2 years w/sleeve considering D/S

[veronicaj5]

You might find since it's such a specialized surgery your surgeon range is a little bit farther, my surgeon is almost 3 hours away. I also live in a big city with a bariatric center of excellence blah blah.. but they don't do DS. Three hours away in network and a qualified surgeon.

 

[Butterfly]

@veronicaj5 definitely. The surgeon on my network list is about 1.5 hours away. Cleveland would be about 3 hours. I'm definitely willing to travel. It's worth it, I think

 

[DianaCox]

Philip Schauer: http://my.clevelandclinic.org/staff_directory/staff_display.aspx?doctorid=6010

I would be VERY careful in asking whether he's doing the DS or a single anastomosis variant, how many he does per month, how many he has done in total. I would also ask these questions about his sleeve revisions - they are complex as well.

 

[Clematis]

Cleveland Clinic's Schauer does only about a handful of unadvertised DS a year and only on 50+ BMI. He also publishes a lot, and in a real eye-roller, has a small study that dismisses DS as being too dangerous because it was based on the SMO or SSMO on which he has worked (a population perhaps coming into the surgery sicker than someone just MO) and dangerous because of the DS' malabsorption -- AND HE GIVES ABYSMAL NUTRITIONAL ADVICE according to one of his patients so, duh, of course people become malnourished. IMO, this was a skewed study all around. I spoke with one of his DS patients (PeteA on another WLS site with initials the same as this state, hint hint) who said Schauer is a great surgeon but does not really want to do the DS. Personally, I tried contacting CCF before I knew all of the above and I could not get them to respond. After an initial 2 minute chat with whomever answered the phone to get my name, address etc, I was transferred to the drearily phlegmatic head of bariatric billing (I would have been self pay). I was not allowed to make an appointment to see a surgeon until I had spoken with this financial person and proved I could pay. I was more than a little irritated that the focus wasn't on whether I was a candidate for WLS but rather if I was solvent. She told me it would have been close to $32k -- NOT for the DS as that was on a case by case basis so would be more. Then she said shed get back to me regarding the DS and I waited and waited and called back 3x for FIVE WEEKS. Then I went to Esquerra in MX who does 2 DS a day vs Schauer's 6 a year. (One of Schauer's studies was on the lack of competence of info one receives from online forums -- a study done BEFORE bariatricfacts was created.)

HOWEVER it has come to my attention that University Hospitals bariatric center is now doing DS http://www.uhhospitals.org/services...r/weight-loss-surgery-options/duodenal-switch. They were not advertising this 6 months ago.

 

[Butterfly]

@Clematis that's crazy about Dr Schauer! Truly.

Just a quick update. I got a referral from my primary care provider and will be seeing Dr Schumacher on 9-12. I've been in touch with 3 ladies who had the d/s with him and were thrilled with him and his office.

I'd love it if I can do this via my insurance company, but I'm keeping my mind open in case Mexico is a better fit. In the meantime, I'm going to read through as many threads here as I can. You all have been so helpful!

 

[Butterfly]

Update: I saw Dr Schumacher on Monday. It's odd, I'm usually quite uncomfortable with doctors, but I felt immediately at ease with him, even when he was examining my abdomen. He admits that he's done far more sleeves than D/S, but said that he agrees that the D/S is the way to go for me. He said that I'd be wasting my time with a gastric bypass. He also complimented me on how well I've done with the sleeve. I'd been feeling like such a failure needing a 2nd surgery, but he insisted that at my starting BMI (around 80), it was inevitable.

He looked at my medical records and said I seem to be in "really good health" and while there are tests he wants to me to have to make sure, he believes I'd be a great candidate for the switch. He's going to have me get a test to look at my sleeve, and he wants a CT of my abdomen to see if I have a hernia. He said if I do, he'd fix it and use the "hole" he uses to repair it for the rest of the surgery.

If I do have a hernia, I wonder if that's something I can use to appeal the 9 month diet I'll have to do? It's worth a try. His insurance specialist is out until this coming Monday so I'll be talking to her then.

 

[galaxygrrl]

Progress! Hooray!

 

[JuliaDS]

Update: I saw Dr Schumacher on Monday. It's odd, I'm usually quite uncomfortable with doctors, but I felt immediately at ease with him, even when he was examining my abdomen. He admits that he's done far more sleeves than D/S, but said that he agrees that the D/S is the way to go for me. He said that I'd be wasting my time with a gastric bypass. He also complimented me on how well I've done with the sleeve. I'd been feeling like such a failure needing a 2nd surgery, but he insisted that at my starting BMI (around 80), it was inevitable.

