alpine lace cooked---2oz---9 grams
Armour deviled canned---3oz---14 grams
Carl budding honey ham---1oz---5 grams
hansel ‘n Gretel Virginia---1oz---5 grams
Healthy choice deli cooked---6 slices(2oz)---10 grams
Hormel curemaster---3oz---14 grams
Kraus---1oz---5 grams
Louis rich dinner slices---3.3oz(1 slice)---16 grams
Oscar Myer deli smoked---4 slices---9 grams
Lower sodium---3 slices---10 grams
Russer Canadian maple---2oz---9 grams
Underwood deviled---2.08oz---8 grams
Underwood deviled light---2.08oz---11 grams

Hot Dog
beef---1 (2oz)---7 grams
beef & pork---1 (2oz)---6 grams
chicken---1 (1.5oz)---6 grams
corndog---1---7 grams
turkey---1 (1.5oz)---6 grams
w/ bun, chili---1---14 grams
w/ bun plain---1---10 grams

Milk
1%---1 cup---8 grams
2%---1 cup---8 grams
buttermilk---1 cup---8 grams
goat---1 cup---9 grams
skim/whole---1 cup---8 grams

Pork
center loin roasted---3oz---24 grams
loin w/fat broiled---3oz---20 grams
pork roast---2oz---10 grams
spareribs---3oz---26 grams
tenderloin roasted---3oz---24 grams

Salmon
baked---3oz---22 grams
pink w/bone canned---3oz---17 grams
salmon cake---3oz---18 grams
smoked---1oz---5 grams

Sausage
bratwurst pork---1 link---12 grams
Italian---2.4oz---13 grams
Kielbasa---2.4oz---8 grams knockwurst pork & beef---1oz---3 grams
Smoked pork---1 link---15 grams
Zungenwurst (tongue)---3.5oz---17 grams
Turkey---2.5oz---11 grams

Shrimp
fried---4 large---6 grams
canned---3oz---20 grams
jambalaya---3oz---11 grams

Tuna
canned light oil---3oz---25 grams
canned light water---3oz---22 grams
canned white oil/water---3oz---23 grams
fresh cooked---3oz---25 grams

Turkey
breast---1 slice---5 grams
breaste w/skin roasted---4oz---32 grams
canned w/broth---1/2 can---17 grams
ground cooked---3oz---20 grams
leg w/ skin roasted---2.5 oz---20 grams

Yogurt
fruit low fat---8oz---9 grams
plain---8oz---8 grams
plain low fat---8oz---12 grams
plain no fat---8oz---13 grams
vanilla lowfat---8oz---11 grams

My first level appeal was denied.  Big surprise.  Sean sent me some ammo for my next go-round.  WOW!!  Very nice of him to gather all of this up.  So I thought I'd share.  Hope this can help someone!

 

some stuff for you to print out and submit with your next appeal....

major insurance companies who realize that the DS is valid:
medicare - http://www.cms.hhs.gov/pf/printpage.asp?ref=http://www.cms.h hs.gov/MCD/viewncd.asp?ncd_id=100.1&ncd_version=2&basket=ncd %3A100%2E1%3A2%3ABariatric+Surgery+for+Treatment+of+Morbid+O besity

Aetna:  http://www.aetna.com/cpb/medical/data/100_199/0157.html

Empire BCBS: http://www.empireblue.com/provider/noapplication/f2/s5/t9/pw_ad080419.pdf

BCBS Georgia: http://www.bcbsga.com/medicalpolicies/policies/mp_pw_a053317.htm

Humana: http://apps.humana.com/tad/tad_new/returnContent.asp?mime=ap plication/pdf&id=5306&issue=132

BC of California:  http://medpolicy.bluecrossca.com/policies/SURG/severe_obesit y.html

BCBS of Missouri: http://www2.bcbsmo.com/provider/medpolicy/policies/SURG/seve re_obesity.html

(I've included so many BCBS since Highmark is a BCBS licensee, they can't ignore that BCBS as a whole sees the DS as valid)

various articles: (some complete articles, some abstracts)
http://www.paclap.com/news&resources/ourpublications/downloads/NutritionalMarkersJan2004.pdf
http://www.paclap.com/news&resources/ourpublications/downloa ds/ObesSurgJune2004.pdf
http://www.paclap.com/news&resources/ourpublications/downloa ds/Obesity_Surgery_April_2003.pdf
http://docserver.ingentaconnect.com/deliver/connect/klu/0960 8923/v14n9/s9.pdf?expires=1191983492&id=39893663&titleid=300 00172&accname=Guest+User&checksum=B2314F4D6586E101EED1FB395B 551E08
http://www.ingentaconnect.com/search/article?title=duodenal+ switch&title_type=tka&year_from=1998&year_to=2007&database=1 &pageSize=20&index=1
http://www.ingentaconnect.com/search/article?title=duodenal+ switch&title_type=tka&year_from=1998&year_to=2007&database=1 &pageSize=20&index=8
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1360120&blobtype=pdf
http://www.nyp.org/news/hospital/884.html
http://jama.ama-assn.org/cgi/reprint/292/14/1724.pdf
http://www.duodenalswitch.com/98marceau.pdf
http://www.duodenalswitch.com/procedure/1998hess/1998hess.ht ml
http://www.duodenalswitch.com/baltasar.pdf

CNN CALLS IT “ THE MOST COMPREHENSIVE STUDY RELEASED PROVING THAT WEIGHT LOSS SURGERY AND OTHER RADICAL [their words sorry] SURGERIES WORK TO SAVE LIVES AND KEEP WEIGHT OFF

 

TIME MAGAZINE

Wednesday, Aug. 22, 2007

Gastric Bypass Lowers Risk of Death

By Sora Song

Whether one regards bariatric surgery — last-resort weight-loss operations such as gastric bypass and stomach stapling — as an essential treatment for obesity or as a failure of the fat person's will, the fact is, it works. Studies have shown that after surgery, patients often lose 50% or more of their excess weight — and keep it off — and symptoms of obesity-related conditions like diabetes, high blood pressure, high cholesterol and sleep apnea are improved or eliminated altogether. Now, two new studies in the New England Journal of Medicine (NEJM) show another long-term benefit: a lower risk of death.

