Newbie and Medicare question
Hi everyone. I have been lurking on the sites for some time and have a few questions to conflicting info. First about me: Im 38 and have a bmi of 45 I have been obese since I was 16. My comordity's are high cholesterol, headaches, treated depressionand hypothyroidism (currently stable). I am interested in the ds after doing alot of research. I am currently on regular medicare a and b. I have a meeting with Dr Oakely in Boise on may 30. I have already attended a seminar. The information that I have run across: Must have a BMI of >40 or a BMI of 35> with comoridity. Some sites have stated that must have a BMI of 35> with 2 comoridty's period. Some sites state that with medicare you don't need a medical supervised diet while others state that you have to have anwhere from a 3 month to 2 year diet. All sites state that you need a psych eval and go to a center of excellance which we have right here in boise. All sites state that Medicare doesn't pre authorize anyone. I have tried a couple of times to talk to someone at Medicare but am getting knowhere. Like everyone else I have tried diet and lifestlyle changes for years. I have tried over the years to have a doctor do a medically documented diet but am only handed a packet of papers, told to follow the information and if I work hard enought the weight will come off, but then i am on my own, needless to say i have gone to fewer and fewer PCP as I keep getting basically slapped in the face. I even tried to talk to a new PCP earlier this month and was told straight up that I wasn't working hard enough and to stop cheating. Im so ready cry and feeling so defeated and such a failure. Anyways that was my woo woo moment. Here are my questions:
1. what is the standard ds bmi
2. do you need to have a medical supervised diet or will somehting like weigh****chers do for those with medicare. if you do need to have a supervised diet with someone in your surgeons office follow you if you are having trouble getting a PCP to do so
3. do you regret having the ds or roux en y
4. does anyone have straight medicare and what hoops did you have to go through to have surgery
5. what do which you had known prior to surgery that you know now
6. should i have the roux en y over the ds
Those are my current questions. I'm sure that I will have more questions as I do more research. Any and all help and comments are welcomed and needed. The good, the bad, and the indifferent. I want to go into this with open eyes, knowing that I can handle anything thrown at me. So start shoveling
Thank you in advance
1. what is the standard ds bmi
2. do you need to have a medical supervised diet or will somehting like weigh****chers do for those with medicare. if you do need to have a supervised diet with someone in your surgeons office follow you if you are having trouble getting a PCP to do so
3. do you regret having the ds or roux en y
4. does anyone have straight medicare and what hoops did you have to go through to have surgery
5. what do which you had known prior to surgery that you know now
6. should i have the roux en y over the ds
Those are my current questions. I'm sure that I will have more questions as I do more research. Any and all help and comments are welcomed and needed. The good, the bad, and the indifferent. I want to go into this with open eyes, knowing that I can handle anything thrown at me. So start shoveling
Thank you in advance
(deactivated member)
on 5/18/12 6:04 am, edited 5/18/12 6:05 am - WA
on 5/18/12 6:04 am, edited 5/18/12 6:05 am - WA
Medicare does not require a 6 month diet. They require a BMI of 35 or more with one co morbitidity not two. and a period of failed diet attempts. And they cover the Lap Band, BPD-DS, and the AGB no NUT visits and NO PSCH eval. This I know because I had my RNY on Medicare in 2008 and I am on the phone with them weekly asking questions about the revision I am planning.
I had my DS in 2009, and at that time, the DS and the RNY were the only two bariatric surgeries covered by Medicare.
My BMI requirement was 35 with one co-morbidity. My BMI on surgery day was nearly 70 with three co-morbidities. All are now resolved. (hypertension, sleep apnea, exercise-induced asthma)
Your surgery must be done at a Bariatric Center of Excellence in order to be covered by Medicare. In my program, psych eval was cash ($110.00). In my program, it was the psych eval that determined the waiting period. Mine was 6 months. I suspect it was because I had been obese for most of my life, and the DS was going to effect a drastic change in my appearance. At 3 years out, I am just now beginning to see my new body, that is, fully clothed. I have lots of loose skin, and have had several bouts of cellulitis (subQ fat infection), caused by friction of the compression garment I wear to support the loose skin. I also have a pretty rigorous cleansing ritual I have to go through in the shower everyday to make sure I clean under all skin flaps, to prevent BO. That can happen just as well with a RNY, depending on how much weight you have to lose.
My tummy is flat but wrinkly, I have bat wings on my arms and no "girls" (picture tennis ball in tube sock) Thank God for the great (and cute!) padded bras they have out now! I rarely go sleeveless, which was also the case pre-op, so I'll get my arms and girls fixed one day, but the lower body skin has now become a medical issue.
Many people do very well with the RNY gastric bypass, but many regain all they lose and more, once the intestinal micro-villi grow more dense to compensate for the malabsorption. DSer's intestinal configuration is more distal than RNY, so the more dense micro-villi are moot with most of us. I don't know any DSer's who have had more than a 10 pound regain. The DS configuration of what is absorbed in what part of the intestine has a lot to do with DS absorption rates 50-60% for protein and complex carbs, 20% for all dietary fat (animal or vegetable) 100% of simple carbs (junk food, white bread, anything made with white flour) and simple sugars (white sugar, regular soda, sugar sweetened fruit drinks, high fructose corn syrup in any food), which can slow down weight loss.
Whether or not you chose RNY or DS, is totally up to you. If you are good at dieting, then you may do well with the RNY. If not, while the DS is the most malabsorptive of all bariatric surgeries, if you can be super-vigilant about taking your vitamins, minerals and a protein shake or two a day as insurance that you get all your protein in, you have a much freer eating style with the DS than you do with the RNY, and you can stay healthy. The DS, the last time I checked, has a 95% cure rate for morbid obesity, compared to 75% (last I checked) with the RNY.
