Lap Band – Final Steps?

May 14, 2008

This morning I went to the Centerpoint Hospital in Independence, MO to have an EGD performed at the request of my insurer, Coventry of Kansas. The idea was to use the EGD to spot any “anatomical problems” in my upper GI tract prior to having the stomach banded.

The procedure is fairly simple. All I had to do was take off my shirt and put on a standard hospital gown, then the nurse got all of my vital signs and started an IV in my arm. This was the part that I was dreading…my veins are somewhat recalcitrant, and they don’t always pop to the surface with enthusiasm. Luckily no re-sticking was required, but I did have to sit in the prep room for around a half-hour watching The Price is Right before I was wheeled into the exam room.

Once there the Doctor explained what would be happening. Basically they would be injecting a strong sedative into my IV and checking with me over the next couple of minutes until I was pretty much out, and then they would proceed with sending a scope down my esophagus to take a look-see. The sedative included an amnesia-inducing effect, so much of my memory of the actual procedure is very hazy at best. I do recall being given oxygen and having the plastic guard placed in my mouth, and I do recall them putting the actual probe in my mouth and throat. I recall having to think a little about breathing through my nose, but the next thing I really remember was being in the recovery room and my wife joining me shortly thereafter.

After about 30 minutes in the recovery room, they unhooked all the monitors and IV and let me try standing up after having a glass of juice. I was a little woozy, but that was pretty much it. Jen drove me home and I’ve been pretty much just napping for the rest of the afternoon.

All of the tests and consultations that the insurance requested in this last round of coverage notifications have been positive – cardiac, pulmonary and now the EGD. All the results will be going back to my primary care physician, who will then get them to the surgeon so she can proceed with getting the approval from Coventry.

I did want to make a note here – while Coventry of Kansas HMO does cover the lap band surgery in general, it is completely up to the individual employer as to whether they include that provision in the policy selection they provide to their employees. We’re very fortunate that Jen works for the State of Missouri – their coverage is excellent, and to be honest if I had managed to find an in-network provider that would do the procedure with my current BMI where it is at I could have had this done a long time ago. So my hope is that I can have this procedure approved by Memorial Day, God willing. Once it’s approved I just need 10 days for the low-sugar liquid diet and then…bam!

Growing Toward Reduction

May 8, 2008

A long time ago I posted a note here about my working toward a bariatric surgery. It’s been quite a ride over the last year and a half that I’ve been in some way thinking about this. Here’s a timeline.

  • September 2006: I learn about a new procedure called a “Lap Band” from Brian Shepard, a good friend and fellow Smokin’ Poobah. I was only peripherally aware of bariatric surgery in general, and like most people I just dismissed it as being way too radical. But the idea of not making a surgical change to my digestive system sounded interesting. I thought about it, researched it on the Internet for a while and decided (eventually) to attend an informational seminar.
  • January 2007: Jen and I attended an informational seminar at Shawnee Mission Medical Center. There are a lot of people there – a LOT – and the presentation is extremely informative. Many of my misconceptions about the surgeries are dispelled and I learned some truly interesting things about weight loss as an industry and the success rates of different weight loss options in general. The catch? SMMC has a maximum BMI restriction, and in order for them to do a surgery on me I’d need to lose at least 80 pounds.
  • February-April 2007: Based on what I learned in January, I decided to return to Weight Watchers one last time and see if I couldn’t get myself down to the maximum BMI allowed at SMMC. I did OK, losing around 35 pounds before That Saturday happened.

That Saturday. The day that I lost interest in attending Weight Watchers ever again. It probably sounds silly, but it was something that I’d feared happening ever since I attended these meetings back in Junior High.

The Weight Watchers meetings I attended were on Englewood Road, and the leader was very nice – energetic, positive and very realistic. I was one of maybe three men in a roomful of at least one hundred women. I haven’t had a problem with that in the past, but That Saturday a topic came up that made me as uncomfortable as a mouse in a cat shop. They started talking about their periods.

For women I am certain that this is No Big Deal, but I’m not comfortable with it. To be more specific, just talking with my wife about her period makes me uncomfortable. Hearing 100 women all start talking at once about the horrors of their periods and how it has made their weight loss journey so much harder was more than I could countenance. And the discussion wasn’t exactly…tasteful. It got a little too graphic for me, and that was my last Weight Watchers meeting. I don’t think the leader intended to drive me out like some kind of male demon inhabiting their all-girl Weight Watchers party, but holy water could not have performed a quicker exorcism.

Back to the time-line…

  • Summer and Fall 2007: Gain back the weight I lost, feel pretty crappy about myself.
  • 11/1/2007: Adopt TJ and realize that I had better get on the stick. This isn’t just about me, it’s about all of us. I start researching other places to have the surgery done.
  • December 2007: I find out about the Minimally Invasive Surgical Hospital in Lenexa, KS. They had a great web site and in an email they said that they didn’t have a maximum BMI, and had successfully performed the surgery on people much larger than me. I schedule myself for their first seminar in 2007, and then discover that a new team member at work had actually already had lap-band surgery there and had very positive things to say about it!
  • January 2008: I attend a seminar and meet with the surgeon the very next week. She tells me that even though I’m interested in the gastric bypass, she recommends a lap band due to the risks associated with my stupid umbilical hernia. Plus, at the time I was considering being a self-pay as I was thinking that Jen was going to quit her job and we’d be on my work insurance which frankly reeks.
  • February 2008: I come to the sick realization that 20K out of pocket plus the risk of an uninsured surgery does not make good sense for the financial health of my family. Jen makes the rather heartbreaking decision to stay at work for the time being, and thankfully we find out that her sister-in-law Jami is wanting to stay home with her two kids and is willing to watch TJ. So I start the process of getting my insurance (through Jen’s employer) to cover the surgery.
  • March 2008-Present: Bariatric surgery is covered by my insurance, but the surgeon that I want to use is out of the Coventry network. The surgeon that is in network is at SMMC, and I have an email from them saying that they won’t operate on me, which should be good enough to get coverage. So I then get: labs, so many blood labs. More than 6 months of documented weight loss attempts from my Doctor. Records of my visits in 2007 to a weight loss specialist that I didn’t include in this time-line, just because it was such a waste of time. A psychiatric evaluation that required three different office visits. An echo-cardiogram. A Doppler echo of my left leg. Another echo-cardiogram and a consultation with a cardiologist. A pulmonary specialist consultation, and finally, next week, the (hopefully) last step: an EGD. Along with tons of paperwork, numerous hours of missed work, hundreds of miles driven around Kansas City trying to get to these appointments (sometimes with less than 2 hours notice!) and who knows how many phone calls back and forth.

In all of this my Doctor and his assistant have just been tremendous. The surgeon and her staff have really gone to bat for me with the insurance company, which has been reluctant to say the least, but there is finally some light at the end of the tunnel. Hopefully sometime before Memorial Day I will have the surgery scheduled and if all goes well I’ll be starting the process of actually LOSING the weight by the end of June.