The larger of the two studies — the largest of its kind — led by researchers at the University of Utah School of Medicine, looked specifically at gastric bypass surgery, also known as Roux-en-Y gastric bypass, which accounts for 80% of all bariatric surgeries in the U.S. The operation involves creating a small walnut-size pouch at the top of the stomach, which is then stapled off and connected to the small intestine lower down than usual; the result is that patients can eat only an ounce of food at a time, and the food bypasses most of the stomach and the top part of the intestine, limiting the number of calories the body absorbs.

In the Utah study, researchers compiled data on 15,850 severely obese people, half of whom had undergone gastric bypass surgery between 1984 and 2002, and half who were from the general population and had had no surgical intervention for obesity. Overall, researchers found, the surgery patients were 40% less likely to die from any cause during a mean 7 years of follow-up, compared with the obese controls. What's more, the mortality rate attributable to obesity-related disease was 52% lower on the whole in the surgery group: after gastric bypass, patients were 92% less likely to die from diabetes, 59% less likely to die from coronary artery disease, and 60% less likely to be killed by cancer.

Results like these have got some doctors intrigued enough to start thinking about bariatric surgery as a treatment for conditions other than obesity —especially diabetes. A growing body of research suggests that the surgery may reverse the disease, a potential solution that could help some 20 million American diabetics. Though the current NEJM study did not specifically study the impact of bariatric surgery on diabetes, it did reveal a 92% reduced risk of death from the disease in surgery patients —findings that support what has been emerging in other experiments. "In more than 80% of patients who are severely obese and have diabetes and then have gastric bypass surgery, the diabetes is cured," says Ted Adams, professor of cardiovascular genetics at the University of Utah School of Medicine and lead author of the new study. "The interesting thing is that the resolution of diabetes happens within a few weeks following surgery, long before patients have lost their weight." Like some other researchers in the field, Adams believes that the surgery triggers other biological mechanisms, separate from weight loss — perhaps an interruption of a crucial biochemical pathway or a change in the release of certain hormones in the stomach or small intestine — that may have powerful effects on diabetes.

"The gastric-bypass patient is really providing a source of intriguing research related to all kinds of disease treatment as well as weight gain and weight loss," says Adams.

The second study, led by researchers at Gothenburg University in Sweden, involved 4,047 obese volunteers, 2,010 who underwent some form of bariatric surgery and 2,037 who received conventional obesity treatment, including lifestyle intervention, behavior modification or no treatment at all. Ten years after surgery, researchers report, the bariatric surgery patients had lost more weight and had a 24% lower risk of death than the comparison group. Though the overall number of subjects in this study is much smaller than the first, the results confirm general benefits of bariatric surgery, and gastric bypass in particular: after 10 years, bypass patients had maintained a 25% weight loss, compared to a 16% loss in patients who had stomach stapling, and 14% in those who underwent a banding procedure.

In both studies, surgery patients had an overall lowered risk of death, but an interesting finding in the Utah study shows that these patients were 58% more likely to die from other causes, such as suicide and accidents. The authors speculate that as people lose weight and become more active, they also become more prone to accidents, which may up their risk of death. Surgery patients may also have pre-existing psychological problems — a history of abuse, perhaps — that can't be resolved by losing weight. "There have been some studies reporting that following bariatric surgery, some individuals may be more prone to chemical dependency, such as increased alcohol use," says Adams. "There's some speculation that certain addictive behaviors that are in place before the surgery — with food, for example — are transferred to alcohol or another addictive behavior."

"Hopefully this research will stimulate additional evaluation of what the optimal approach is for evaluating candidates for this surgery," says Adams. "I think we should never lose track of the importance of individual evaluation of benefits and risks."

Last year, an estimated 177,600 patients underwent bariatric surgery, a figure that's likely to grow as Americans get fatter and fatter. Though modern surgery techniques have become more sophisticated, less invasive and safer than in the past, the bariatric procedure still carries all the risks of any other operation. Patients have a .5% to 1% chance of death. The risk of gallstones goes up. Sometimes a second surgery is necessary. And all patients must be careful to make up for vitamin and mineral deficiencies. The surgery isn't for everyone; current guidelines recommend it as a last resort, only for the morbidly obese who have a BMI of 40 and higher, or for the obese with a BMI of 35 and higher plus a serious weight-related illness like diabetes or hypertension.

