Attacked for hating diets and MY surgery choice.

Since you live in CA, if you qualify for WLS, you can get the DS.  The CA DMHC will OVERTURN denials of the DS almost without exception.  They are making KAISER pay for them!  You have no idea how lucky we are to have such a great consumer insurance agency in this state. The short version: have your husband do what it takes to get qualifed for WLS in general (probably RNY).  If they want him to do a six month diet, appeal to the DMHC to get that waived.  After the approval for the RNY (or before, so you have it in hand when you get approval), pay out of pocket for a consult with a DS surgeon, and get a letter recommending the DS over the RNY.  Present to the insurance company with a request for the DS.  They deny, you appeal, they deny again, you appeal to second level review, they deny, you appeal to the DMHC and get the denial overturned. Pain in the ass, but it costs THEM money, puts the DMHC on notice that they are misbehaving and you will win, and make them pay.

Thanks,  Lisa... ... Sheesh! Been going through my formally corrupted database here and just now caught this. ...So.... Just a slight correction on what Diana proffered below regarding your husband where she writes as follows: "...If they want him to do a six month diet, appeal to the DMHC to get that waived..." I'm quite sure Diana intended to substitute the word appeal with grievance here on the diet requirement. Hell, she's the one I stole the concept from, but that doesn't stop me from taking some delight in correcting an attorney, any attorney when I get the opportunity, even one as capable, bright and helpful as she has been to the WLS community. That's indisputable even if some may have issues with her advisorial approach at times... For any health plan diet requirement here in CA your hubby needs only  to file a grievance DIRECTLY with the (CA Dept of Managed Health Care), hereafter, referred to as the (DMHC).and not an appeal.  Not hard, and rather streamlined in terms of the usual appeals process which Diana outlines correctly for your hubby here.

In essence hubby only needs to get the grievance forms from  DMHC and move directly to that process. Here is the DMHC document that establishes that there is no proper basis for requiring a diet: http://www.hmohelp.ca.gov/boards/cap/bariatricrev.pdf SUMMARY CONCLUSION There is no literature presented by any authority that mandated weight loss, once a patient has been identified as a candidate for bariatric surgery, is indicated. There is a mixture of results that question whether weight or truncal obesity is a risk factor for complications after bariatric surgery. The more analytic studies have not found that body mass index (BMI) or total weight is an independent risk factor for complications or death from bariatric surgery. No institution that has recently published data on bariatric surgery describes a protocol requiring weight loss between identification of the need for surgery and the surgery. Many institutions in California have published results of surgery with particular focus on factors that contribute to morbidity and mortality. No paper from a California institution mentions mandated weight loss before bariatric surgery. Nor does any literature regarding the treatment for the morbidly obese recommend continued weight loss during the period between identification of the need for bariatric surgery and the surgery. Mandated weight loss prior to indicated bariatric surgery is without evidence-based support. Mandated weight loss prior to indicated bariatric surgery leaves the patient at increased risk from the patient’s comorbidities. Mandated weight loss prior to indicated bariatric surgery is not medically necessary. Mandated weight loss prior to indicated bariatric surgery would be deviant from the standard of care practiced in the United States and other published countries. The risks of delaying bariatric surgery, while not entirely known in the short-term, are real and can be measured. Any potential value of losing weight prior to bariatric surgery is theoretical and not supported by any data. An experimental study including fully informed consent to determine if there were a reduction in risks or other benefit from mandated weight loss prior to bariatric surgery is indicated. You can see these diet requirement overturning decisions yourself http://tinyurl.com/42om93 mixed in with others. But these were in the form of external appeals which is not needed for eliminating the diet retirement . Hope that helps and good luck, but you and hubby aren't likely to need any luck getting his DS approval, especially, here in CA. Rock

Count me in the list of recent pre-ops who have been helped by Rock's information. I was too scared to even consider the DS until Rock gently insisted that the popular idea that the DS was an outdated procedure is not supported by current medical research. Thanks, Rock

Feel better now that you have put me in my place and made me look bad for the Cali board? Whatever!!  I do NOT regret my surgery choice either and if eating all those bad foods that got us here in the first place makes you happy, then have at them!!! That is not why I had WLS!!!  Everyone just needs to do their research and make the best decision for themselves, which is an individual thing between you and your surgeon!  And then whatever surgery you choose, you have to do your part in making it work! It is only a tool and you have to work it right! Not just so you don't gain the weight back, but because your life depends on it!!!  If you were attempting to chase me from the Cali board, you failed! I'm here to stay and I really don't care what anyone thinks about what I said, I'd say it again!!! Hope you feel better! have a good life, Becky

