Hi

[HereIGoAgain]

Ok so I had Sleeve surgery done in 2012. My surgeon was in Burbank (about 90 miles from my home one direction) My employers switched insurance shortly after my sleeve surgery so I did not have much aftercare post surgery. In hindsight I started having difficulties almost immediately (intense heartburn, constant hunger, slow weightloss that stalled in the first 6 months and never began again despite constant diet and exercise) Now I am almost 4 years post op and have recently learned I have 3 hernias (one hiatal, one abdominal, the last is unclear to me). I suspect my sleeve also has something not quite right based on the lack of weightloss and constant heartburn but those could just be related to hernias or just me I suppose. Id like to troubleshoot these issues with a bariatric surgeon as opposed to the general surgeon my doctor is sending me to. My current PCP however is anti weightloss surgery and refuses to refer me to back a bariatric surgeon to discuss my concerns as they relate to my sleeve and hernias and has made it quite clear his thoughts on my weight and how its my fault. I am awaiting an appointment as well with a gastric specialist to be sure I am not having troubles with my pyloric valve (luckily the urgent care doctor made these referrals before seeing my PCP as he is unwilling to help with any of it and tells me to "eat less").

I was hoping to find a local doctor who is at least willing to refer me back to a bariatric surgeon to consult on my troubles, since I am HMO I can not self refer. At the bare minimum I need to switch doctors as my current primary refuses to even read me the full results of my CT scan and is uneducated on anything having to do with real weightloss. I dont know really where to begin but if anyone here is in Southern California and can recommend a good general practitioner that is receptive to making referrals to bariatric surgeons that would be great. As an aside I would love to see Dr Keshshian to discuss revision to DS but I imagine with my BMI currently being below 40 I may not be a candidate.

Thanks in advance

 

[southernlady]

Welcome @HereIGoAgain

As for your BMI being below 40....depends on possible comorbids. I had my DS at a 35.2 BMI.

 

[HereIGoAgain]

Thanks for the welcome While I am thankful to have good health (very thankful), in terms of revision unfortunately I dont think I have any of the traditional comorbidities. I have elevated cholesteral but really not very high. Also I had to have my gallbladder removed earlier this year and likely have GERD but no hypertension, diabetes or sleep apnea. DO you know if there is a list of the usual comorbidities they are looking for?

 

[Clematis]

Hello @HereIGoAgain

1. You need a new PCP. Try going to a few WLS support meetings for the sole purpose of asking participants about their PCPs and how supportive they are.

2. Are you on a PPI for your heartburn?

3. If you are below BMI 40 and don't have co-morbidities (pretty much all the ones you listed that you DON'T have), your insurance company is unlikely to cover the addition of the switch to your sleeve.

4. Are you able to self pay? I went to Esquerra in Mexicali for a virgin DS -- about $11k. He will do this on someone <40 BMI. He can also fix your hernias while he's in there.

Good luck!

 

[HereIGoAgain]

Thanks for the great suggestions. The nearest support group is about 45 miles away but its still probably my best bet.

Per the PPI, yes. I have been on Omeprazole for a few years. I'm prescribed 40mgs daily but if I ever forget to take it I end up having to take rantidine as a quick fix since the heartburn gets so bad.

I imagine insurance wont pick it up unless I gain weight which, although I am not far off, goes against everything in me to do. I am fighting as hard as I can to keep weight off. Also I wouldnt be able to self pay (way too much student loan debt I am currently working on). Right now I would mostly like to be able to have a bariatric surgeon fix my hernias to be sure my pyloric valva and sleeve is also ok. If I can work towards revision too that would be ideal.

Thanks Again!

 

[Larra]

Hi and welcome! I'm so glad to see you here. As you are already seeing, there is a lot more info and support here than, shall we say, elsewhere.

Revision MIGHT be covered if it is being done to fix complications from your original bariatric surgery. It will depend on your policy, which is why you need to get your hands on that EOC (Evidence of Coverage) document. The standard criteria for a primary bariatric surgery are not the same as those for revisions - sometimes it makes getting approval better, sometimes worse. But without your policy, you have no way of knowing. You also MIGHT have appeal rights, again your policy will give you this important information.

At the very least, you should be able to get coverage for treatment for the hernias and maybe for other issues, depending on what is found on diagnostic testing and on what the surgeon recommends. And regarding your CT scan, you can get a copy of the report yourself, from whatever hospital or clinic you went to for the test. Of course you should also be able to get it from your pcp, but it sounds like he's a real jerk. You will probably need to sign some kind of release to get the report, and their may be a small fee for copying.

AND, if/when you do get an appointment with Dr. K (I'm thinking positive for you), you could also get a disc with the images from the CT scan for him to review himself. That may be necessary to sort out all this hernia business, and who knows what else might be on the images. Again there may be a fee for this, I don't know.

Lastly, regarding Mexico as a possibility. I understand about the finances. But don't give up! You never know what the future holds. It may take awhile, and you may need to make sacrifices along the way, or maybe a relative will help out, you never know. Never give up.