HELP! Just now "informed" I probably won't qualify for DS because BMI under 60

[galaxygrrl]

Wait a minute all....the sleeve works for a lot of people. The DS is better for sure. But if Writegirl can't get the DS, personally, I believe a sleeve is better than nothing and there is always a revision. There are lots of people who get the sleeve and do just fine.

Fight the good fight writegirl and see where you end up. But, be careful of taking an all or nothing approach. The sleeve might be able to get you to where you are going.

 

[DSRIGGS]

I guess it depends on how one defines success. Average EWL for the VSG is 55-60%. I know numerous people who had the VSG and I can't recall anyone who hasn't revised to the sleeve or wants to revise to the sleeve. The one person whom I know who hasn't revised but wants to, has horrible GERD and hasn't kept much weight off.

The average EWL for VSG is 55-60% after 5 years. So using my body height which is 6'2 and using easy numbers had I weighed 500 lbs that would have given me a BMI of 64. To get a 25 BMI (no longer overweight) that would be 195 lbs for that height. So my EWL would be 500 - 195 = 305 lbs.

Example
Surgical Weight = 500 lbs; BMI = 64; 25 BMI weight = 195 lbs

55% * 305 = 168 lbs = weight after losing 55% of EWL = 332 lbs = 42.6 BMI

60% * 305 = 183 lbs = weight after losing 60% of EWL = 317 lbs = 40.7 BMI

FOR ME that would not have been worth it sufficient for the trade off having to diet the rest of my life. The main reason I had the DS was to get my T2DM under control. I don't have the numbers but Dr K told me that he sees that T2DM initially resolves in most VSG patients, but in a significant percentage of his patient population that it returns after 12-18 months.

The VSG is definitely a superior procedure to the RnY GBP, but for me it was not going to be adequate so I chose the DS. I was actually 338 lbs at surgery so the VSG at 55% EWL would have only gotten me to 260 lbs or a 33 BMI. That wasn't what I wanted.

My other rationale for not choosing the VSG is that many surgeons think that a smaller sleeve gives better weight loss compared to a large sleeve, and in doing so they create significant problems for the patient. That can be stricture and or very severe GERD. A study was done and a 32 fr bougie compared to a 56 fr bougie showed no difference in average weight loss. My bougie size might be off slightly but those are the numbers I remember.

We all have to make our own decisions as to what works for us. Some policies have a one time Bariatric Surgery procedure clause. A VSG can be a move in a positive direction and the patient has to decide if it is enough for them.

NOTE: Although I was 338 at surgery time I was 361 before starting the 5 days liquid diet so I really count the 361 at my real weight pre surgery.

 

[writegirl]

My fear of getting even worse acid reflux makes me really wary of the VSG. I don't have any desire to live like that and have the kind of calorie restriction that makes eating stressful. I already second guess every dietary choice I make. I'm tired of stressing out about food. Not being able to drink and eat scares me because of the acid reflux. I just don't know if I can feel good about VSG. I think I would be forever waiting for it to fail--for me to fail at WL again.

 

[Clematis]

But DS IS a VSG plus a switch @writegirl so if you are fearful of a VSG worsening reflux, shouldn't you have that same fear over a DS? There are few DSers who are NOT on a PPI.

 

[southernlady]

But DS IS a VSG plus a switch @writegirl so if you are fearful of a VSG worsening reflux, shouldn't you have that same fear over a DS? There are few DSers who are NOT on a PPI.

Except for the DS, the sleeve part can be made larger. Those of us with tiny sleeves seem to have more issues with reflux.

 

[galaxygrrl]

I guess it depends on how one defines success. Average EWL for the VSG is 55-60%. I know numerous people who had the VSG and I can't recall anyone who hasn't revised to the sleeve or wants to revise to the sleeve. The one person whom I know who hasn't revised but wants to, has horrible GERD and hasn't kept much weight off.

The average EWL for VSG is 55-60% after 5 years. So using my body height which is 6'2 and using easy numbers had I weighed 500 lbs that would have given me a BMI of 64. To get a 25 BMI (no longer overweight) that would be 195 lbs for that height. So my EWL would be 500 - 195 = 305 lbs.