He looked at my medical records and said I seem to be in "really good health" and while there are tests he wants to me to have to make sure, he believes I'd be a great candidate for the switch. He's going to have me get a test to look at my sleeve, and he wants a CT of my abdomen to see if I have a hernia. He said if I do, he'd fix it and use the "hole" he uses to repair it for the rest of the surgery.

If I do have a hernia, I wonder if that's something I can use to appeal the 9 month diet I'll have to do? It's worth a try. His insurance specialist is out until this coming Monday so I'll be talking to her then.

Great news!

 

[Butterfly]

I've been away a long time. College has been kicking my butt.

I've met with the surgeon's office and their weight loss team a few times and really like them. It may end up that I go to Mexico after all, though.

See, when I started school my employer cut my hours to make me part time and took away my insurance. I make so little that I qualified for Medicaid under the Medicaid expansion under the ACA. (You can probably see where this is going). Now that Trump & Ryan have said they'll be kicking people off Medicaid & the ACA, I'll have no benefits at all.

The insurance company that I have via Medicaid requires a 9 month diet. I'm only on month #3. The insurance specialist at the surgeon's office is going to submit it to my insurance on Monday, but I'm sure it'll get denied for the diet. I guess I could appeal it, but I'm afraid that won't work. Does anyone know if those appeals ever work? I mean, it's not like I haven't done this before... it's a revision.

If I absolutely have to, I can see about getting a home equity loan and go to Mexico, but taking on an additional $15K in debt seems so daunting when I'm already stretched to the max on money right now. Once I'm done with school, things will be better, but for now it would be TOUGH.

Ideas? Thanks so much.

 

[Jen2016]

Couple important things
-All hope is not lost. Keep on track because Trump, etc will most likely take a while to push anything through with the ACA. There is a chance that they may have to grandfather some people under precious coverage.
-what's your BMI? I had a 6 month requirement and my BMI was over 50 and I was approved with only 3 or 4 months of the dirt.
-There are the 2 appeal gurus on these pages who have helped many people succeed in the appeals process.

So keep on keepin' on, and see how things progress. Good luck!

 

[Butterfly]

@Jen2016
My BMI is 56 and my blood pressure has been kicking up a fuss lately. My nurse practicioner has me on 3 meds right now to see if we can get it down. I have sleep apnea and GERD as well. Most likely PCOS.

I'm going to keep my fingers crossed. Maybe it'll be a bit before I get kicked off

Thank you! You've given me a bit of hope. I love the sound of appeal gurus, maybe they'll take pity on me.

 

[Larra]

We aren't gurus, but we have helped some people. If you haven't already, get your EOC (evidence of coverage) which outlines both your criteria for bariatric surgery, including revisions, and also your appeals rights, if any.
There is absolutely no proven benefit from the pre-op diet requirements. It's just a barrier to necessary medical care. If you do need to appeal you can argue this, and @DianaCox has the official statement from the AMSBS to that effect, but insurers are not legally required to make their criteria evidence based. They can and do include such requirements just because they can.

 

[Jen2016]

@Jen2016
My BMI is 56 and my blood pressure has been kicking up a fuss lately. My nurse practicioner has me on 3 meds right now to see if we can get it down. I have sleep apnea and GERD as well. Most likely PCOS.

I'm going to keep my fingers crossed. Maybe it'll be a bit before I get kicked off

Thank you! You've given me a bit of hope. I love the sound of appeal gurus, maybe they'll take pity on me.

You can do this! And just remember to keep fighting!! No one cares more about your health than you!

 

[Butterfly]

We aren't gurus, but we have helped some people. If you haven't already, get your EOC (evidence of coverage) which outlines both your criteria for bariatric surgery, including revisions, and also your appeals rights, if any.
There is absolutely no proven benefit from the pre-op diet requirements. It's just a barrier to necessary medical care. If you do need to appeal you can argue this, and @DianaCox has the official statement from the AMSBS to that effect, but insurers are not legally required to make their criteria evidence based. They can and do include such requirements just because they can.

I will do that. It's worth a shot! Thank you so much.

Have a good holiday, all.