Wtf Medicaid

So apparently Arkansas Medicaid is not reimbursing the surgeons office here for the sleeve like they are suppsed to and the surgeons nurse just told me. She did say that she got an email last week saying the hospital and medicaid are working on it. I'm so upset because I just finished everything they needed me to do and was stoked. I DO NOT want the bypass. My aunt was miserable from hers. Has anyone dealt with anything like this?

Side note: the nurse told me to email her the beginning of march to see if it has resolved.

That's a good question. Medicaid in some states goes through a Federal program with matching state funds. With the recent government shutdown, it may be as simple (not to you) as a delay in personnel to move money around. I'd do a polite, kind touch up email about 1/2 way to March just to gently remind her you are waiting.

I appreciate your response and that's a great idea! I will shoot her an email around the 18th. That will give her 2 weeks to hear something.

Can I ask why you don't want the bypass? I know it's a very personal medical decision, but one person having a bad experience might not be a good reason to pick the VSG instead. We have lots of people here who've had the RNY and been very successful and happy with it :)

My aunt had a lot of serious vitamin deficiencies and the "dumping" caused her to be seriously malnourished. My main reason for wanting VSG is because I've had my heart set on it for so long and I've been doing 8 months of research on it plus the idea of having my insides rearranged everywhere terrifies me. If I didn't have a choice come March i would have to do it.

If you want VSG, you should go for it! But I do want to point out-- vitamin deficiency is possible with VSG as well as RNY. The ASMBS (medical group overseeing WLS) recommends that patients from both types of surgery take the same type of supplements. If you stay on top of your vitamins and have your blood work done regularly to check for deficiency, you should be fine.

Dumping is caused by eating sweets and carbs. Most folks here avoid it by eating a high-protein, low-carb diet and seem to have no trouble with it.

Having your guts rearranged is scary-- but then again, so is having 80% of your stomach permanently removed forever! :)

Glad you're confident in your choice, good luck to you!

I think that it is worth pointing out that these recommendations are for the first cut after surgery, and may differ markedly from what actually is needed by patients 2,3,5 or 10 years out. As we see with the classic NSAID issue, many surgeons simply apply their RNY experience to their VSG patients, and this ripples through to the ASMBS "recommendations" - depending upon who writes them up this year. The RNY inherently malabsorbes minerals due to the bypassing of the duodenum along with the stomach; the VSG may have some minor absorption issues due to altered stomach processing or possible medication conflicts (the PPI vs. calcium prospect, for instance) but generally nothing on the order of what is experienced with the RNY or DS. This is why periodic iron infusions are fairly common amongst the RNY population but fairly rare in the VSG population (and somewhere in between with the DS population.) So, the OP has good reason to be concerned and show a preference for the VSG. Also, if one is disinclined to be compliant with supplements, one will get into a lot more trouble more quickly with an RNY (and DS) than with a VSG where diet can supply the majority of needed vits and minerals.

That said, pre-existing medical conditions can sway the decision one way or the other (GERD against the VSG, RA or some conditions requiring GI monitoring against the RNY) that need to be considered with one's medical team. Also, while one may not want a malabsorbing procedure, some may need malabsorption to get the job done

Do you have any research or evidence to suggest that doctors or the asmbs are being "lazy" on regards to their supplement recommendations, or observing that vsg patients receive iron infusions less frequently?

Not so much "lazy" ( I would reserve that for those who still impose those liquid pre-op diets on their patients!) as inertia coupled with priorities. Most bariatric surgeons are self-taught on the sleeve (it's simple and straitforward - just "general surgery", anybody can do it...) so it follows that they use their gathered experience to the fullest (otherwise, why else have it?****il such time as that proves to be detrimental. Particularly as the VSG is usually just a sideline for them, at least initially. Over supplementing doesn't have much of a downside as there are few toxicity issues to worry about (B6 is one of the few) and it only means additional hassle for the patient to take pills 4-5 times a day rather than once or twice. The main evidence, other than our physiology, are those practices that have been in the sleeve business long term and tend to be largely divorced from the bypass business - they tend to have much simpler protocols. Our plan, for instance, is for 1000mg of calcium and a dose of iron initially, not due to any malabsorption but simply because we aren't able to eat enough for a while to get what we need from food. But that's just a temporary thing. Longer term, some may need some, more or less, just like non-WLS folks. Likewise with a multivitamin - no need to double up on those as we are only looking for the basic RDA when we aren't eating much beyond protein, and there is no notable malabsorption; I don't even take a daily multi anymore as it isn't necessary as our diet is adequately varied, with only selected vits needed to fill in gaps. IOW, we are pretty normal and not markedly different from "regular" people.

On infusions, that again is a matter of physiology, as well as experience gleaned from talking with the docs over the years - lots of these things come out in our support group discussions and from seeing what others have been experiencing over the years. I had a bleed a couple of years ago which dumped all of the iron related levels and recovered them with oral supplement - very difficult to do with an RNY when their absorption is a fraction of ours.

So you have no research, but only your own conjecture. Got it, thanks!