Example
Surgical Weight = 500 lbs; BMI = 64; 25 BMI weight = 195 lbs

55% * 305 = 168 lbs = weight after losing 55% of EWL = 332 lbs = 42.6 BMI

60% * 305 = 183 lbs = weight after losing 60% of EWL = 317 lbs = 40.7 BMI

FOR ME that would not have been worth it sufficient for the trade off having to diet the rest of my life. The main reason I had the DS was to get my T2DM under control. I don't have the numbers but Dr K told me that he sees that T2DM initially resolves in most VSG patients, but in a significant percentage of his patient population that it returns after 12-18 months.

The VSG is definitely a superior procedure to the RnY GBP, but for me it was not going to be adequate so I chose the DS. I was actually 338 lbs at surgery so the VSG at 55% EWL would have only gotten me to 260 lbs or a 33 BMI. That wasn't what I wanted.

My other rationale for not choosing the VSG is that many surgeons think that a smaller sleeve gives better weight loss compared to a large sleeve, and in doing so they create significant problems for the patient. That can be stricture and or very severe GERD. A study was done and a 32 fr bougie compared to a 56 fr bougie showed no difference in average weight loss. My bougie size might be off slightly but those are the numbers I remember.

We all have to make our own decisions as to what works for us. Some policies have a one time Bariatric Surgery procedure clause. A VSG can be a move in a positive direction and the patient has to decide if it is enough for them.

NOTE: Although I was 338 at surgery time I was 361 before starting the 5 days liquid diet so I really count the 361 at my real weight pre surgery.

I'm calling you out on this post. It was one of the most tone deaf things I have ever read and you have written a number of them on this board. In this case Writegirl might not be able to get the DS because of insurance issues, does not have money for Mexico and might only be able to get the sleeve. As I said before, the sleeve is a much better option than doing nothing. It will knock 50% of the weight off. And it might do even more. That is what the data says. Unfortunately, Writegirl might have the choice of doing nothing or getting the Sleeve and not have a choice of a DS and get the DS latler. Did you read her original post that says she is in tears about the fact she might only be able to get the sleeve. We all know the data you posted including Writegirl.

Thats said, I would hope the goal of this board is help people make the right choice for them given the various restrictions in their lives. That is why I wrote what I did to be supportive and to show there is another option besides the DS.

There is a constructive path here for writegirl

(1) Fight to get the DS and hope DianaCox and Larra can work their magic
(2) If that does not work, try the sleeve and hope for the best.
(3) In a few years if the Sleeve does not work, get a revision.

You posting what you did added no value.

@writegirl. Get help from DianaCox and Larra and lets hope for the best. If not seriously consider the sleeve, it works for some people and you can always get a revision. Let us all know how we can help.

 

[DianaCox]

The "option" to have the sleeve first as a stand-alone procedure is not with zero risk - in fact, it carries a great deal of risk:

• Stand-alone sleeves are generally constructed SMALLER, increasing the risk of reflux.
• If they are not constructed smaller, restriction is lost more quickly - although eventually, a good deal of restriction is lost in any case - smaller sleeves "last" about a year longer, but at the cost of a good deal of suffering initially, but long-term results are the same - even if they lose more initially, they gain a good deal back when the body adapts to the restriction and the stomach stretches.
• Many insurance plans (including the one she doesn't know about that she might have in 3-5 years when she needs a revision) have one-bariatric-surgery-per-lifetime exclusions.
• Two-step DSs have less long-term weight loss overall.
• Two surgeries = two anesthesia risks, two recoveries, two periods of disability (loss of income), less effective overall.

I hope we can get this sorted out for her, but PLEASE don't diminish the risks of two surgeries as inconsequential.

 

[galaxygrrl]

I really was not suggesting a two step operation as the ideal option or even the only option. My concern here is trying to make sure there is a open mind that the sleeve is better than nothing. And personally, I would get the sleeve over nothing and see what happens.

My fingers are crossed that you can get this sorted out.

 

[KathrynK]

But DS IS a VSG plus a switch @writegirl so if you are fearful of a VSG worsening reflux, shouldn't you have that same fear over a DS? There are few DSers who are NOT on a PPI.