~Questions to ask a doctor when considering them to be your Surgeon~

1. How much common channel will I have?
2. How many supplements should I take? If they say none, ask if you CAN take them.
3. What vitamins supplements should I take post-op?
4. How big will my stomach be?
5. Can/should I drink milk after surgery? Sugar? Fats?
6. How often do I need labs?
7. How long am I off solid foods?
8. Of my excess weight, what percentage will I lose? What percentage will I keep off?
9. How "strict" of a diet will I be on?
10. If I am still nauseated or vomiting after surgery, what will yo do for me?
11. What is your mortality rate?
12. How many DS surgeries have you performed?
13. How many DS patients lost?
14. How many leaks?
15. What do you think my goal weight should be?
16. What is the pre-op diet?
17. What are the preparations for the surgery?
18. What is the post-op diet?
19. Can labs be ordered by my PCP and faxed to your office for analysis?
20. What do I do about my medications pre-op? Post-op?
21. How will the incision be closed? Stitches, Steri-Strips, Glue or Staples?
22. How long is the Open incision?
23. Will my surgery be open or laproscopic?
24. How long should the surgery take, barring complications?
25. Will I go home with a feeding tube?
26. Do I bring my CPAP machine with me?
27. Will I be in I.C.U., due to my sleep apnea?
28. Will I have the leg compression devices that help prevent blood clots?
29. Will I get a binder in the hospital?  Or Do I need to provide my own?
30. How soon will I be able to drive?
31. Will I have an epidural?
32. Will I be tested for H. Pylori bacteria? And, is there anything I can do to prevent it?
33. Have you ever started a DS and couldn't complete it?
34. Will I have a drainage tube? For how long? Will I go home with it?
35. What type of pain medication will I be given for home use?
36. Are there gowns in the hospital for someone of my size?
37. After surgery, when can I resume my normal activities?
38. Do I have a limit on how much I can carry or lift? For how long?
39. How soon can I begin an exercise regimen, besides walking?
40. Do you have a list of medications that I can/cannot take?
41. What about future pregnancies? Will they be considered high risk? Will I need a                specialized OB/GYN?
42. Should I get a medic alert bracelet?
43. When will the staples/stitches be removed?  Will I have either?
44. Will I get injections of Heparin, to prevent blood clots?
45. What supplements can I take to help prevent/lessen/diminish hair loss?
46. How many of your patients have lost their spleens?
47. What are my odds of getting a hernia?
48. Can I actually cause a hernia?
49. Will I have a Foley? If so, how long will it stay in?
50. After surgery, how do you detect for leaks?
51. What are my odds of getting a UTI, bladder infection or yeast infection?
52. Can I meet the anesthesiologist beforehand?
53. How soon will I be able to shower after surgery?
54. When is the soonest I can get scheduled for surgery?
55. What are my odds of adhesions?
56. What is the youngest person you would perform this surgery on?
57. How long do I stay in Recovery?
58. Can someone stay with me IN the hospital?
59. How long before I will be at 100% healed, barring complications?
60. How long will I be in the hospital?
61. How often are follow-up visits, post-op?
62. What year did you begin performing WLS?
63. Are you a general surgeon, or do you specialize in Bariatrics only?
64. Are my gallbladder and or appendix removed during surgery?

 

I posted to a question yesterday regarding getting insurnace to cover the DS on an appeal and got several people asking me where I got all my info.  I promised to post anything I had on anything to do with insurance, BPD, DS, revisions, anything useful I ever found.  In case I have to appeal (which I probably will), I will be armed with facts.  Here are some articles and some links to articles.  Grab a drink and sit down cuz you will be reading for awhile!!!  Good luck.  Oh and please remember, some of this stuff is pertaining to DS, BPD, and some to RNY.  Just change the surgery to the one you want (I'm guessing DS), change the comorbidities to the ones you have, etc.  I actually have more, but at times I just print what I want and don't save it.  Sorry!!

 

http://www.duodenalswitch.com/procedure/1998bpd/1998bpd.html

 

http://wp.dmhc.ca.gov/imr/detail.asp?id=4024&optFormat=html&cboDetermination=0&cmdSearch=Search&cboMC=Morbid+Obesity&cboTreatment2=0&cboDiagnosis2=0&cboDT=0&cboType=0&txtDetails=switch

 

http://www.growley.com/mywls/appeal/research-appeal.html

 

http://216.109.125.130/search/cache?ei=UTF-8&p=biliopancreatic+diversion+Scopinaro&fr=slv8-&u=www.medscape.com/viewarticle/483290&w=biliopancreatic+diversion+diversions+scopinaro&d=TS7oXurnO_mx&icp=1&.intl=us

 

http://216.109.125.130/search/cache?ei=UTF-8&p=biliopancreatic+diversion+Scopinaro&fr=slv8-&u=clos.net/lib/bpd/biliopancreatic_diversion.htm&w=biliopancreatic+diversion+diversions+scopinaro&d=MVC_WOrnO7f_&icp=1&.intl=us

 

THIS IS THE MOST INFORMATIVE THING I HAVE EVER READ ABOUT THE DS!!

PLEASE READ THIS BEFORE MAKING YOUR DECISION ON WHICH SURGERY TO GET!

It is a sad truth that there is a lot of misinformation being circulated about the duodenal switch (DS) procedure. Even more sadly, much of it comes from RNY surgeons and their patients, who have various degrees of vested interest in promoting their surgery (or in certain cases, dissing WLS altogether). I would hope that each and every potential WLS patient who is researching what to do about treating his or her morbid obesity has access to the FACTS before making the decision about which surgery to have.

For a number of years, insurance approval has been the vehicle by which access to the DS procedure has been limited -- most of the largest insurers, including Blue Cross, Blue Shield, Aetna and Cigna, have cited misleading information and each others' policies to claim that the DS is "experimenal," "investigational" or "unsafe and inadequately studied." However, the papers cited by these insurance companies to support this allegation are often not even related to the correct procedure.

When the DS was introduced, it was an improvement over the Biliopancreatic Diversion procedure, or BPD -- unfortunately, this led to the procedure being called the BPD/DS, which is a misnomer. While the intestinal part of the BPD is essentially the same as the DS, the stomach part is VERY different. The problems with the BPD are much more like a distal RNY than the currently practiced DS, as the BPD involves removing much of the lower part of the stomach, including the parts that absorb vitamin B12 and iron, and the pyloric valve, and BPD issues include potentially serious malnutrition issues. What insurance companies often do is to cite papers discussing the very real problems with the BPD (which is rarely performed anymore) against the DS, which is quite inappropriate. In addition, they completely ignore the growing body of scientific evidence that is approaching 20 years of study on the DS and the wonderful results that have been established.