I liked the DS because the basic anatomical structures of the stomach remain (esophageal and pyloric valves remain intact), and the part of the stomach that produces the hunger hormone ghrelin, the greater curvature, is removed. The remaining stomach tube still churns and breaks down food. With the RNY, a food pouch is created, with no valves controlling input and outflow, and there is no churning, and very little stomach acid to digest food. The greater curvature of the stomach is left to lie fallow in the abdominal cavity, and continues to produce ghrelin. Hunger will return eventually with the DS, but it will not be ravenous, unless you allow yourself to go too long without eating, or if you are an emotional eater. I eat small meals every 2-3 hours, with DS-friendly snacks like yogurt, cottage cheese and hard cheeses like cheddar and Swiss in between. I do allow myself to "splurge" on a dessert or something else, but I have learned my limit, in order to avoid intestinal distress (foul gas and diarrhea). My bowel habits, unlike the warning some doctors give of lifelong constant diarrhea are unfounded. I hit the toilet three times when I first get up, and I'm done for the day. Solid and semi-solid, no diarrhea, unless I've had something to cause that. Salad is good for that, in my digestive system.
With the RNY, if you eat sugar or something high in sugar, you can get "dumping syndrome", (sweating, heart palpitations, nausea, etc). DSer's don't dump, because there is regulation of how quickly the sugar enters our systems, thanks to that pyloric valve that remains intact.
www.dsfacts.com is a good source of information. Everything I've said here is from my own experience. I am not a medical professional, nor do I play one on TV
Good luck as you research which surgery is best for you.
My BMI requirement was 35 with one co-morbidity. My BMI on surgery day was nearly 70 with three co-morbidities. All are now resolved. (hypertension, sleep apnea, exercise-induced asthma)
Your surgery must be done at a Bariatric Center of Excellence in order to be covered by Medicare. In my program, psych eval was cash ($110.00). In my program, it was the psych eval that determined the waiting period. Mine was 6 months. I suspect it was because I had been obese for most of my life, and the DS was going to effect a drastic change in my appearance. At 3 years out, I am just now beginning to see my new body, that is, fully clothed. I have lots of loose skin, and have had several bouts of cellulitis (subQ fat infection), caused by friction of the compression garment I wear to support the loose skin. I also have a pretty rigorous cleansing ritual I have to go through in the shower everyday to make sure I clean under all skin flaps, to prevent BO. That can happen just as well with a RNY, depending on how much weight you have to lose.
My tummy is flat but wrinkly, I have bat wings on my arms and no "girls" (picture tennis ball in tube sock) Thank God for the great (and cute!) padded bras they have out now! I rarely go sleeveless, which was also the case pre-op, so I'll get my arms and girls fixed one day, but the lower body skin has now become a medical issue.
Many people do very well with the RNY gastric bypass, but many regain all they lose and more, once the intestinal micro-villi grow more dense to compensate for the malabsorption. DSer's intestinal configuration is more distal than RNY, so the more dense micro-villi are moot with most of us. I don't know any DSer's who have had more than a 10 pound regain. The DS configuration of what is absorbed in what part of the intestine has a lot to do with DS absorption rates 50-60% for protein and complex carbs, 20% for all dietary fat (animal or vegetable) 100% of simple carbs (junk food, white bread, anything made with white flour) and simple sugars (white sugar, regular soda, sugar sweetened fruit drinks, high fructose corn syrup in any food), which can slow down weight loss.
Whether or not you chose RNY or DS, is totally up to you. If you are good at dieting, then you may do well with the RNY. If not, while the DS is the most malabsorptive of all bariatric surgeries, if you can be super-vigilant about taking your vitamins, minerals and a protein shake or two a day as insurance that you get all your protein in, you have a much freer eating style with the DS than you do with the RNY, and you can stay healthy. The DS, the last time I checked, has a 95% cure rate for morbid obesity, compared to 75% (last I checked) with the RNY.
I liked the DS because the basic anatomical structures of the stomach remain (esophageal and pyloric valves remain intact), and the part of the stomach that produces the hunger hormone ghrelin, the greater curvature, is removed. The remaining stomach tube still churns and breaks down food. With the RNY, a food pouch is created, with no valves controlling input and outflow, and there is no churning, and very little stomach acid to digest food. The greater curvature of the stomach is left to lie fallow in the abdominal cavity, and continues to produce ghrelin. Hunger will return eventually with the DS, but it will not be ravenous, unless you allow yourself to go too long without eating, or if you are an emotional eater. I eat small meals every 2-3 hours, with DS-friendly snacks like yogurt, cottage cheese and hard cheeses like cheddar and Swiss in between. I do allow myself to "splurge" on a dessert or something else, but I have learned my limit, in order to avoid intestinal distress (foul gas and diarrhea). My bowel habits, unlike the warning some doctors give of lifelong constant diarrhea are unfounded. I hit the toilet three times when I first get up, and I'm done for the day. Solid and semi-solid, no diarrhea, unless I've had something to cause that. Salad is good for that, in my digestive system.
With the RNY, if you eat sugar or something high in sugar, you can get "dumping syndrome", (sweating, heart palpitations, nausea, etc). DSer's don't dump, because there is regulation of how quickly the sugar enters our systems, thanks to that pyloric valve that remains intact.
www.dsfacts.com is a good source of information. Everything I've said here is from my own experience. I am not a medical professional, nor do I play one on TV
Good luck as you research which surgery is best for you.
HW 405/SW 397/CW 138/GW 160 Do the research! Check the stats!
The DS is *THE* solution to Severe Morbid Obesity!
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