I haven't needed a PPI. Before DS surgery, I had a very successful outpatient procedure for reflux, fundoplication. When I had the procedure, I hadn't planned to have bariatric surgery, so I don't know if it is an option. As for his office screwup, if the insurance "magicians" here can't budge the company, VSG is far, far better than the band or RNY. And, some people don't get reflux or if they do, it doesn't last for many. If the goal is to be healthier, it is better to get VSG while you have a chance, in my opinion, since you don't know what your situation or insurance will be on the future. As I am 12 years out, and facing some DS related complications, there are certainly risks as well as benefits to consider. I am lucky to have good insurance now to deal with these complications, since I would have been hard pressed to pay for them under Trump care. Just the annual blood tests mandatory with DS are expensive and my infusion treatments for anemia would have been at least $7k without my insurance. There are many roads to success, and I hope you get the results you want, despite this rocky road to get there!

 

[DSRIGGS]

I'm calling you out on this post. It was one of the most tone deaf things I have ever read and you have written a number of them on this board. In this case Writegirl might not be able to get the DS because of insurance issues, does not have money for Mexico and might only be able to get the sleeve. As I said before, the sleeve is a much better option than doing nothing. It will knock 50% of the weight off. And it might do even more. That is what the data says. Unfortunately, Writegirl might have the choice of doing nothing or getting the Sleeve and not have a choice of a DS and get the DS latler. Did you read her original post that says she is in tears about the fact she might only be able to get the sleeve. We all know the data you posted including Writegirl.

Thats said, I would hope the goal of this board is help people make the right choice for them given the various restrictions in their lives. That is why I wrote what I did to be supportive and to show there is another option besides the DS.

There is a constructive path here for writegirl

(1) Fight to get the DS and hope DianaCox and Larra can work their magic
(2) If that does not work, try the sleeve and hope for the best.
(3) In a few years if the Sleeve does not work, get a revision.

You posting what you did added no value.

@writegirl. Get help from DianaCox and Larra and lets hope for the best. If not seriously consider the sleeve, it works for some people and you can always get a revision. Let us all know how we can help.

With all due respect your post is off base(and frankly after your smart ass reply to me you don't deserve any respect from me). Your post IS WHAT YOU WANT HER TO DO. I stated in my post that it is up to the individual to make their own decision. I simply presented the facts in a numerical fashion because some people aren't good at visualizing those things. Writegirl already said that she doesn't want the VSG because she knows it doesn't meet HER NEEDS (Not my needs, not your needs but her needs). The data shows that the VSG does not meet the needs of a person with a 60+ BMI.

Writegirl pursuing appeal for the DS is the right move. If she exhaust her appeal to no avail then she has a decision to make.

BTW, my friend who had the VSG and wanted a DS but wasn't approved. She messaged me earlier today that she just found out yesterday that she is approved to have a DS, and to get her fucked up sleeve from the VSG addressed as well. That makes not one single person who I know who had the VSG who didn't get revised to the DS. That number of people who I know who had a VSG and then later had it converted to the DS because it failed them is somewhere between 10-15. Zero VSG'rs that I know who still have the VSG only.

 

[Butterfly]

I realize that I'm still somewhat new and I AM a sleeve who will be revising to a DS next month so obviously the sleeve wasn't enough for me, but I truly understand what @galaxygrrl is getting at. At the time my insurance covered NO WLS procedures and I had the sleeve because I had limited money and didn't know anyone who'd been to Mexico so I had the sleeve. If I hadn't done that, I'm honestly not sure if I'd be here today or if I'd be here but weigh 600 pounds.

I'm not saying it's the right choice in this situation or for anyone else, but because I lost so much weight on the sleeve I was able to restart my life. I started taking classes and now I'm a nursing student. Without the sleeve, I know I wouldn't be on the road to a better life, I'd be six feet under or even heavier.

Now I have a different insurance company that does cover it and I'm grateful for that. @writegirl, if ALL else fails and it's the sleeve or nothing, sort through your choices and make the best one for YOU.

I'm hoping the helpful ladies here can help you convince the insurance company, and you'll get the DS you want. Take care.

 

[DSRIGGS]

I realize that I'm still somewhat new and I AM a sleeve who will be revising to a DS next month so obviously the sleeve wasn't enough for me, but I truly understand what @galaxygrrl is getting at. At the time my insurance covered NO WLS procedures and I had the sleeve because I had limited money and didn't know anyone who'd been to Mexico so I had the sleeve. If I hadn't done that, I'm honestly not sure if I'd be here today or if I'd be here but weigh 600 pounds.