Over the past several years, and due in no small part to the steady pressure exerted by patients demanding the DS procedure, there have been numerous inroads made into educating both the insurance companies and the external reviewers who end up ruling on the appeals of die-hard DS wannabees. The tide appears to finally be turning, as one after another insurance company is beginning to acknowledge the beneficial effects and safety of the DS. Blue Cross of California has recently changed their official policy to permit the DS, and it seems from recent legal challenges that Blue Shield will not be far behind. The national Blue Cross/Blue Shield Technology Evaluation Center assessment of the DS is currently being reviewed as well, and there is a good possibility that they will reclassify the status of the DS. The most recent CPT Code book for 2005 has given the DS a new, Category I, code number, indicating that it is now a generally recognized procedure and not still being evaluated for safety and efficacy.

In addition to the many published articles that have come out recently praising the DS procedure (available on request), there is now an almost astonishing new source of analysis and validation of the procedure -- the external reviewers of the Center for Health Dispute Resolution of Maximus. This organization has been contracted to perform external reviews for 25 states, Federal government employees and Medicare/Medicaid appeals. They now appear to be taking the position that essentially ANY patient (including those with a BMI under 50) should qualify for the DS, and that insurers are improperly refusing to acknowledge this. One of the most available sources of information about this sea change is the published decisions of the California Department of Managed Health Care, which is the agency to whom California HMO participants appeal denials of coverage.

Needless to say, organizations such as CHDR are inclined to be very conservative, since they are hired by politically influenced state agencies -- as you can imagine, it is likely that the insurance companies will have SOME input to how such state reviews are conducted. In addition, these organizations are also performing PRIVATE external medical reviews for insurance companies which are able to chose who will perform the external reviews of their own decisions. So it is in my opinion a significant fact that CHDR is now supporting the DS and overturning almost every denial that comes their way, at least in California (which is the only source of published opinions I have found -- I will be happy to provide the link to it on request, because putting it here will make this posting difficult to read, since it will stretch out the entire posting and all posts in response sideways to accommodate the entire link).
(*Leslie's Edit: This is the link: http://tinyurl.com/9ufl3 )

Here are some quoted comments on the DS in these published decisions by CHDR, which has NO vested interest whatsoever in seeing this procedure being more commonly performed, other than their own intellectual honesty:

* Techniques in duodenal switch have been available since the 1980s. There is now sufficient data to show that duodenal switch has a superior long-term outcome when compared to gastric bypass.
* In the Roux-en-Y procedure dumping syndrome, stomal ulcers, and vitamin deficiency are commonly seen.
* Long-term studies of the duodenal switch procedure demonstrate equal effectiveness with less need for a highly restrictive diet than with gastric bypass.
* There is a significant risk of marginal ulceration with the standard gastric bypass that does not appear to be present in the duodenal switch procedure.
* The data strongly supports the high failure rate of Roux-en-y gastric bypass in patients who are super morbidly obese.
* Review of the medical literature indicates revisional weight loss surgeries have a high complication rate. A patient who has failed a restrictive operation (Lap-Band) is more likely to fail another restrictive operation longer-term unless a malabsorptive element is added. The study cited above reported high incidence of protein and nutritional deficiency after revision of gastric bypass to distal gastric bypass. Furthermore, a patient with a BMI of 48 may have a high failure rate after a restrictive procedure. A more suitable option may be a hybrid procedure such as duodenal switch.
* The duodenal switch procedure has a track record greater than 15 years. The anticipated complications associated with other malabsorptive procedures (i.e., distal gastric bypass, jejunoileal bypass) has not been encountered with the duodenal switch.
* At the 2003 American Society of Bariatric Surgeons meeting held in Boston, Massachusetts, scientific papers were presented, which indicated there is growing evidence that protein malnutrition is a much larger problem post gastric bypass than was initially suspected.
* Techniques in duodenal switch have been available since the 1980s. With duodenal switch, patients lose weight in the range of 69% to 80%.
* Complications have been reported to be comparable to other operations. Multiple vitamin deficiencies, mineral deficiencies, bacterial overgrowth issues seem all to be comparable and less than other alternative surgeries. Hundreds of duodenal switch operations have been performed on patients in California and they appear to have a good track record of positive results.

In addition to this clarifying information about the safety and efficacy, I also want to make people understand that the "socially unacceptable" side effects of the DS surgery are often exaggerated in the extreme by those who don't have actual information from real patients to be making such statements. Again, sometimes this is confabulation of the problems associated with the BPD to apply to the DS, which is inappropriate. Sometimes, it is purely to steer patients from a surgery the surgeon doesn't perform (the DS) to one they do (the RNY or LapBand). Here is my experience, which I have substantially in common with most DSers:

