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Hello to all of my DS brothers and sisters. I know it has been a very, very long time since I’ve posted. I cannot really explain what drove me from active (gung ho) participant to extreme lurker.  The only thing close to an explanation I can offer is that at first I just didn’t feel up to it.

I came out of my surgery on 11/06/09 and sort of started out on the wrong foot. I spent 6 days in the hospital whereas I should have been out in 3 to 4. This was not a horrible six days for me because frankly I hardly remember any of it. I can remember Dr. Husted saying that my blood pressure was pretty high and he would not let me go until it came down. He also told me at one point that I didn’t have “the look” of someone that was ready to go home.

I did make it home on November 14 after spending two additional days in Somerset, KY to make sure I was out of the immediate complications window. I can honestly tell you that there hasn’t been many things easy about my progress up to now. Nothing has been unexpected, but nothing has been easy. When they say this is a big surgery, believe it. You will be hoping someone got the plate numbers off that dump truck than ran you over. Seriously it is not that bad, but I do not want any newbies or pre-ops not fully understanding the scope of this or any weight loss surgery. This stuff is big time, so do not fool yourselves otherwise.

I think during the first two week after being home I probably had enough gas to fully supply a space shuttle mission to the international space station. That has subsided now and I have no more gas now than I did pre-op. My bathroom issues are DS normal. They are different than before surgery, but actually they are better. I would go probably two to three times a day pre-op at random intervals. Now I usually go twice in the morning then 85% of the time I’m done for the day. When I do have another trip later in the day it has yet to have a sense of urgency to it. So yes, the “you’ll shit yourself do death” BS is just that for most of us…… BS!

Now on to why I’m popping up in here today. 2010 is literally hours away from us now. My new year’s resolution is to be more active and to do my DS duty in “paying it forward”. We have to get the message out about this wonderful WLS option. I’m down 61 pounds and tomorrow I’m just 8 weeks out! Some of you might say that is great, and even though I’m not totally complaining, I’m slightly concerned it may be too fast.

I always said I would do my part, so damnit here I am to do just that.

I was overwhelmed the other day by a wave of emotion. It amazes me how we can lie to ourselves for so long that it becomes the truth. I have been telling myself since forever that being obese is OK.

I thought back to the times in school. All the girls that ignored me. All the girls that were my "friends". My lunch table was me and 9 girls. They loved being around me. They loved it when I made them laugh. They just didn't love me. I was the fat boy. Not worthy of love. But I was OK with it.

We went several times to Six Flags Over Georgia on school trips. I clearly remember watching all my friends ride all the roller coasters and have so much fun. I watched from the side lines because those rides were not built to accommodate this fat boy. It didn't bother me then. I had convinced myself it didn't matter. But now all of a sudden it does matter. I've taken my kids to the same amusement park and I'm still forced to watch from the outside. I want to be sitting right next to my children hearing them scream. Watching their faces light up with joy.

My whole life flashed before my eyes. All the things I missed out on. All the school dances I was too embarrassed to attend. All the years spent being the "big fat funny friend".

I'm just venting right now and trying not to cry about it. I am finding it rather therapeutic right now to simply write it out. It wasn't OK. It totally sucked.

Now I'm almost 40 years old and I can get over it. Right now all I want is to be healthy, and mobile, and free. Free from this heavy ass body that has been holding me back.

I want to be all I can be for the woman I have in my life that loves me in spite of. My size has never mattered to her. I find it hard to believe a lot, but deep down I know she loves me.

I want to frolic with my kids until THEY run outta gas. My 5 year old boy started playing football and there isn't one tough bone in his body. That is my fault. I've never been able to get down in the dirt with him and make him tough. I cannot wait to play a wrestle and rough house with him. That is what daddies are supposed to do. I will make it there.

Oh. And I will make it back to Six Flags one day. I'm coming with a vengeance too. I'm gonna ride EVERYTHING until the wheels fall off. It will be MY day of reckoning.

