Encouraged/Bummed

I went to see the plastic surgeon today for my six-month follow-up re: Blobby. My follow-up went well, so I started asking about reconstructive surgery.  He said a tummy tuck would be fully covered if my BMI gets to 30-31.  Otherwise, it will cost me around $8100, which is not outrageous in terms of medical surgery, but it might as well be 8.1 million. I figured I'd need to lose 20 lbs to get to a BMI of 31, but after talking to my WLS counselor, it looks like I'll have to get to 180 in order to have a BMI of 30.8.  Sigh.  That's 40 more lbs.  How on earth am I going to lose 40 more lbs this late into the game?  This feels more daunting than losing the first 300 lbs. My WLS counselor was surprised that my BMI needed to be at 30.  He said, "You've already lost so much weight!"  He thinks 40 more lbs is doable, but not easy. It might be easier to either start saving or grow four more inches.  BMI charts discriminate against those of us who aren't 6 feet tall. My plastic surgeon was really nice today, not at all a butthead like he was last spring.  He gave me a lot of praise about getting off the O2, etc. Kix

Oh Kix,

I am sorry about your day..but try and think positive...40lbs.!!!.. how many times have you crashed dieted and loss that much weight.  I mean some people may disagree with me, but to be able to get your surgery covered by your insurance..it may be worth it. Of course maybe waiting until after the holidays would be wise. Whether or not you go through with the surgery, You a major sucess story,Y our life has surely improved, and you have truly been an inspiration to many. Keep your chin up.. Lynn

Lynn, thanks for the kind words.  To be honest, I didn't expect Kaiser to even consider covering it at all.  In the time since I had WLS, many of their plans have changed so people now have a 30% copay for WLS.  I didn't, all I had to pay was my $350 inpatient copay.  Now that so many people have had WLS and want reconstructive surgery, I'm sure that's why they have the BMI requirement in place. What bummed me out was the thought of needing to lose 40 lbs!  20 sounds doable, but 40 sounds insurmountable.  I haven't given up, though! Kix

I have absolute faith that you can lose another 40 pounds if you decide that's what you want to do.  Sure it'll be harder and slower than losing the first 300 pounds (ironic, eh), but you can absolutely do this.  My weight loss ground to an almost standstill around 15-16 months out.  I struggled for a few months and almost decided that 220 pounds was going to be my lowest weight.   At my 18 month follow-up appointment, my doctor said something that gave me the motivation to keep trying.  What he said was that, up to that point my weight loss was largely governed by my surgical restriction.  If I wanted to continue to lose, he said I was going to have to work for it; keep track of my calories, continue to exercise, keep up with the fluids, etc.  But that how much I lost was really up to me at that point.  In the old days, I would have been disheartened, thrown up my hands, and headed for the nearest Snickers.  But by then I had learned that I could control what I put in my mouth, and that eating healthy was a great thing.  So I just kept doing the right things.  Is the weight loss slower than molasses in Alaska in January?  Sure.  I've only lost 30 pounds since last December, which seems almost inconsequential considering that I'd lost 174 pounds in the preceding 14 months.  But losing that 30 pounds feels pretty damn incredible to someone who has been obese since she was 5 years old.   If you want it, you can achieve it!!!!

Kellie

Kellie, I've got you beat.  I was born two months early, so my mother decided the only way for me to survive was to feed me whenever I wanted to be fed.  I was fat by age 1!  My WLS counselor said he thought it would take me a year to lose 40 lbs, along with a lot of hard work.  He's also going to have my resting metabolic rate tested to see if I burn anything at all unless I run like a rodent on a wheel.   It shouldn't be as big a deal as I'm making it, I guess it just caught me off guard.  My personal WLS goal has always been "under 200 lbs" and now I have a concrete number to aim for (180), which is a bit disconcerting.  Of course, I've never shied away from a challenge, so perhaps this is meant to be. Kix

I had my resting metabolism testing back in May by New Leaf Fitness; I was running at about 2000 calories per day.  According to my body composition monitor, my metabolic rate is around 1750 right now.  I think that's a little low, since it's just calculating based on my body fat/skeletal muscle/weight; the New Leaf testing was based on the gas-exchange rate in my breath.  (I don't understand all the science, but I was told it's one of the most accurate testing methods.)   One of the fitness folks at my gym was telling that doing interval training is supposed to help bump up your metabolism.  I haven't had time to look into that in more detail, but perhaps you want to check into that as well.   Keep us posted on how you're doing - you can do this :-) Kellie

Kix, I was going to ask why the PS couldn't request an exception to the 30-31BMI rule (if that's the insurance company's rule, not his) because 1) you have already far surpassed the statistic for expected surgical weight loss outcome, 2) have "stabilized" for "x" number of months, or 3) the other health reasons surgery is needed. I read Kellie's reply, and now I understand how weight loss can go beyond what we are told to expect, and how so many of you lose such huge amounts. So I'm not sure my thoughts are even relevant, but I wanted to throw them in as a means of support. When you get some time, can you explain why us tall folk get off easier with the BMI charts? Isn't BMI, BMI? -Julie

Julie, I'm not sure why Kaiser uses a BMI of 30 as a cutoff (no pun intended), except perhaps to keep from having to operate on every person who has had WLS.  I plan to investigate further, and see if perhaps an exception can be made.  I had to fight to get WLS, and I'm not sure I'm up to fighting them again for plastics. Tall folks have it easier in terms of BMI because height is part of the equation they use to figure out one's BMI.  If I was 5'9", I'd only need to lose 10 more lbs to qualify for plastics.  Alas, I'm 5'5". Kix

I wonder if other plastic surgeons would say the same thing?  Is this an insurance FACT or just something he thinks?  I'm sure if you fight it enough you could get it covered.  Or you could think about Optifast or something like that again?  I just don't see how someone whose lost so much already and is stable would be turned down right off the bat.  Good luck! Either way, I have no doubt you could get that last 40 lbs off if you were determined to.  Look what you've already accomplished!

Dunny, I wasn't exactly turned down.  The PS said it would be a covered benefit if my BMI was between 30-31.  It's a Kaiser thing.  They are more than happy to operate as an elective procedure. When I want to get my arms and boobs done, it will be out of my pocket, since there is no medical reason for either procedure.  He isn't as confident about the thighs -- he said thigh PS is tricky and none of the Kaiser surgeons are very skilled at it, so if he did the thighs, he wouldn't take a whole lot off other than excess skin near the knees. I appreciated his candor today.  How many docs would admit they aren't skilled at something? I have always thought about going to Brazil for plastics, I would just prefer to get it done here at home if I can find a way to do it.  Although a trip to Brazil sounds pretty good to me! I'm thinking about doing a protein drink diet (not Optifast, though, too much sugar) for a week to see if I can stand it, and if it makes a difference.  I get a tasty protein drink from Wally's (EAS low carb protein) that is 110 calories per serving. You're right about one thing, I can do just about anything I put my mind to doing.  What I need to do is find the inner reserves to git-r-done. Kix