Say some prayers!!

I searched the nursing and medicine databases for research at work and thanks to what you guys have told me decided on DS. 

I called Dr Lalors office today to make sure my insurance would cover it and the financial rep said that it is a covered surgery. 

Here is the issue. She said that he generally only does DS on patient's with a BMI over 50. 

She had me make an appt to come in again on Friday to talk to him. 

I am hoping I can get him to agree. 

My BMI is about 46. It has been as high as 48 but I lost a some weight a while back and have managed to keep it off. 

I have type 2 diabetes, and hypertension. I'd love to have another baby and not have to be on all of these meds. But my main goal is to get rid of the DM and HTN.

At 38 years old, I'd like the best shot I have at reversing that, at least as long as possible. Right now, my DM is well controlled with diet and meds. My last HbAIC was 6.3, This is seems like an idea time to have surgery... while I can still change things, you know? 

On my dad's side, all my relatives have DM. Even the skinny ones. 

The ones who were over weight, even a little, developed it sooner. (in their 30s)

On my moms side there is also diabetes.

Several of my relatives have died prematurely (in 50's and 60's) to diabetes related complications. 

I know even being a little over weight can make a difference, 

I only get one weight loss surgery per lifetime on my  insurance policy. 

The other issue is that my insurance company is regional (not a national company like blue cross or united health care). 

There are only 2 weight loss surgeons who are providers and Dr Lalor is the only one who does DS who would be covered. 

So... if he says no, I am going to have to go with RNY.... 

I am feeling a little anxious about all of this, so prayers would be appreciated. 

Thanks!

 

Please try to convince him DS or nothing. RNY doesn't have the success curing diabetes that the DS does and it sounds like that is as big an issue as the weight. Sending up prayers for you, or as we say on the boards around here, swinging critters for you.  ; )

--gina

The DS has better results for type 2 diabetes than RNY, and the difference in results is greater than was previously believed. We used to think RNY had about 84% resolution rate - not as good as DS (95-98%) but still pretty good. It turns out, though, that for a lot of people with RNY, the diabetes recurs after a few years, reducing the true rate of resolution to something like 44%.

With the one wls per lifetime restriction, you're in a tough position. You need to stay strong and insist on the DS. If Dr. L. refuses based on your "low" bmi, see if you can appeal to your insurance for the DS with a provider not in their network, based on the DS being a covered service but not available to you in-network. This is often successful.

Bottom line, this should be your decision, not subject to the beliefs of one surgeon and the limited provider options of your insurer. Don't let anyone else make this decision for you. YOU are the one who will live with this decision for the rest of your life, not the surgeon and not someone at your insurance company.

Larra

Good points. I could try to appeal to Paramount. I think I seen on the surgeons list there is someone in Dayton, OH and a couple in Michigan. I could probably also go to Cleveland or Columbus if there was someone there. 

I'm keeping my fingers crossed for Friday. 

That's the spirit, Sonyamarie!

When considering any surgical options, you always have to weigh both the potential risks and the potential benefits. Your surgeon seems to have taken into account the potential risks (or at least his perception of them) but downplayed the potential far greater benefits to you of the Ds. I hope you will be able to prevail upon him how close you are to the magic bmi in terms of actual pounds and the medical reasons for your decision to have DS rather than RNY. But if not, appeal to your insurer. The DS is a standard of care operation for anyone who qualifies medically for bariatric surgery, and not just for people with a bmi over 50. Stay strong!

Larra

NO.

Your surgeon works for YOU, and that means that YOU get to make all the decisions.

Thanks for your input. I don't know that I agree with that. 

Maybe it's because I work in the health care field?

I feel like its more of a partnership? 

If both people aren't in agreement then I feel like there could be issues. 

I'll say a little prayer. I hope it works out for you. Sounds like you have some good arguments to make with the Doctor over the diabetes. Good luck.

Food for thought - my surgeon mentioned that my heighest weight is what really qualifies me for the DS, not necessarily where you were able to get after a bit of weight loss. Also, when you calculate it out into pounds it's far less intimidating than BMI numbers. My BMI is 47.5 but I'm only like 15 pounds from a BMI of 50. Just some things to consider.

Good luck!!!

I'm somewhere between 5'6 and 5'7 depending on who is doing the measuring. If you use 5'6 then I'd need to add 20 lbs. Blah. They tend to get a little excited if you gain wait in your waiting period and work with the dietician I hear. 

I'm just going to give it my best shot.