|
Post by kokoro on Mar 29, 2015 21:59:08 GMT -5
Just a quick update: I had the first surgeon's appointment Monday. He said to never get a lap band ever, and suggested I consider a VSG first because I have not reagined weight at all over the past five years from weight loss with my counselor, which is a good sign for its efficacy on its own. I have not regained at all since I started weight loss in 2009...probably because I've been in counseling since then.
However, he also said if I decide to pursue a DS he is happy to recommend the University of Chicago as he did his own residency there. He said to think about it carefully and do more research, and speak with folks who have had both procedures. He also did affirm that we could always do the DS later at U of C if the VSG was not sufficent, but agreed that I may not wish to do surgery twice. My PCP has also said she will support whichever decision I make.
I'm still inclined towards the DS. U of C appointment w/Prachand is on 4/29 - we'll see what they say. I'm currently at 390 lbs (higher than it was yesterday...thanks, stupid period), so my weight loss has been slow this month, but still going to keep working at it till the U of C appointment, of course.
The problem is time off work, still. I'm looking into temporary disability for ~8 weeks, since with my luck I will have complications with the DS. I will post updates as time goes on. I'm also going to calculate how much the DS aftercare is (all the expensive vitamins, etc.) and be sure I can afford it long-term. I may be neurotic, but I just like to have my bases covered.
Thanks again everyone for encouraging me and advising patience. I appreciate it very much.
|
|
|
Post by goodkel on Mar 30, 2015 2:22:23 GMT -5
390 means you have a lot of weight to lose. Your best bet for getting it all off and keeping it off is the DS.
I am glad that you are doing your research.
The cost of vitamins can add up, but many you can buy at your local drugstores and Walmart. Shop for sales and stock up.
Labs should be covered by your insurance.
As you are losing weight, thrift stores, consignment shops, and eBay can make buying clothes, that you will only fit into temporarily, much less costly.
There are many ways to do this frugally.
|
|
|
Post by caprice on Mar 30, 2015 5:42:46 GMT -5
one thing you want to be absolutely sure of if you decide to do VSG only, with expectation that you could revise: If insurance is covering your VSG, is there a possibility that they would refuse to pay for a second surgery, even if a surgeon deemed it medically necessary? DS is a big step, and there are trade-offs, as you are aware, I just want you to keep that question in mind (along with the many others )
|
|
|
Post by Joanne on Mar 30, 2015 7:10:36 GMT -5
I agree you have to think about it very carefully.
I think the chances of the VSG being effective long term at your weight, though, are not good. Longer term studies are showing an average of 50% loss of excess weight. Without knowing your height, it looks like you are at least 200 pounds overweight? With the VSG it is likely you will remain about 100 pounds overweight.
The DS isn't something to go into without careful consideration. You will lose weight with the VSG, which will improve your health. Whether the remaining difference between what you could achieve with the DS vs VSG would require you determining it was worth the trade off.
As Janet said, I would be very, very cautious with the approach the doctor suggested, that if the VSG alone wasn't sufficient you could add the DS. We hear this a lot from doctors because from a surgical point of view it makes sense. However, it rarely makes sense from a practical point of view. Here are the reasons:
-Many insurances have a "once in a life time" bariatric clause. If you use it up on the VSG, the DS wont be covered. -The VSG may make you lose enough to no longer qualify for WLS, but you may still be obese. For example, your BMI may be 39. -You may lose your job, coverage, circumstances may change and you may not have health insurance that covers WLS at all -Two surgeries = two recovery periods, two times off work (lost income), etc.
There is a lot to think about. In all honesty if your starting weight were lower I would think the VSG would be something for you to consider more seriously. At higher BMI's it is usually not effective enough long term.
|
|
|
Post by kokoro on Mar 31, 2015 10:36:53 GMT -5
Thanks again for all the input. I called insurance. They said they will cover the DS completely as well as any resulting complications or necessary revisions in the future if something goes wrong or the length requires adjustment. Since my starting BMI is so high that means any future issues will be taken care of and any revisions as well. They will not cover a two stage procedure, though. I also really dont want to break it up for many of the reasons you all mentioned. I may have to wait a year for the DS because of the need for disability, and by that time I may not meet the 50 BMI requirement. My PCP who is also a bariatrician said she will do whatever it takes to get me the DS if that is what I want. She still wants me to keep losing weight too of course. I never thought I'd ever be so annoyed at losing weight on my own, heh. She thinks insurance could be petitioned for a two stage procedure due to the fact my BMI was originally way higher (well over 100), but I dislike gambling. It's also the best time for me to get surgery this summer because it's before my clinical rotations for grad school. I keep reigning myself in and remind myself to be patient, and that there is always a way to make time for it. So basically I will keep reading about the DS voraciously and wait so I don't make hasty choices.