* I have a bowel movement every morning as soon as I wake up. Sometimes, I have another one after breakfast, IF I am still at home. Sometimes, I have another one shortly before bedtime. I NEVER have to go poop outside my house (except when I'm traveling, of course, and then only at the hotel). I do not have diarrhea, uncontrollable need to poop, or anything like that. In fact, my post-op issues with IBS have significantly improved, and my bathroom habits are BETTER than they were pre-op. It smells somewhat worse then it did pre-op, but not that much worse, and a quick spray of Ozium takes care of any lingering smell.
* I fart, and it stinks, IF AND ONLY IF I have eaten some of the foods that disagree with me, such as white bread, most pasta, onions, beans and broccoli. This will happen 4-6 hours after eating such foods, so I can still eat them if I know I will not be around people (other than my family) when it kicks in. I can also take Gas-X and smell-reducing agents such as Beano, Devrom or Innermint with the meal to ameliorate the gas. It is entirely dealable with, and not really worse than it was pre-op with my IBS issues. The gas WAS more of a problem in the first 2-3 months after surgery, but it has gotten a LOT better since then, both because I have learned how to manage my diet and because my body has accommodated. Plus, I take a probiotic every day to help maintain my internal flora.
* I take the following vitamins at 15 months out, and my one year labs were perfect: One prenatal vitamin, and 4 calcium citrate pills. That's it. No malnutrition or protein or vitamin deficiencies. I don't even need to supplement the fat soluble vitamins A, D, E or K.
* I don't diet anymore. I eat what I want, starting with protein. I can eat about 2/3 of what I used to eat and I feel full -- comfortably -- when I'm done.
* I don't barf, ever, even if I overeat (which I'm less inclined to do, though sometimes I eat reflexively while watching TV). At worst, I get a little uncomfortable, and I immediately stop. No nausea, ever, either.

There's more, but you get the picture? The so-called "socially unacceptable problems" that you probably have heard about the DS are for the most part, scare tactics, a myth and I daresay a LIE.

Other facts that should be understood (from a preprint of an ongoing study by Hess et al.):

* The DS is a CURE for type II diabetes. In Europe, the intestinal part of the DS is being performed on people who are not obese to cure type II diabetes. There is data going out over 10 years now demonstrating the cure rate is 98%.
* The average excess weight loss at ten years is 76%.
* 94% of 10 year out patients are in the satisfactory category (50% or more excess weight loss).
* There are no foreign materials used.
* The pylorus is retained and controls the stomach emptying.
* There is no small stoma that could dilate causing failure, allowing the patient to eat normal meals.
* There is no dumping syndrome.
* If the patient takes vitamins and minerals as instructed, as well as eats sufficient protein as instructed, which is easily accomplished eating normal food and without “protein shakes” or other supplementation, they will have little or no malnutrition issues.
* The average lab results on a ten year cohort are all within the normal range.
* Long-term studies have shown little or no serious or irremediable nutritional squellae, contrary to frequently expressed – but unsubstantiated – concerns.
* It is certainly no longer considered an experimental or investigational procedure, either by the American Society for Bariatric Surgery (ASBS) or by the surgeons who perform it.

It is still true that there are not that many surgeons offering the DS as compared with the RNY. It is a more difficult procedure to learn and to perform properly, as the tissue of the duodenum is harder to stitch. You ONLY want an experienced surgeon performing this procedure on you (but that's true for ANY surgery). Many insurance companies are still balking at covering it, but if pressed, they often will cave in, and more of them are now accepting it. But you must ask yourself, which surgery can I live with for the rest of my life -- which will give me the BEST quality of life, as well as ability to maintain my hard-earned weight loss without constant dieting? For me, there was only one answer, and that was the DS. (Written by and posted with permission by Diana Cox)

Good luck to everyone in making the best and most informed choice you can.

http://www.growley.com/mywls/research/scopinaro.html

 

I went through to look for the appeal letter and I couldn't find it either.  I know I saw it before so I looked through the previous posts and someone had attached one so here it is.  I am also in the process of appealing so I really hope this helps both of us!  You can change in the areas that are relevant in your case.  Good luck!

Dear Sir or Madam,

This letter is to appeal your denial for RNY gastric bypass surgery referral that I received on _____________ (Diagnosis Code 278.01 Procedure Code 43847).

I was referred for this surgery by my PCP, who is very concerned about my health because of my severe morbid obesity. I am a __ year old, morbidly obese female who is __feet, __inches tall and weigh, at this time, ___ lbs., giving me a body mass index of _____The body mass index is calculated by dividing a person's weight in kilograms by their height in meters squared. When a man's BMI is over 27.8, or woman's exceeds 27.3, that person is considered obese. The degree of obesity associated with a particular BMI ranges from mild obesity at a BMI near 27, moderate obesity at a BMI between 27–30, severe obesity at 30–35, to very severe obesity for patients with a BMI of 40 or greater^1,2,3. Therefore, I may be classified as being very severely obese. The annual number of deaths in attributable to obesity has been estimated to be 300,000 deaths per year^4,5. With my abnormally high BMI, I am at an estimated 190 percent increased risk of death at my present weight.

I am having significant adverse symptoms from my obesity. I have difficulty standing or walking for any length of time. I have difficulty performing my daily activities, and in participating with my family in recreational activities. I have severe pain of my weight-bearing back, joints and feet. I now have bone spurs on both my feet that are aggravated by my weight as well as Plantar Fasciitis. An increase in body weight adds trauma to weight bearing joints and excess body weight is a major predictor of osteoarthritis of the knees. This is a mechanical problem and not a metabolic one. Weight loss will markedly decrease the chance of developing osteoarthritis.

I also suffer from shortness of breath and I have exercise induced asthma. Being as obese as I am, almost everything I do is considered exercise by my body. I cannot go anywhere without my inhaler close by. Breathing normal is a thing of the past. Constantly out of breath is a way of life. A sad way of life. There are several abnormalities in pulmonary function in obese individuals. At one extreme are patients with so-called Pickwickian syndrome, or the obesity-hypoventilation syndrome, which is characterized by somnolence and hypoventilation; it eventually leads to cor pulmonale. In patients who are less obese, there is a fairly uniform decrease in expiratory reserve volume and a tendency to reduction in all lung volumes. A low maximum rate of voluntary ventilation and venous admixture is also present. As an individual becomes more obese, the muscular work required for ventilation increases. In addition, respiratory muscles may not function normally in obese individuals.

Because of my extensive GERD, (Gastroesophageal Reflux Disease), pains and aches in my back, shoulders (extra large breasts) and legs I have difficulty sleeping, and therefore, am fatigued and tired during the day. This surgery usually cures acid reflux and sleep disturbances.