I HAVE AN ANNOUNCEMENT:

After a year of "playing the game" I finally have been blessed with a date for my Duodenal Switch surgery. As it stands right now I will be switched on September 02, 2009 in Marietta, Georgia by the fabulous Dr. Dennis C. Smith Jr. I will forever be grateful to each and every one of you beloved people out here on this forum. I have no idea how people survive this without you. I hope that my arrival onto the darkside makes me a true DS warrior like so many of you are. I want to pay it forward and be there for the others too. I hope to be an inspiration to some newbie one day. I also hope I carry this torch well and can makee all you vets proud of me. I know the seriousness of the DS and I will not let you guys down. Thank you one and all.

I'm not sure if this has already made it out there, but I heard from "behind the scenes" the other day that this could possibly be happening. I did not post it because I did not have the proof in my hand. Well now I have it. Now understand that I was just denied last month because the BPD-DS was considered "investigational" by BlueCross BlueShield of Alabama. Well they have officially changed their stance. They now cover the DS. There is a +50 BMI catch to it, but as anybody that has dealt with "demsumbitches" will tell you, this is an enormous leap in the right direction. I also heard that this is possibly part of a new national stance by BC/BS. Below is exactly what their policy states now regarding the DS. I hope some of you get some real pleasure in this. I know I did. Now if we can just get them to wake the "F" up about that +50 BMI bullsheet. Oh well. Tiny victories.....

Malabsorptive Procedures: Open or laparoscopic biliopancreatic bypass (i.e., the Scopinaro) procedure with duodenal switch meets Blue Cross and Blue Shield of Alabama’s medica criteria for coverage for treatment of the morbidly obese patients with BMI of 50 kg/m2 or more when the following criteria are met:

 

1. Documentation must be present of participation in medically supervised weight loss program. For purposes of coverage, we (BCBS) recognize medical supervision of the diet and activity program by practicing MD's who are not bariatric surgeons, such as family practitioners, internists, and other primary care specialties. Documentation provided by these health care providers will be recognized in the review process. At least one attempt must occur during the one year prior to request for surgery or date of surgery. Documentation must support participation in the program for six consecutive months. The following criteria must be met for this participation:

a. Documentation of participation in a physician supervised program of nutrition and increased physical activity (including dietitian consultation, low calorie diet, increased physical activity and behavioral modification). Documentation of program participation must appear in the medical record by the attending physician. Documentation should include comments by the physician regarding

 

patient progress or lack of progress. A letter does not meet this requirement. There must be medical records to document medically supervised weight loss attempts;

 

 

OR

 

b. Acceptable with medical record documentation of medical supervision are: Weight Watchers, LA Weight Loss, Jenny Craig, EatRight etc. Not acceptable are self-directed programs such as joining a gym, Atkins’ diet, calorie counting, low fat, cutting back, internet programs, etc.

 

2. A complete history and physical must be performed by the bariatric surgeon to include height and weight.

 

3. The patient must be at least 18 years of age.

 

4. Due to the surgical morbidity associated with concomitant pulmonary disease coverage will not be provided for anyone who has smoked in less than eight weeks prior to surgery

