Mixed feelings - husband getting "PS"

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DianaCox

Bad Cop
Joined
Dec 30, 2013
Messages
6,351
Location
San Jose
For a "manly man," my husband is oddly self-conscious about his body. He was unusually tall and extremely skinny as a kid, a teen and a young man (and teased about it terribly), and then in his 30s-40s went from 130 to 250 lbs on his 6'+ frame.

When I had my DS, he simultaneous discovered that he could tolerate Coke Zero to feed his Coke habit (3 or more Big Gulps/day). He dropped 30 lbs in almost the same time I did, just from that change. Jerk.

He stayed around 210-220 most of the time after that, carrying essentially ALL of his excess weight intraabdominally (not good for someone with a family history of diabetes).

Charles has had an umbilical hernia for several years. Last summer, he was doing sit ups with our trainer when he was horrified to see that he had a huge ridge of belly just off center and above his belly button sticking up like a mountain range when he tightened his stomach muscles - it was a diastasis recti (the same thing that pregnant women get from the overstretching of the stomach wall).

He saw the general surgeon last summer, who said the umbilical hernia needs to be fixed, but the diastasis is considered cosmetic. He decided he wanted it fixed anyway - and I said I didn't have a problem paying for that, but the surgeon said he would not get a good cosmetic outcome unless he lost some of the belly.

That advice, combined with some dire warnings about diabetes and sleep apnea I made sure he heard, and a bad bout of post-upper respiratory infection asthma that lasted for months, apparently motivated him to actually buckle down and lose almost 30 lbs over the last several months and - hallelujah! - to quit smoking.

Also over the last several months, an inguinal hernia repair with mesh he had about 11 years ago was bothering him, and he decided he wanted it revised - and, perhaps, while the doctor was in the neighborhood, some FUPA-suction.

So, back to the surgeon we went, armed with some additional information - that sometimes, if you repair a diastasis at the same time as an umbilical hernia, you can avoid putting mesh in the umbilical hernia, and thus it MIGHT be covered by insurance. Amazingly (to me), the general surgeon somewhat agreed that that was a good idea - but deferred to sending Charles to a plastic surgeon, who would be the one to do the diastasis repair.

We then switched to discussing the inguinal hernia scar revision - and got a bit of a rude surprise - it was hurting him not because of scar tissue, but because he had torn a new hernia just under the edge of the mesh - and it REALLY needs to be repaired. Again, with respect to the simultaneous FUPA-suction, she deferred to the PS. She also wasn't sure about doing that much surgery at once (mostly because it is in two different places, and the inguinal repair is done lap, but of course the umbilical and diastasis repair means lifting up the entire skin of the abdomen.

Monday, we saw the PS. He too thought it was a good idea to fix the diastasis and umbilical hernia together, and took a look at the inguinal hernia and then the FUPA - and he said no way Jose - FUPA-suction in the presence of mesh in the area is a prescription for infected mesh.

SO - my husband may get his tummy "tucked," and covered by insurance, while I keep my saggy belly. Due to the way they do the diastasis repair, he might end up with a little bit of a FUPA lift in the process anyway

We won't know for a while, because I told the insurance person to NOT submit the procedures separately (which they were about to do) in order to make it clear the PS procedure (diastasis) was part and parcel of the umbilical hernia repair; I also told them to let me read what they are submitting before they do, so I can "fix" it if necessary. He doesn't see the general surgeon again until September 3rd, when she will put in her part (the two hernias) - but I want both procedures to be submitted to the insurance company TOGETHER, so we won't know if this worked for a while. He's already scheduled for surgery for Sept. 23rd.

And dontcha know, incidental to a CT scan I had last month, it turns out I have an incisional hernia that may need repair too - but I am in no shape for any plastics weight-wise - not worth it, so I'm going to try to put it off if it's safe to do so. I guess I'm going to have to catch up to how good looking my hubby is going to be after he gets his internal corset! I wonder if that will motivate me (including that he now most annoyingly weighs less than me again).
 
I hope he gets what he needs and so do you.

it's terrible people get teased for being skinny, I used to work with a very thin woman who heard that crap all the time. what is wrong with people!
 
Hoping you both take it easy until you can get your respective hernias repaired. I've got to say I *hate* mesh, so wonderful if he can avoid (more of) it by getting the diastasis repaired. I hope you get a tuck with your repair too, if that is what you want!
 
I've seen pix - he looked like a cross between a giant lollipop with horn-rimmed glasses and a vulture pose (giant noggin, neck projecting it forward). Doesn't make it right, but he was odd looking - he is one of those who has gotten better and better looking as he's aged.