Hi Sweetie!  I have to say that I fall on your side of the coin with this issue.  I did not see what you wrote before, but I did notice that I was not answered by Diana OR Rock when I asked about the healthiness of eating food like Rock insists they eat or the fact that their **** does stink, and wayyyyy worse because they are passing undigested, rotten like food.  Before I get jumped on by DSers, I had a consult with a doctor that they, the DSers, deem to be like a God, Dr. Ara Kesishian (spelling??) and when I asked him about the stinky **** his EXACT words were, "You have to make a choice - you will have bowel movements that are offensive due to their odor if you choose the DS.  If you don't like this unpleasant side effect, the DS is not for you."  This is exactly why I chose the RNY. Don't let anyone chase you away, honey, cause we gotta do Vegas, baby!! Much love and hugs to you! Jillie 

Thanks sweetie!!! I did see your post and meant to send you a thanks! And as for the smelly gas, OMGosh, I have been around it personally and it is HORRID beyond words!!! And I could NOT live with that on a daily basis!!! And as far as whether they dum*****t, the DSer I know very well, has what she calls "DS dumps" and I have witnessed them many a time, so they do happen.   I'm not going anywhere and can't wait for Vegas Baby!!!!   How are you feeling sweetie?  much love and hugs back at you, Becky

Morning, Becky, Hope this finds you having a lovely enjoyable holiday weekend in spite of the rather odd weather we seem to be having. Can you believe the winds the last few days? Say, I came across a post that Lola of CO uses liberally here and there and did so in two parts in contributing to our thread- http://tinyurl.com/4laxun -over at the R&R board. In a very elemental, common sense way it delineates how we come to WLS from different perspectives and subsequently make our choices without conferring mostly, but for the dry statistics, one surgery choice is better than another. More importantly, I think it supports some of the excellent points you and Jill have tried to put forward here. You’ll note that Lola had responses to similar threads posted elsewhere where it helped pre-ops decide in FAVOR of getting an RnY,hence supporting more your WLS worldview. And it does so with clarity my skills at writing are woefully lacking in. Take it for just some added clarity or even an olive branch if you will, but I hope at the very least it goes to making clear we are all entitled to the dignity and respect for the choices we ultimately make. The “combined” posts read as follows: ------------------ Yep -- 'twas really said... word for word.  Actually, the entire list was taken directly from a couple of RNY vs DS threads.  Every single statement was quoted.

Funny thing is, I've had RNYers tell me that this list helped them to solidify their decision to get the RnY... as I said, it is in the attitude.

I made this list, not to slam anyone's surgery choice but just to point out how differently we can look at the same thing:

RNY - I got the surgery so I'd dump and the fear of that would keep me away from sugar.
DS - I got the surgery so that I wouldn't dump.

RNY - I needed the restriction to correct my relationship with food.
DS - I didn't want the restriction because I want to enjoy my relationship with food.

RNY - I wanted/needed to change my eating habits.
DS - I've dieted my whole life -- I want to quit dieting.

RNY - I'm sick of dieting and failing.
DS - I'm sick of dieting and failing.

RNY - I want a tool that I can work.
DS - I want a surgery that does the work.

RNY - I didn't want to be able to cheat the surgery.
DS - I want to be able to 'cheat' from time to time.

RNY - I want to be healthy.
DS - I want to be healthy.

RNY - I didn't want someone cutting off my stomach.
DS - I don't want a blind stomach.

RNY - I don't want to have to eat massive amounts of food.
DS - I want to be able to eat what I want.

RNY - I needed to change my habits.
DS - I've been trying to change my habits my whole life!

RNY - I never want to eat sugar or fat again!
DS - I don't want sugar and fat to be 'off-limits'.

RNY -- I want the convenience of a close by surgeon.
DS -- I want the convenience of a one-time surgery.

RNY - My insurance would only pay for the RNY.
DS - I fought my insurance long and hard for what I wanted.

RNY - I need to not eat fat because of my high cholesterol.
DS - I need to not absorb fat because of my high cholesterol.