I have borderline Diabetes at this point. Diabetes is a common concomitant of obesity.

I have made many, many attempts to lose weight. This has gone my entire life. As a chubby child, I was bribed to lose “just 10 pounds” and I’ll buy this or that for you, by my father and grandparents. These scenarios always ended in disappointment for us all because I did not totally succeed. As you can imagine, it caused substantial pain and severe depression in me. I have done Jenny Craig , Weight Watchers, Carnation, Herbalife, grapefruit, Atkins, Jane Fonda , Richard Simmons , and many more. With each and every one of these attempts I gave 100%, only to fail again and again. I was put on medications by my doctor to help lose weight. I have been put on medications over and over again. I would lose some weight then gain it all back, and more. I have also tried many exercise programs. From personal trainers to large and well named gyms. My biggest and longest success was from the HMR system and was medically supervised during the 2.5 years of the program. I was 120# successful. It was exhilarating. I did the classes, did the exercise and ate well. I loved me and my life. Then the slow creep started happening. I even tried non conventional ways out of desperation and still no long term success. As you can see, I have spent most of my childhood and all of my adult life trying to lose weight. I am now at the very edge of disability and am at a point where everything is an effort. The obese individual has functional impairment in the activities of daily living. This dysfunction impacts sleep, recreation, work and social interactions.

I have studied, researched and learned about the weight loss surgeries for the last 3 years. I do not take this decision lightly. I know the risks involved with the surgery as well as the risk if I do not have it. I have made this decision to go forth with the surgery on my own with education to back me up. I have my PCP behind me as well as my Psychologist. They believe this to be extremely beneficial for me physically and emotionally. They both have written letters of recommendation for me to have this procedure.

Economic costs of Obesity:
Obesity has been shown to directly increase health care costs. In an article in the March 9, 1998 issue of the Archives of Internal Medicine 17, 118 members of the Kaiser Permenente Medical Care Program were studied to determine the association between body fatness and health care costs. The results showed that patients with BMIs greater than 30 had a 2.4 times greater risk for increased inpatient and outpatient costs than patients with BMIs under 30.

Indirect costs:
Americans spend an additional $33 billion dollars annually on weight-reduction products and services, including diet foods, products, and programs. Most of these expenditures, as is evidenced in this case, are not effective. Rather it can expected that they will continue to gain weight and the costs of co-morbid conditions, including the ones they already have and ones they surely will acquire as time goes on, will far outweigh the costs of gastric bypass surgery that we are asking you to please approve for me.

I am a 40 year old woman, with a loving and supportive husband. I have two active step-children and two wonderful and beautiful teenage children that I care about and want to be more involved in their lives and hobbies. At this point I am reduced to being the “fat show mom” at the horse shows and rides. The one that pumps everyone up with positive things, meanwhile on a number of medications for sever depression because of the shame, and embarrassment I have in myself and for my family because of my obesity. Just doing my regular chores around the hobby farm is beyond exhausting anymore and even more painful.

As you can see I have exhausted all the traditional ways to lose weight. The gastric bypass is an approved and proven means to permanently lose weight. I 100%, thouroughly, physically and emotionally am ready for this in my life. I know all the risks involved. I have started to attend support meetings to help me be a better patient and success. I continue to have my counseling appointments. I feel that mental health is just as important, if not more, because most of what obese people have problems with are on the mental side of dealing with food, weight, exercise and all the other facets to this huge problem. Please, I am just short of begging you for my life, Please approve this surgery for me. Thank you.

Ever sincerely,

 

Enter your insurance name here

Enter your insurance address here

Enter your insurance phone number here

Re: (enter your name here)
Social Security No: (enter your ss# here)
Identification No: (enter your insurance id# here)

 

Request for Pre-approval for Gastric Bypass
(CPT-4 Code = 43847)

Note: I meet both Milliman and Robertson and U.S. Federal Guidelines.

I meet both Milliman and Robertson and U.S. Federal Guidelines.

1. Milliman and Robertson Guidelines for the Gastric Surgery for Clinically Severe Obesity 15 CPT-4: 43847

AND,

2. U.S. Federal Clinical Practice Guidelines for the Treatment of Obesity set down in National Institutes of Health Consensus Conference. Released June 17, 1998, the Federal guidelines on obesity were by the National Heart, Lung, and Blood Institute (NHLBI), in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)).

 

 

January 11, 2003 (Enter the correct date here)

 

 

Dear Sir/Madam;

I am writing to request your pre-approval for gastric bypass surgery (Diagnosis Code 278.01 Procedure Code 43847).

I am 5 ft 1 ¾ inches tall and I weigh 280 pounds. My body mass index is 51.6. The body mass index is calculated by dividing a person's weight in kilograms by their height in meters squared. When a man's BMI is over 27.8, or woman's exceeds 27.3, that person is considered obese. The degree of obesity associated with a particular BMI ranges from mild obesity at a BMI near 27, moderate obesity at a BMI between 27 - 30, severe obesity at 30 - 35, to very severe obesity for patients with a BMI of 40 or greater 1,2,3. Therefore, I am classified as being very severely obese. The annual number of deaths in America attributable to obesity has been estimated to be 300,000 deaths per year4,5. With my abnormally high BMI, I am at an estimated _____ percent increased risk of death at my present weight.

I ask for your pre-approval for this surgery. I will detail the issues of medical necessity.

I am having significant adverse symptoms from my obesity. I have difficulty standing, and in doing any kind of exercise, even walking more than a short distance. I have difficulty performing any daily activities, and in participating with my family in recreational activities.