I would like to start this out with “You are not going to believe this”, but I already know that most of you will. I can say honestly that I do believe they said it, but it still amazes me how asinine “The Evil Empire” (a.k.a. BlueCross BlueShield) can be.  To bring you up to speed on things: Back in May of 2009, Dr. Smith’s office submitted paperwork to BC/BS for pre-approval. A month rocks by and they deny me by saying what they always say. “The BPD/DS is considered “investigational” and therefore is a non-covered procedure”. I then hired an appeal specialist to appeal my case to my company’s human resources department. I work for a self-funded company that has a history of supporting the duodenal switch. My HR department took their sweet time, but came back with a decision in my favor. They instructed BC/BS to cover the duodenal switch if in fact I meet BC/BS’s criteria for bariatric surgery. All seems well…….. Two weeks later Dr. Smith’s office gets a letter stating I must prove to them that I’ve been MO for at least three years. This is BC/BS’s official policy regarding the 3 year matter; The condition of morbid obesity (BMI ≥ 40 or BMI ≥ 35 with presence of comorbid conditions) must be of at least 3 years duration. There must be documentation in medical records by a primary care or attending physician of patient height and weight for the past 3 years. A letter from the primary care physician and dated photographs will be considered in lieu of recorded heights and weights. Random reviews of these patients’ charts for accuracy of stated information will be conducted. Notice the italics part above? Well that is the route I went, because frankly I’m not a run to the doctor kind of person. I don’t really have consistent medical records due to the fact I never go to the doctor. Anyway I submitted several photos that were not actually dated, but they were of me with my kids as they were growing up. I went back as for as 2004 when my son was born and my daughter was 5. They are now 5 and 10 years old. I mean it is an obvious transformation. That just seems to me to be better than dating. You can fake a dated photo a lot easier than you can fake a 2 month old baby turning into a 5 year old kid. Geez! Now I will move on to the letter from my PCP. I will put it out here word for word with the exception of omitting my last name. Please read it along with BC/BS’s response to it, and tell me you find any sanity within it. Here it goes: Ref: William XXXXXX DOB: 05/XX/XXXX To Whom It May Concern: Please be advised that I have been taking care of William XXXXXX for a number of years, and he has had morbid obesity as his diagnosis. Looking back at his record, he has had morbid obesity for his entire adult life. Nine years ago his weight was measured at 311 pounds, and it’s been between 311 to 350 ever since. I have numerous records in the chart of his weight being 311 to his current weight of approximately 350. This is not a new development. As stated, he has been overweight his entire adult life, and I believe it is now time to have surgical intervention for morbid obesity. Sincerely, Charles XXXXXXXX, MD   Does that not clearly state that I've been a minimum of 311 pounds for the last 9 years?

From BC/BS in response to above: Dennis C. Smith Jr., MD Patient: William XXXXXX Dear Dr. Smith, We are contacting you regarding the proposed treatment for your patient. Our medical staff is unable to make a predetermination for the proposed treatment at this time. In order to make a determination, our medical staff need medical records documenting the patient’s weight in 2006 and 2007. If the medical records are not available, out medical staff will need original dated photographs for 2006 and 2007. Please submit the requested information along with a copy of this letter to the following address: BC/BS of Alabama
When I called BC/BS to ask the WTF their deal was they actually told me that I must provide records from 2006 to 2007. I said my PCP's letter clearly states the I've been at least 311 pounds between the years of 2000 to 2009. She said that is what is says, but they need documentation for 2006 to 2007. I asked if she realized that 2006 and 2007 fall into the date range of 2000 to 2009 that my doctor testified to in his letter. This went round and round and round like a dog chasing his tail. I ended up just hanging up in her face before I started letting the "stupid muthafuckas" start flying outta my mouth. How do you deal with such idiocy?

I am so happy today.
I am so sad today.
I feel so liberated.
I feel so shocked.  

I did get what I was asking for. A letter from my human resources department overturning Blue Cross and Blue Shield of Alabama in their decision to deny coverage of the Duodenal Switch. It is not the actual approval, but it is the next best thing. I was so elated for about 5 minutes. Then all the fore mentioned emotions hit me like a wave from a turbulent sea.  

My Mama always told me to be very careful of what you ask for. You just might get it. I have researched this until my eyes were on the verge of falling out. I do not think there is one more thing out there for me to read on this subject. I have made my choice, and I am sticking with it. I know all these feelings are normal and expected. I just wasn't as ready for them as I thought I was. I am scared, but not for me. I am scared for my family. I am scared of them being without me. Who is going to walk my little girl (10) down the aisle on her wedding day? Will it be me? Who will teach my son (5) about sports? About women (yeah! like I've figured them out) and how to treat them? About how to be a good husband, father and man?  

I know, blah blah blah..... yadda yadda yadda..... Get over yourself and pick yourself up. Let's get this over with and get things where they need to be. I have read a hundred or so of these posts. I know mine is no different. Well for those out there battling their insurance companies, do not give up. Fight the good fight and soon you could receive the following letter as well. Good luck and God Speed to all!  

Some of the names below have been changed in order to protect the innocent (snicker). My last name has been omitted for security.    

Dear Ms. (my appeal specialists):  

This is in response to your letter dated May 23, 2009, concerning Blue Cross Blue Shield of Alabama's (BCBSAL) denial of a proposed bariatric surgery procedure for William. Your letter is considered to be an inquiry under the International Paper Company Group Health and Welfare Plan (the Plan).  