|
|
|
Post by goodkel on Mar 31, 2015 11:44:03 GMT -5
The two stage DS is generally unnecessary and riskier. All the risks associated with surgery are doubled. You will need two recovery periods off from work. Of course your insurance doesn't want to pay for two surgeries when one will do.
It is ridiculous either way. I had a BMI of 41.something at the time of my DS and I have known lightweights under 40 BMI who have been very successful with no problems, either.
Basically, if you qualify for any bariatric surgery, you qualify for the DS.
If your surgeon is insisting on this, find another one if you think you will fall below 50 prior to your surgery. You don't want to go through all the prep work only to discover that you are at 48 on the day of surgery and he won't give you anything but a VSG. If he agrees to make an exception for you, get it in writing.
You don't want to waste your time and who knows how many times your insurance will agree to pay for pre-op testing.
|
|
|
Post by kokoro on Mar 31, 2015 15:32:25 GMT -5
I definitely agree with all of your points, goodkel. While it wasn't a DS, I remember recovering from abdominal surgery as morbidly obese all too well. Since WLS recovery is even worse in general, I sure don't want to go through that twice if it can be avoided....ugh.
I don't blame BCBS for not wanting to pay twice, either. I spend a good chunk of my income on insurance, but it's been worth it a thousand times over. They pretty much pay for 95% of anything I'd need in general. I had to get an MRI and it was immediately approved without them batting an eyelash. This is the first time I've even been told they might not cover something so I have no complaints.
The surgeon I already spoke to was quite upfront and had no issues sending be to U of C for the DS if that's what I wanted. My PCP is the same way. The surgeon is familiar with the DS (he trained at U of C) which makes it a bit easier on that front. He is very pro-VSG, but he said I ultimately know what is best for my situation and that he will gladly support me no matter what.
The only medical person who is against waiting is my therapist (who is in the same profession as I am). He is concerned about me waiting a year for me to get the disability leave/save up enough for FMLA, because I will graduate and sit for licensure next May after my clinical hours are done and jump into practicing and teaching. Being overweight is (unfortunately) a huge obstacle when you are a therapist. I made an info packet with the data and studies to show him why it's a better option in the long run, so we'll see how that next appointment goes...
Current plan is: getting stricter with my VLC/nearly zero carb food plan, and talking with my PCP about other non-surgical options to bide the time until I can get disability and/or have a good chunk of money saved for FMLA. I'm not going to rush any decisions, especially when the stakes are so high. The University of Chicago is only 1-2 hours away (mostly of that city traffic rather than distance) so I am very fortunate in that regard in terms of waiting.
|
|
|
Post by caprice on Apr 1, 2015 5:17:58 GMT -5
I don't envy you the decisions you are faced with, but want to say again that I think it is absolutely stunning that you have done so much for yourself in getting healthier, mind and body, these last several years. I hope the good stuff falls into place for you, the sooner the better.
|
|
indianamom
Full Member
Posts: 210
Surgery Type: DS
Surgery Date: January 17, 2014
Surgeon: Dr. Vivek Prachand (Univ. of Chicago)
|
Post by indianamom on Apr 4, 2015 6:10:20 GMT -5
Dr. Praschand is terrific. Excellent surgeon and human being. Can't even see where my incisions were. He has a great bedside manner and spends a lot of time with the patient. However, he won't recommend the ds for everyone. He recommends where there is the need AND he believes the patient has the ability and desire to follow the food and vitamin regimen. I came very prepared with lots of questions. I ultimately asked him if I were his wife or sister, what would he recommend. I had been to a different doctor in indiana who only did the sleeve and bypass and was pushing for the bypass... Never educating me that the ds ever existed. I went to dr. Praschand at the urging of my ENT at University of Chicago who told me to get a second opinion. Dr. Praschand recommended the ds because of the amount of weight I had to lose ( I started around 320ish) and because he and the committee that decides whether to accept a patient thought I would be diligent with the follow-up. Best of luck. I will be interested to hear how your visit goes.i
|
|