*I suffer from stress incontinence and have to wear protective pads at all times. A large heavy abdomen, and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing. This condition is strongly associated with being overweight, and is usually relieved by weight loss.

**I have sleep apnea. Sleep apnea -- the stoppage of breathing during sleep -- is common in the clinically severe obese. The health effects of this condition may be severe. It has been estimated that up to 50 percent of sleep apnea patients have high blood pressure. Risk for heart attack and stroke also increase in those with sleep apnea. People with sleep apnea often feel very sleepy during the day and their concentration and daytime performance suffers. The consequences include depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep while at work, on the phone, or driving. This condition has a high mortality rate, and is a life-threatening problem. People are usually cured of sleep apnea by this surgery and the permanent weight loss it brings.

**I have sleep disturbances and one doctor suggests a sleep study for sleep apnea. The weight loss would help with sleep disturbances and cure sleep apnea.

*I am diabetic. In addition to being a morbid and lethal disease, diabetes has been shown to be very expensive to treat. Rubin et. al. in a study in 1992 showed that yearly health care expenditures for confirmed diabetics ($11,157) were more than four times greater than for nondiabetics. In 1992, diabetics constituted 4.5% of the U.S. population but accounted for 14.6% of total U.S. health care expenditures ($105 billion). Confirmed diabetics constituted 3.1% of the U.S. population but accounted for 11.9% of total U.S. health care expenditures ($85 billion). Health care expenditures for people with diabetes constituted about one in seven health care dollars spent in 1992. (Diabetes in America, 2nd Edition, The National Institutes of Diabetes and Digestive and Kidney Diseases, 1995, NIH publication number 95-1468.) Health care insurers should take note of these findings. Gastric Bypass has been shown to cure diabetes and thus it is cost effective for insurers to pay for surgery to cure diabetes and prevent its complications. Nearly 80 percent of patients with NIDDM are obese.

*I also suffer from high blood pressure. Essential hypertension, the progressive elevation of blood pressure, is much more common in obese persons, and leads to development of heart disease, and damage to the blood vessels throughout the body, causing susceptibility to strokes, kidney damage, and hardening of the arteries. If hypertension is not under control, many complications can occur as a direct result of continued high blood pressure. 60% of hypertensive people are obese. The weight loss attained by gastric bypass surgery will cure hypertension.

*I have gastroesophageal reflux disease (GERD). This condition is dangerous, because of the possibility of pneumonia or lung injury. The esophagus may become scarred and constricted, causing trouble with swallowing. Approximately 10 - 15% of patients with even mild sporadic symptoms of heartburn will develop a condition called Barrett's esophagus, which is a pre-malignant change in the lining membrane of the esophagus, a cause of esophageal cancer. Pathologic conditions associated with GERD include erythema, isolated erosion, confluent erosions, circumferential erosions, deep ulcers, esophageal stricture, replacement of normal esophageal epithelium with abnormal (Barrett's) epithelium, pulmonary aspiration, chronic cough, and reflux laryngitis.

*Also, I have high cholesterol. When there is too much cholesterol in your blood, the excess can become trapped in the walls of your arteries. By building up there, the cholesterol helps to cause hardening of the arteries or atherosclerosis. And atherosclerosis causes most heart attacks. How? The cholesterol buildup narrows the arteries that supply blood to the heart, slowing or even blocking the flow of blood to the heart. So, the heart gets less oxygen than it needs. This weakens the heart muscle, and chest pain (angina) may occur. If a blood clot forms in the narrowed artery, a heart attack (myocardial infarction) or even death can result.

*Arthritis is a major comorbid condition that I have. One of the nearly intolerable problems is the constant pain of the weight-bearing joints. An increase in body weight adds trauma to weight bearing joints and excess body weight is a major predictor of osteoarthritis. This is a mechanical problem and not a metabolic one. The hips, knees, ankles and feet have to bear most of the weight of the body. These joints tend to wear out more quickly, or to develop degenerative arthritis much earlier and more frequently, than in the normal-weighted person. Eventually, joint replacement surgery may be needed, to relieve the severe pain. Unfortunately, the obese person faces a disadvantage there too -- joint replacement has much poorer results in the obese. Many orthopedic surgeons refuse to perform the surgery in severely overweight patients. The permanent weight loss of gastric bypass surgery will markedly decrease problems with arthritis and the ever-increasing expenses to the insurance companies that will surely follow.

* I suffer from venous stasis disease. The veins of the lower legs carry blood back to the heart, and they are equipped with an elaborate system of delicate one-way valves, to allow them to carry blood "uphill". The pressure of a large abdomen may increase the load on these valves, eventually causing damage or destruction. The blood pressure in the lower legs then increases, causing swelling, thickening of the skin, and sometimes ulceration of the skin. Weight loss after gastric bypass can relieve venous stasis disease.

* I have hypercholesterolemia (high cholesterol). When there is too much cholesterol in your blood, the excess can become trapped in the walls of your arteries. By building up there, the cholesterol helps to cause hardening of the arteries or atherosclerosis. And atherosclerosis causes most heart attacks. How? The cholesterol buildup narrows the arteries that supply blood to the heart, slowing or even blocking the flow of blood to the heart. So, the heart gets less oxygen than it needs. This weakens the heart muscle, and chest pain (angina) may occur. If a blood clot forms in the narrowed artery, a heart attack (myocardial infarction) or even death can result.

*Because of my weight, I am depressed. Seriously overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, and cannot enjoy theatre seats, or a ride in a bus or airliner. There is no wonder, that anxiety and depression might accompany years of suffering from the effects of a genetic condition -- one which skinny people all believe should be controlled easily by will power.
I suffer from depression related to obesity and I am on_________________ to treat it.