I'm not saying it's the right choice in this situation or for anyone else, but because I lost so much weight on the sleeve I was able to restart my life. I started taking classes and now I'm a nursing student. Without the sleeve, I know I wouldn't be on the road to a better life, I'd be six feet under or even heavier.

Now I have a different insurance company that does cover it and I'm grateful for that. @writegirl, if ALL else fails and it's the sleeve or nothing, sort through your choices and make the best one for YOU.

I'm hoping the helpful ladies here can help you convince the insurance company, and you'll get the DS you want. Take care.

I am glad you are on your way and the VSG helped kick start things for you. Hopefully your upcoming revision goes smoothly as well as your recovery.

I am certainly not telling writegirl not to get a VSG. I simply put in numerical terms what a VSG likely out come could look like. Only Writegirl can decide what is right for her.

My problem with the response to my reply where I laid out what the data says a likely outcome will be and then CLEARLY STATED that is up to the individual to DECIDE WHAT IS RIGHT for them....was being told my post was not helpful and that I am tone deaf. We are big boys and girls here and can have reasonable discussions where we don't always see eye to eye, without attacking the messenger for stating a rational and data driven response. I have had to damn many surgeries on my gut and know what kind of problems that can lead to. I don't want to see anybody go through that if it can be avoided.

 

[galaxygrrl]

@writegirl Remember, success is not always a straight line and it's not always easy! I hope Larra and Diana can help you, but also realize the sleeve might save your life.

There are lots of people you bump into online during your weight lost journey, one of the most constructive people I bumped into was a nice woman on Facebook. She said to me people love their surgery and defend their surgery and don't think the other ones work well. This forum has group think on the DS, but there are FB groups where people love their sleeve. And remember, the sleeve originally was just the first part of the DS, it was never developed as a stand alone surgery. Everyone who got the sleeve was suppose to go back to get the DS. But for some the sleeve worked and then, never went back.

I'm not an expert for sure, but I just think in life you need to keep pushing and deal with the hand you are dealt. I'm sorry this is hard for you.

 

[writegirl]

I just want to thank you all for your kind support and the discussion on this matter. I don't want to be the catalyst for anyone arguing with others on this community. I love that everyone here is cool with free thought and open discourse on so many issues relating to WLS and life before/after WLS. Each one of you has given me more to think about as I contemplate whatever options I may have. I'm glad you're all willing to lay out the risks and the benefits (@KathrynK gave me some insight into what possible future risks I might encounter with DS, for example, and I really appreciate that). So far, I have decided on the following course of action if my DS is denied by my insurance:

1.) If denied, I will appeal and hope that my surgeon can sway the deciision.
2.) If that does not work, I may consider seeing what my next "appeal" option might be.
3.) Because I am kind of playing beat the clock in terms of possibly losing my insurance later this year, if the process for appeals takes too long, I may opt for the VSG (I do not want it, but I also do not want to continue living with all this extra weight).
4.) If I "must" get a VSG, I will discuss what a revision would look like with my surgeon before I get the surgery, with the understanding that I see myself seeking a revision in the future.
5.) The instant I get the unwanted VSG, I will start keeping a journal of any struggles or issues that I have that seem to arise from it (Worsend GERD, for example). That way, I will have documentation to bring to my primary care physician to start making the case for a future revision.

That may seem over-intentionalizing the idea of a revision. While I realize I may never need a revision (maybe I will not want one), I would rather be hyper-intentional in making sure any and all issues with the VSG are medically documented in case I do need a revision in the future.

I don't see what more I can do, but if you have any suggestions, I will gladly consider those.

Hugs to all of you for your help and kindness during my meltdown/freak out over this.

 

[Larra]

I think you've come up with a good game plan. I would just add to ask the folks at your surgeon's office to get going on the authorization request ASAP to get to the probably denial ASAP, because you can't start appeals until you get a denial.
Also, see if your insurer has an option for a peer to peer appeal that your surgeon could do. Sometimes these work, though not always, but they don't take away any of your other appeals rights, so it's worth a shot.
Lastly, if you do end up with a sleeve, talk with the surgeon before hand about making a looser sleeve to lessen the risk of GERD problems.

And remember, if you are doing appeals, @DianaCox and I can give you a hand with putting together a strong appeals letter. There are never any guarantees, but a strongly prepared case will improve your chances.