According to the information available to us, Dr. Dennis C. Smith, Jr., M.D., requested preauthorization from BCBSAL for coverage of CPT 43845 - biliopancreatic diversion with duodenal switch. BCBSAL denied the proposed surgery on the basis that this is not a covered procedure under the plan.  

As part of our review, our office contacted two other claims administrators who handle selffunded medical plans for International Paper. We asked these two claims administrators whether "biliopancreatic diversion with duodenal switch" is considered a covered procedure when the patient meets the claims administrator's established criteria for bariatric surgery. Both of our other claims administrators indicated that this procedure would be covered if the patient meets their bariatric surgery criteria.  

As a result of this review, we have instructed BCBSAL to cover biliopancreatic diversion with duodenal switch when the patient meets BCBSAL's established criteria for approval of bariatric surgery. We have asked BCBSAL to review the medical documentation submitted by Dr. Smith to determine whether Mr. William meets their bariatric surgery criteria. BCBSAL will respond directly to Dr. Smith and Mr. William with their determination.  

Sincerely,
Benefits Analyst,
Global Compensation and Benefits Office of the Plan Administrator

March 14, 2009

It is definitely timefor a journey update. As I mentioned in my last post my journey has the same destination, it just has a new road map. I started with getting referred by my PCP for a lap-band with a local surgeon. Local surgeon enlightened me on the RNY (Oh WOW!!!). My researching then discovered the Holy Grail of WLS. The Biliopancreatic Diversion with Duodenal Switch.

At this point in the journey I researched and chose my surgeon. His name is Dr. Dennis Smith, Jr., MD, FACS in Marietta, Georgia at The Advanced Obesity Surgery Center. And OMG am I impressed with this man! In the WLS world I have discovered that our surgeons are like our kids. Whoever your surgeon is, he is the best in the world (at least to you anyways). Yours is OK, but mine is the best. Dr. Smith does all of his surgeries laparoscopically which was important to me. He says he can actually see everything better. Just 2 minutes in a room alone with this man and you know he is the right choice. He is calm. intelligent, to the point and you cannot stump him. It is not a one-way street with this man. You must be right for him and he must be right for you or this surgery ain't going to happen. He does not bend or budge on anything he requires or expects of you. If you want long term success, in my humble opinion, this is the type surgeon you must seek. Please don't take this the wrong way. He is very serious about your safety and success, but he isn't a hard ass. He even chuckled a bit with me during our session. Just don't go in thinking he will bend the rules for you. Would you really want him to? The Advance Obesity Surgery Center and Dr. Dennis Smith, Jr. have been awarded the "Center of Excellence" designation as a bariatric center. This badge has to be earned.

Enough about Dr. Smith for now. As for me, Thursday March 14th I had my nutritionist consultation. I went Friday March 13th and all in one swoop got my Upper GI, gallbladder ultrasound and pre-op labs done (15 vials of blood mind you). Things I have left to do are a cardiac clearance, pulmonary clearance and a psychiatric clearance. I've already had the cardiac and pulmonary tests done. I just need to meet with the doctors and have them issue a clearance to Dr. Smith. I also quit smoking on December 29, 2008. I have been cigarette free long enough now to qualify for surgery. Ieveryday I will never pick up another cigarette. There are many things I have done in my life that I wish I hadn't, but picking up my first cigarette is so far out in front at #1 it really needs it's own category.

Looks like my locomotive in picking up steam. I'm getting. Wish me luck!

January 03, 2009
Just a little update here about something I have been pondering over the last month or so. I am going Duodenal Switch or nothing at all. I have really beat my head against the wall  studying this. The RNY at first seemed like my answer. Then I found the DS. I have decided after much soul searching that DS is for me. Unfoutunately I will have to change surgeons as mine doesn't offer the BPD/DS. That does make me a bit sad. I personally really like Dr. Mora. And so goes life.......