*Coronary artery disease is another problem caused by clinically severe obesity. Severely obese persons are approximately 6 times as likely to develop heart disease as those who are normal-weighted. Coronary disease is pre-disposed by increased levels of blood fats, and the metabolic effects of obesity. Increased load on the heart leads to early development of congestive heart failure. Severely obese persons are 40 times as likely to suffer sudden death, in many cases due to cardiac rhythm disturbances.

*I become short of breath on any exertion. I cannot climb even one flight of stairs without stopping, and have a very difficult time performing the ordinary day-to-day duties of living, such as shopping, cleaning, getting in and out of a car or chairs, or to board a bus. I was once physically active, playing sports, and enjoying gardening, but at this time, I find that I am unable to perform any recreational activity, and feel depressed because I cannot control or lose the weight. Climbing stairs or even walking short distances causes the obese to become very short of breath. Obese persons find that exercise causes them to be out of breath very quickly. The lungs are decreased in size, and the chest wall is very heavy and difficult to lift. At the same time, the demand for oxygen is greater, with any physical activity. This condition prevents normal physical activities and exercise, often interferes with usual daily activities, such as shopping, yard-work or stair climbing, and can be completely disabling. Losing weight will cure respiratory problems.

*I have been diagnosed with Obesity Hypoventilation Syndrome. This condition occurs primarily in the very severely obese -- over 350 lbs. It is characterized by episodes of drowsiness, or narcosis, occurring during awake hours, and is caused by abnormalities of breathing and accumulation of toxic levels of carbon dioxide in the blood. It is often associated with sleep apnea, and may be hard to distinguish from it. After gastric bypass and the weight loss it brings, OHS will be relieved with weight loss.

(Add new paragraph here if necessary for things such as chronic back problems? Chronic leg/foot problems? Use of a cane, walker, or wheelchair? Name anything else that you can think of to help your claim for medical necessity. -- if this area is not needed delete it)

*I have chronic skin problems. I am in a constant battle with yeast infections and chronic rashes in the folds of my body. The obesity causes these skin folds so that skin rubs on skin and the moisture trapped in those creases cause the infections and rashes.

I have made many attempts to lose weight, including
Weight Watchers
Jenny Craig
NutraSystem
Herbal Life
Atkins diet
Mayo Clinic Diet
Nutritionist consults
Hypnotism
Acupuncture
Gym memberships
Various workout videos

Richard Simmons
Redux
Meridia
Phen-fen
Xenical
Pondimin
……and many of the over-the-counter diet plans and diet medications.

I have included exercise with all weight-loss attempts. I can lose some weight, but then I gain it all back and more. There is not one study that shows that dieting brings permanent weight loss. The National Institutes of Health, in 1991 and 1992 consensus statements, rebutted conventional diets for morbid obesity, and pointed to this important fact: Diets alone cannot be successful for the morbidly obese.

Obesity has been shown to directly increase health care costs. In an article in the March 9, 1998, issue of the Archives of Internal Medicine 17,118 members of the Kaiser Permenente Medical Care Program were studied to determine the association between body fatness and health care costs. The results showed that patients with BMIs greater than 30 had a 2.4 times greater risk for increased inpatient and outpatient costs than patients with BMIs under 30. For patients with BMIs greater than 30, the study also showed increases in health care costs related to diabetes and hypertension.

Americans spend an additional $33 billion dollars annually on weight-reduction products and services, including diet foods, products, and programs. Most of these expenditures, as is evidenced in my case, are not effective. Rather it can expected that I will continue to gain weight over the ensuing years and add to this present list of obesity associated illnesses.

Seriously obese persons suffer inability to qualify for many types of employment, and discrimination in employment opportunities, as well. They tend to have higher rates of unemployment, and a lower socioeconomic status. Ignorant persons often make rude and disparaging comments, and there is a general societal belief that obesity is a consequence of a lack of self-discipline, or moral weakness. Many severely obese persons find it preferable to avoid social interactions or public places, choosing to limit their own freedom, rather than suffer embarrassment.

I do not want the surgery just so I can look great. I need it for health reasons, as you can see. I need it so that my children don’t lose their mother to an early death caused by morbid obesity. I ask that you pre-approve this surgery so that I can become a healthy, productive person once again. Thank you very much for your consideration.

 

Sincerely,

 

 

 

____________________
Your name

 

 

Reference Sources:
1. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Institute of Medicine, National Academy of Sciences. 1995; 50-51.
2. Kuczmarski, R.J., Johnson, C.L., Flegal, K.M., Campbell, S.M. Increasing prevalence of overweight among US adults. Journal of the American Medical Association. 1994; 272:205-211.
3. Troiano, R.P., Kuczmarski, R.J., Johnson, C.L., Flegal, K.M., Campbell, S.M. Overweight prevalence and trends for children and adolescents: The National Health and Nutrition Examination Surveys, 1963 to 1991. Archives of Pediatrics and Adolescent Medicine,1995; 149:1085-1091.
4. Daily dietary fat and total food-energy intakes: Third National Health and Nutrition Examination Survey, Phase I, 1988-1991. MMWR Morbidity and Mortality Weekly Report. 1994; 43:116-117, 123-125.
5. Weight control: What works and why. Medical Essay. Mayo Foundation for Medical Education and Research, 1994.

Well, I have been waiting a long time to get insurance approval.  I still don't have it.  I had a nissen wrap years ago, so my surgeon, Dr. Prachand, wanted to see my upper gi results.  After 3 months and 3 copies sent to him, he finally got to see it a few weeks ago.  The lady I am dealing with at University of Chicago will be faxing the paperwork to my insurance (Highmark BCBS of PPO) any day now.  I keep lurking on the boards and watching everyone else getting their DS and I can't wait for it to be me.  But for now, I still sit here waiting....