Actually, we both have - this is Jan 2002, not at my highest:
incyteparty-jan2602.jpg


Even in his wild habitat, not posing - well, sticking his tongue out at me:

10524597_10152257796791173_7995647718973488086_n.jpg
 
You both look great then and now.

There is nobody better then you Diana to have on ones side both as a partner and an advocate.

Big brain bigger heart!

Best,
Whit
 
I like that he seems to be a little bit sassy. And I agree, you are adorable together. Mostly, though, you sound like you are enjoying each other, and that's something to be proud of!
 
With his tender bits and pieces, I'm going to have to do a bit more of the physical stuff on our RV trip that starts tomorrow. Could be interesting. But I'm NOT doing the sewage part, even if it's mostly mine.
 
UPDATE: So, of course nothing went smoothly the last few weeks.

First, the general surgeon had to cancel his pre-op appointment Aug. 22nd. As I said, I had asked the PS not to submit his request for preauthorization until after the pre-op appointment (since the general surgeon had to first consult with the PS, there was that extra appointment), so that ALL of the procedures being done by both surgeons were submitted together. So the appointment was rescheduled for Sept. 3rd, and this time WE had something come up at the last minute and couldn't go. So then it was rescheduled AGAIN for the 10th - 13 days prior to surgery. At that appointment, I asked the surgeon to check out another "PUFA" lump on the left, and sure enough, it appears he's blown yet ANOTHER hernia - may as well be in for dollar as in for a dime, right?

At that point, I asked the general surgeon if I could write her a "script" for dictating her progress note that was going to be submitted with the diagnosis and procedure codes for preauthorization to the insurance company, together with the same from the PS, in order to use "magic words" of medical necessity of the abdominoplasty, and then asked that the insurance submission people NOT submit the combined request for preauthorization until I reviewed it.

Tuesday, they called me back, and she used my script to dictate her notes and said there was medical necessity - but that's when things got interesting. The PS used the CPT code for abdominoplasty - which covered THREE procedures: lipectomy/liposuction, skin reduction, and plication of the diastasis - in other words, a tummy tuck, which is a cosmetic procedure. BUT THERE IS NO SEPARATE CODE FOR THE PLICATION, WHEN THAT'S ALL THAT IS GOING TO BE DONE, as part of an umbilical hernia repair, in order to avoid mesh and decrease the likelihood of recurrence of the umbilical hernia (well, that and the fact that they are removing his belly button). So, I corresponded with the PS, and asked if there was ANY other way to code it, and he said he didn't know one.

I've spent the last two days on the phone, multiple times per day, with both the medical group insurance department and our insurance pre-certification group (in Maryland, so 3 time zones ahead), trying to get people to speak to me, so I can explain what the purpose of the procedure is, to make sure the reviewers understood that this was NOT cosmetic, even though it is using cosmetic CPT codes (and there ARE no others). Mid-afternoon today, I heard from the medical group insurance coordinator that the insurance company was asking for MORE information including pix - and that's when I found out that the pix that the PS took WERE NEVER SUBMITTED to the insurance coordinator. ARGGHH!! Finally, at 4:30 her time, the insurance company nurse/reviewer called me and said that she still didn't understand - so I explained it to her, and then she said, OK, I'll have to take this to the medical director FIRST THING MONDAY AM. I was FURIOUS - his surgery is scheduled for Tuesday! There are two surgeons and an anesthesiologist involved, the operating room, the overnight stay, me being there with him, and ALL the stuff that's coming up in the next few months that depend on him healing from the surgery first! If they have to cancel the surgery because it wasn't approved in time (or the plication isn't approved at all) that could move things out another month or six weeks at least!

I may have hissed at her. I explained, again, how important it was to get this reviewed, PROPERLY, right away, and asked her to call me ASAP on Monday.

An hour later (5:30 her time, on a Friday), she called me back, and said she got it in front of the medical director and it was approved.
:bacondance::banana::danc::s1gyahoo:

We can now start preparing for his surgery in earnest. He spent the day emptying and removing a dead water heater from the pool house, and will be putting the new one in tomorrow, so maybe he can rip one more body part by Tuesday.
 
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Ugh! What a pain in the neck! Glad you got the preapproval in time! How many hernia can there be? Have you addressed what might happen if they go in and think mesh is necessary?

For what it's worth, I've been working (mainly) since a 5am conference call this morning and am getting a bit bleary-eyed, so apologies if I'm off base, but a bit worried about just diastasis repair for all that. I had one along with a panniculectomy when I was SMO and it all came loose again and again. I've had so many people in there now, I need a zipper...

Wishing you the best. Glad you have one thing you can cross off your list. Now on to being an abdominal surgery patient caretaker. It's a tough week ahead, I'd guess. BEt you'll find a way to make it fun!
 
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