I know I will have one helluva a battle to get my insurance to approve, but I am arming myself (with a lot of help from a few other DSers) for the war. Luckily for me I work for a company that is self-insured. Blue Cross simply administers their policies for them. I will have to convince my company to overrule BC/BS once they deny me. I am still doing my 6 month supervised diet thing, and haven't reached the point of being denied by my insurance company.... yet!

October 20, 2008

I met my doctor today for my very first one on one. I met him before, but it was at a group informational meeting. I just listened and learned then. Today I hammered him with questions. I usually do not like most people in general, but I really like this man. Dr. Parham Mora is a very calm and mild mannered gentleman. He is very knowledgable about the topic at hand, and unlike most uptight Docs, he even laughed a little. My general MD referred me to him and suggested LapBand. I have researched the matter, and was leaning towards RNY. I asked DR. Mora what he reccomended, and he stated that he doesn't tell patients one way or the other. It is totally up to me. He said I should just research, research, research until I come up with an answer that I could live with. I said "Doc, I'm researching right now, and you are my source". He chuckled at that. "Who better to tell me what would best suit me than you? You are the expert". He still didn't tell me what to do (which I liked), but he did say that people with a BMI in my range (48) generally do better in the long run with RNY. He was very upfront about his surgery record too. He said he has done well over 300 procedures, and out of those 4 have passed away. But NONE were WLS related. Thanks Dr. Mora for putting my mind at ease!

October 19, 2008

Well tomorrow (10-20-08) is a pretty big day for me. I'm going for my first visit with Dr. Parham Mora. I hope all goes well. I'm nervous. I hope I get a lot of good answers to my question and concerns. I'll let you guys know how it all went.

October 14, 2008
I am here to start a journey, and hope it a long and fruitful one. I have the same story as everyone else here. Childhood = fat. Teens = fat. Adulthood = fat. Yo-yo diets.... weight up & down. Blah, blah, blah.....

I am on a firefighting team here at the mill where I work. We are required to have annual physicals. The doctor performing them wanted me to come see him in his office for a "complete" physical. I had not been to a doctor in ummm... let's see... hell I don't know, but it was a freaking really really long time ago. Anyway blood pressure was low, heart was fine, lungs great, blood work was pretty good except for cholesterol was slightly high. All in all the doc said my health was excellent, but "it" was coming. "It" being all the health problems associated with morbid obesity.

My family history indicates him to be correct. My uncle just passed away in June of 2008. He was a lot like me. Very active to be so big. He amazed me at how he got around. That poor man was 5'10" and (no joke here) 550 pounds. And healthy! He was 53 when he died of a blood clot on his lung. Yet my grandfather had that beat. He died when I was three. Believe it or not, I do remember him a little. I remember how big he was. It must have been quite an impression on a three year old. My dad (who is strangely "normal" in size) told me that my grandfather was about 6'5" and weighed about 580 pounds when he died at 45 of a heart attack. This man worked a farm! Walked from sun up to sun down behind a mule! I don't even like pulling the weeds out of my flower bed. 

I am 38 years old, and am actually fairly active. I get around better than a lot of my co-workers that do not have weight problems. Most people are astonished when they first see the things I do. I can climb just about anything. I get myself into tight places, and work on equipment. I have never really had any pain in my knees or feet. So you are probably asking yourself "What's the problem?" Well, at my "complete" physical I discoverd something that really scared me. The most I have ever weighed was about 300 pounds. I tipped the doctor's scales at 344 pounds. Can you say wake up call?

I have always been the typicl hard headed male. I thought I was Superman. Other people are weak, and I am strong. Like I said earlier, my co-workers are used to seeing me have no problems doing the job I do even at my weight. The truth is that as I have started aging, it is getting harder and harder to do. Everything is starting to hurt more and more. First my knees, then my feet. Now it is my back. God my back is killing me! I am too proud to let anybody see my pain so I grin and bear it. I have to do something. I have dieted just like everybody else here. I even lost 110 pounds once. I lost it, but I soon found it. I am scared to death that my life has come to this. I think WLS surgery is extreme, but I feel it may be my only way. I have two children ages 9 and 4. I don't want them to barely remember me like I remember my grandfather. Plus my beautiful wife deserves better. I can't stand the thought of the man she replaces me with when I'm gone. I must live on so I can kick his ass first. J/K