RNY - I didn't want to risk that much malabsorption.
DS - Based on my own diet history, I knew that I needed the added malabsorption to keep off the weight.

RNY - I need help to lose weight.
DS - I'm great at losing weight, what I need is help to keep it off.

RNY:  I know what's best for ME.
DS:  I've seen the revision board, and people don't always choose
what's best the first time.

RNY:  Published, peer-reviewed studies are rhetoric.
DS:  I based my decision on statistics from published, peer-reviewed studies.

RNY:  You can't know anything about a surgery unless you have had that surgery.
DS:  I can know the likely results and complications of a surgery even if I'm pre-op because I did my research.

RNY:  There's no need to put down other types of WLS.
DS:  Statistically the DS is best and comparing and contrasting with the other surgery types is the only way to promote it effectively ------------------
Take good care, Rock Video courtesy of Fat G. http://s230.photobucket.com/albums/ee217/dsfatG/?action=view¤t=DS.flv

My apologies, Jill and to anyone else I haven't got back to.. I wanted to respond to your very reasonable queries sooner. Lots going on here professionally and I just don't have those mad skills at multitasking that I suspect you do. Oh, and as for me, for what it's worth, I did have slightly more flatulence Post-Op until I boarded a late train on a good probiotic. Actually have far less now than I did Pre-Op and odor?? Well, about the same or better than Pre-Op now. Go figure, but I'm believer even though I am well aware probiotics don't always do the trick alone for everyone. I actually had more of an issue with short-term belching Post-OP after meals which is also virtually nonexistent now. Bowel movements are well formed to slightly looser with higher fat intake days. Never diarrhea, but for the very few times I have labored under a viral gastroenteritis or food poisoning. I usually go twice in the AM and occasionally once in the PM. Here's a thought to dispel some of this mythology. Lets make it a competition. All of us malabsorbtive surgery types decide on a mutually agreed to panel of  judges for us to mail in fresh, well persevered samples of fecal matter with controls on diet the day before for all participants. Who among us offends the most? Can you take the heat? Just-a-wondering Rock

Jilliecats, Did this paragraph Rock wrote escape your grasp?  I believe he answered your question about the unhealthiness of eating the DS way right here: "Your reasoning that we might possibility still be unhealthy and thin eating so called bad foods would seem completely logical based on people’s normal anatomy.  And we can be unhealthy if we don’t supplement, get enough protein in and keep abreast of our labs. But remember, we DS’rs don’t absorb 80% of the fats we ingest. That 80% passes right through the GI tract without ever getting into blood stream. And it’s crucial we all get some degree of fats in our system. Fat is part of every cell membrane in the body.  It helps transport nutrients and metabolites across cell membranes. Your body uses fat to make a variety of other building blocks needed for everything from hormones to immune function. And, yes, to a degree, the right fats  keep our arteries healthy but also for prostaglandular activity. Prostaglandins are a family of hormones that help control things like fertility, inflammation, immunity and communication between cells."
It is not that DSers are passing as you call it  "undigested, rotten like food" - it is the FAT that is being malabsorbed ... it never gets in the bloodstream, so it is as if it was never ingested.  So even a full-fat version of a fatty food (milk, cottage cheese, salad dressing, mayo, etc) is as if DSers have eaten the LOW FAT version.  I've never seen ANY undigested rotting food in my poo (except for the day after corn on the cob, which of course, even non ops find in their poo!) And, as Rock explained, every body NEEDS some fat to support cell activity. Oh and Dr. K?   Dr K is Dr K.  That's all I'm sayin ... But here is MY real life experience as a DSer ... I am 3.5 years post op DS and my kids say that DH's BMs still smell worse than mine and DH has NEVER had any surgery.   So for pre ops  in the researching stage reading this, remember having a DS does not automatically mean a life of poo that is stinkier than a RNYer.  But yes, my poo is stinkier than pre op.  But then again, I go when I get up in the a.m. and I'm done for the day.   So it doesn't impact my life. Laurie

Laurie,  Did it escape your grasp that the paragraph was written to answer my question, not before I asked the question? Congratulations on the ability to have non stinky poop.  I am glad that you chose the surgery you did and wish you all the luck in the world.  I seem to be getting along just fine with the surgery I chose.   Happy Memorial Day and remember all the fallen who gave their lives for the freedoms we are expressing here and now. Jill Harper