Plastic surgery

Hey ya'll, Does anyone know for sure about whether Medicare will ever pay for the plastic surgery needed after this procedure. 207 lbs in 15-1/2 months does not leave a pretty picture. I know they won't "pre-approve"--they didn't the gastric surgery, but I already knew they had paid for the surgery for others. I need to know if anyone knows of any time (and the cir****tances) where they paid for the plastic surgery. I have not experienced much on the skin breakdown b/c I am very careful to take care of myself. However, the skin over the sides of my bra is getting really sore--almost like being bruised--not to mention the 3-1/2 inches of skin hanging below my upper arms and the skin that lays on my eyelids now. I'm hoping my working out 3-4 times a week will help w/the thighs that want to lay on my knees (really fun on the one that was replaced in January!) and the butt that wants to slap the back of my thighs every time I move, but the rest, I am afraid, is hopeless, barring a true miracle. Not a pretty sight, I'm afraid . Thanks for any info. Blessings, Cyndi

Hi, I am afraid that I have bad news for you. At least the last I heard. Unfortunately even the GBS is still in many area considered "cosmetic elective" surgery. That is changing slowly. Drs. and ins. companies are starting to realize that when a pt. weighs 100#(or more) over a healthy weight for their ht. , age etc. that they are going to have many other health problems. Not to mention the fact that pts. who weight that much can't even get around easily. However even though thoughts on the GBS itself are starting to change most people I have talked to or heard about say that medicaid, medicare and ins. co. are of the mind that the plastic is strictly cosmetic. That the pt. has lost the weight so their health should improve. But the extra skin(on abdomen, thighs, back of legs and butt), breast reduction/lift are cosmetic. They think this because they say that no extra helth benefit is gained from removing the skin etc. I think they are wrong though. they are not considering the pts. mental health. To have gone through as much as we have to even get to the point of needing plastic surgery definately affects our psyches. I know it is very depressing to look at all the skin just hanging there. I also read an article written by a plastic surgeon who said that when there are large amounts of hanging skin, that fat gets sort of trapped in the folds. That then the pt. doesn't lose that fat. It just sits there. Which in the long run can't be good physically or mentally.I understand exactly how you feel. It took me 4 years to find a veterans hospital that was still doing the GBS. Then I had to get them to accept me as an out of area pt. I live in Seattle. They do not do the surgery or the plastic surgery here anymore. I finally found a surgeon at the San Francisco VA who was still doing the surgery and was willing to accept me as a pt. whihc was quite a feat cause I am on methadone for opiate addiction. I was acccepted to the Portland Or. VA until the Dr. found out I was on methadone. Even though I had not used any illict dugs on over 3 years back then.He said I probably wouldn't be able to make the necessary behavioral changes. Boy was I angry. I told him I had made more behavioral changes to stay clean for that long then manay pt.s will ever make. So I was turned away 2 days before my surgery. But I digress. S.F. did accept me. The surgeon did know about the methadone and actually medicated me way over what I thought she would. She gave me Morphine at ahigher dose then most pt. can even take. I got it more often. I had it in the epidural, in the PCA machine, plus she ordered an extra Morphine shot every 30 min. if I needed it. Anyway I know you didn't ask all of this. I am sorry I am rambling. So I had my surgery 12 mos. ago. I am 5'5". I weighed 330# prior to surgery. I now weigh 166#. The one bad thing that happened when I had my surgery(other then being in the most excrutiating pain of my life) was that in the open RNY there is a very big incision. They use staples to close an incision that size at the S.F. VA. My Dr had no way of knowing this, cause I didn't know. But I was allergic to the staples. I started to get an infection. Because of that the staples had to come out the same week they were put in. I still had to cough etc. to clear my lungs. Even with steri strips and 2 binders on when I coughed I opened about 1/4 of in. of my incision. It was very tiny. The docs checked me and steri striped me again. We thought it was fine. It healed great on the outside. But evidently the tiny opening didn't close on the inside. because of that I developed this huge(and I do mean huge) hernia in my upper abdomen. I have been waiting till I lost enough weight. My surgeon said if I could stand it, and I held on till my weight was almost at my targeted amoun t that she would have the plastic surgeon in the O.R. too to do my tummy tuck. So that is happening next Thurs. The part I am upset about is this plastic surgeon said he willnot do my thighs. He said that they have had pt. who got infected due to the area that has to be opened.Whihc of course is the groin area. He said since we prespire there it is a very "dirty" area. And is very hard to keep clean and dry. He said in about 6-9 mos.He will do the breast reduction/lift and maybe he will feel better about doing the thighs by then. He evidently is a good plastic surgeon. My doc in Seattle always checks out the Drs. in S.F. everytime I have to see a different one. She said he has an excellent record. I also know that private Drs. do this surgery all the time. It is called "body sculpting" when they do everything but the breasts. They must have good results or no Drs. would do it. So I can only concur that because he isn't getting paid for this, at least not like if he was a private Dr. he doesn't want to do the more difficult of the surgeries. I was informed that he has a private practice also. If you could see my thighs and the back of my legs up by my butt you would be grossed out. The skin if just horrible. So I really do understand how you feel. Even though I am at least getting the tummy tuck I am still depressed. I knew that I would of course never wear a bikini or maybe not even a 2 piece at all. But I used to be a lifeguard and swimming instructor and was really looking forward to wearing a bathing suit and being able to take my 5 yr. old grandson swimming. He is disappointed every summer because I won't get in a bathing suit and take him swimming. My daughter said I can just get some "board" shorts. Those are made out the same material as a windbreaker is. Surfers and boogie board and skim board riders wear them. But my thighs are bad practically all the way to my knees(well like 3 inches fomr the knee). So I can't even wear those. It is depressing when you work as hard as I have to lose the weight. As hard as I am sure we all have worked. I ofucrse feel 100% better. I am still very glad I had the surgery. I would just like the rest of the procedure that I started to be done. I have a 30yr. old son. He has a very dry wit. He is a great kid. when I was worried about having the GBS. Then wondering if I had it what about the plastic surgery. He "Mom you have 2 choices. YOu can look bad(meaning I could look big) with your clothes on and your clothes off. Or you can have the surgery and look bad with your clothes off by great with them on". So I guess when I look at it that way , he has a point. Not to mention that fact that I can walk about 5 miles a day now(2.5 each way) I can actually shop in a store that does't have baskets for me to lean on. I was beginning to think I would never shop anaywhere but K-Mart, because they have baskets. It was horrible. So all in all I have had a positive experience. I also got the name of a plastic surgeon who does all the rest of the surgeries I mentioned. He is at a VA in I think Wadsworth, CA. The VA will send me there if he will accept me as a pt. So we will see. I hope you get the plastic surgery approved Cyndi. One piece of advice. Since I am 100% disabled due the posttrauamtic stress disorder I developed in the Navy medical corps I have to deal with the government all the time. I usually get accomplished what I need to with them. but it takes a lot longer than dealing with "civilian" companies. So my advice to you is that if you are going to try and get medicare/medicaid to pay for this surgery, go to the plastic surgeon. Get the referral for the surgery you need. Have the surgeon send the consult in to medicare. And if it were me, I would have the surgeon list any physical problems this could cause if left not done. Then if you can, also if it were me I would go to see a psychiatrist(MD or PH.d) counselor orsocial worker who has a masters degree and therefore does psychiatric counseling. if a mental health professional says not having this plastic surgery is causing you significant mental health issues. That will also help. Again I am sorry for the info you didn't need and for the general rambling message. Because of my PTSD sometimes my thoughts get fragmented and switch from one subject to another. I wish you good success. Keep us posted. Cindy(from Seattle)