The DS Surgery

I have had a lot of questions about the surgery that I have chosen. So I thought that I would explain it to the best of my ability. Here Goes. I am having a Biliopancreatic Diversion with a duodenal switch (BPD/DS). This surgery works two ways: restriction and malabsorption. Below is a picture of what my anatomy will look like after the surgery.

BPD/ DS                                Gastric Bypass

So basically what will happen is that the doctor will make a sleeve out of my stomach and the rest (about 75%) will be taken out. This is the restrictive portion of the surgery; it will restrict the amount of food I can ingest. I will not have a “pouch” like with a gastric bypass (GB). Then the doctor will work his magic with my small intestines. My digestive loop will be shortened, and a bilopancreatic loop will be reattached at almost the large intestines (this is called the common tract). Because of the way that this surgery reconstructs the small intestines, I will only be absorbing food in the small portion of the small intestines from the site that attaches the BP loop to the digestive loop. There will be less absorption with the DS than with the GB. Because of the severity of the malabsorbtion I will have to take a lot of supplements. I will also have to eat a lot of protein because of the way it is absorbed.

Set Backs

So I thought that I was done with all of the testing and just waiting on insurance approval. I called my patient advocate and didn’t hear back from her. I finally called back and spoke with a different advocate on Thursday. I was informed that I had some more information that they needed.  Here is what I had to submit for my insurance approval:

Certificate of Seminar Attendance and class attendance- I got this way back in November when I attended the Seminar (my third or fourth I can’t remember anymore).

Must be a member on the plan for a minimum of 24 months- My insurance is trying to give me grief over this because I have only had my own insurance coverage for a little over a year, but I was on Cameron’s for 8 years before this.

5 years of medical records (must include documented weight history.  2-3 office notes per year. I was told that I only had to get from 2007 on.

BMI of 35 or greater with TWO co-morbidities ** If you are over the age of 50 or have a BMI of 50 or more, you must obtain both a cardiac and a pulmonary clearance. My current BMI is somewhere between 51 and 54 (it varies on by which doctor I visit).

6 month physician supervised diet.  They must be consecutive and within the last two years. Your doctor must put you on a specific diet and exercise program (if medically capable.)  You must follow up with your doctor once a month for 6 months without missing any months.  All visits must be documented and signed by your physician.  Please follow your doctor’s instructions your; insurance company wants to see that you can follow a weight loss regimen.  A letter summarizing any of the previous information will not be accepted. Because I did not stop my monthly visits I now have 11 months worth of visits.

2 Doctors Letters to support diagnosis of morbid obesity (Medical necessity) I thought that I had several doctors that said that they would write one for me, but found out that only Travis, my PCP, had actually sent one in. So I found myself one short.

Psychological Evaluation (must include MMPI) I got this completed at the surgeons office, it was in my file.

Cardiac Clearance (required by your insurance company) I had the echo test and the clearance, but the advocate said the doctor wanted the actual EKG and Stress tests for my file.

Pulmonary Clearance (required by your insurance company) The test was in my file and I was told that I was good on this.

My doctor also requires that I see a dietician, which I did about three weeks ago. So I had to get five years worth of medical records that include weights, 1 letter from a doctor confirming a diagnosis of morbid obesity, tests from my cardiologist, and I had the dietician fax over her notes. All by Monday. Not bad, right. I was feeling really good. The advocate told me that it would take 48 hrs for my file to get through quality control, 1-2 weeks for insurance approval and I could have my surgery scheduled by the end of April. Awesome, right?

I called the alternative advocate back on Monday. She didn’t have the second letter from the doctor or the notes from the dietician. So I talked to the dietician, and started to call the other doctors that might be able write the letter. I had left a message for another doctor. A small set back, but still moving right along. I also spoke with the dietician and she got her noted faxed right away. Great on the right track. Until. . .

I got a call today from my advocate, not the nice one so willing to help me that has been so great to take all of my calls and help with a pleasant attitude, no it was the advocate that I had called three weeks ago and needed help from, and guess what. She hadn’t completed my file and the doctor needs more stuff from me. I have to get a sleep study (I have been trying since like October for my insurance to ok one and I still haven’t gotten approval for this). I had to get medical records for 2006, because 07-11 isn't five years(who taught her math). I also have to get a release from a rheumatologist that I saw one time to see if she could figure out what the heck was wrong with me back in November. She couldn’t help me, I had an infection causing joint pain and a good long dose of antibiotics and surgery fixed that. AND I have to get a clearance letter from my pulmonologist, you know, the one they said was completed. So yeah, it looks like I will not be getting my insurance approval anytime soon. I don’t know how long it will take to final convince my insurance that I have to have the sleep test. I think that what makes me the angriest about the whole situation is that if the dang advocate would have just called me back three weeks ago, I would be three weeks ahead of where I am now. Sometimes I feel that I am not supposed to be getting the surgery; if I was it would just fall into place and be done. I have seen my coworkers sail through with 6 months worth of work and bam they are done. I sure hope my surgeon is worth the headache that I have after having to deal with all of this. I am ranting, and feeling sorry for myself, I know, but sometime I feel like there is no point to this. Cam is worried that I will give up. But I really do want it to bad. So onward and upward. Things can only go up once you hit the bottom. Right?

My support system

Today is a really big milestone for me. It is my 10th wedding anniversary. As most people that are reading this know, I have never done anything for a solid 10 years. I never lived in the same house for 10 years, not even growing up; heck I never lived with the same person for 10 years straight. So for me this is truly an amazing event. This exciting day has gotten me thinking of my support system. One thing that has really been emphasized to me throughout my journey this far is having a really sturdy support system.

My Support

I have to say that I am very lucky, I have found an overwhelming amount of support; from my friends, family and coworkers. I was worried about telling people that I was thinking about bariatric surgery. I was concerned about telling my family. I didn't want anyone to think that I was weak and not able to accomplish this on my own. My weight has been a topic of discussion between myself and members of my family for some time now. I think that I projected my own feeling of not being strong enough to lose the weight by diet and exercise onto what other people thought of me.

My husband has been my biggest supporter. He is a rock for me to lean on when I do not have the strength. He has always told me that I am perfect in his eyes. I only wish I could see myself the way he sees me. I have to say that when he realized how I saw myself he wanted to do everything to make me see myself the way he saw me. He wants me to be happy and if this will make me happy he was willing to support me. He still tells me I am perfect to him.

I also have a unique experience in that so many people in my life have had bariatric surgery. Two of my biggest sources of inspirations, information and support come from Tracy and Kellie. They are friends and more. Cameron works with Tracy and Kellie is my boss.  I got to know Tracy when she and Cameron became friends at the sheriff’s office. She is truly a one of a kind person. She tells it like it is and would give the shirt off her back to anyone in need. She had gb surgery about 2 years ago. She has been open and honest with me about the whole process. Kellie, who happens to be Tracy sister, is also a great support. She had gb about 6 months before Tracy did. The honest information that the two have shared with me has helped me to make an informed decision. I know that I can go to them with any question and they will give me an honest and straightforward answer. I am very lucky to have them in my life. My support system is really great.

Next Steps

I have also reached the next step in the long process toward my surgery. I received cardiac clearance yesterday. I am now waiting for insurance approval.