Post V Day Blues.....

Hey Grads, Valentine's Day is done, My Darlin' is fast asleep, And I'm Bummed Out. Not because of Romance, That's Great, But from my day....... Today was my 1st Consult with my Plastic Surgeon To get started toward my Panniculectomy / Tummy Tuck this summer. He was highly recommended By 3 of my Doctors, and the Case Manager for my local Bariatric Center. I had spent so much time prior to going to the PS By getting recommendations from the rest of my Doctors, Getting ALL of my "ducks in a Row," I thought. Going into it I have in my arsenal- Letter of Necessity from my PCP, Letter of Necessity /Recommended course of Action from my Dermatologist, Letter of Necessity /Recommended course of Action from my Bariatric Surgeon, A Secondary Insurance That does in fact cover the procedure, 10 months stable weight (will be 14 by anticipated surgery date) And a 3 month window free and clear from work In which to re-cooperate. Drove the hour and a half to meet with the PS this morning. Problem? The Plastic Surgeon thought I was Too High of a Risk To warrant any type of "elective" surgery. Artificial Heart Valve, On Coumadin, And a history of Complications / Seroma. Doesn't matter that I've had 7 major surgeries While on Coumadin, He's "not comfortable" due to the risk of My Heart Valve "throwing a clot" While off of Coumadin in surgery And causing a Stroke. "A Tummy Tuck would be out of the question Just from the extensive mesh And the previous Abdominal reconstruction." That's fine by me I said, "I'm not looking to be an Abs Model, Just looking not to have blood stains on the waist band Of my shorts." He recommended finding a better way to live with Managing the bleeding from the chaffing rash that results from Being on Coumadin. "I'm sure it is a constant problem, But people routinely live with 'managed' life long problems. Get a second opinion, but I think you'll be hard pressed to find Any PS willing to take on such a High Risk." So, $90 for that. After an hour and a half drive there, Over an hour and a half wait (appointment at 9:00, met him at 10:45) All in All, It was a long drive home from that appointment. Sort of "Catch 22." The reason The Panniculectomy is declared "The recommended course of Action and necessary" by the other Docs is that the Coumadin causes Extensive bleeding / small but significant blood loss When ever the rash "acts up" which is often. But the very fact that I'm on Coumadin, Makes me a high risk patient, To be Avoided. So, second opinion in my future, but that presents Another obstacle. I live here in the middle of No-Where Mississippi. Fortunately, one of the major "Bariatric Centers of Excellence" In the South, just happens to be in this little town. A Bariatric Floor / Wing with Folks coming from 5 states around to have their WLS Here. But for PS? None in this little town. The closest that was recommended Because he does primarily WLS Post-ops who've lost much weight Is in a city about an hour and a half from here. The next closest city would be Memphis Tennessee, but so far Haven't found a PS there who takes insurance at all. Just "private practice" folk doing eye lifts and facial peels. Next closest option? Birmingham Alabama or Atlanta Ga. Both would require moving over there for about 3 weeks For any "aftercare" and the Consults and visits prior to A Surgery date would each be overnight travel each visit Even flights over for Atlanta. So, I begin to wonder, Am I just "spoiled" from having a Bariatric "Center of Excellence" 5 miles from my home? What do other folk do traveling across country to "Check up" with their Drs.? Or, Since I already travel from coast to coast in my business, Do I just gather up the additional cash to cover Extended possible stay in some PS Mecca like Los Angeles, and move out there for the summer for a month. The insurance would cover the surgery And I'd pick up the tab for an extended stay Out of town? Be about the same as a "self-pay" somewhere near by. However, if this PS is right, And I'm really Too High of a Risk, Would another PS take on my case? What if the same sorts of complications I've had in the past "Popped up?" Some of my "unexpected Stays" in the Hospital have ranged from 1 week to 6. 2 to 2 ½ weeks "on the Road" I could maybe handle monetarily, But if I had to pay to stay, and find place for my family to stay While "complications" got ironed out, I could be $Wiped Out $ by the whole deal. Which leads me to think- Maybe he's absolutely right. "Too Risky." Just go find a way to deal with the "management" Of a life long "issue" of bleeding and painful rash. Then, I'm bummed out..... Sort of like being back at that- Dealing with a life of Morbid Obesity without Any Co-Morbidities, which is where I was when this all started. Painfully, annoying Life. So Much babble...... I'm kinda Down. I'm scouring the web for solutions for the next few days And weighing all of my potential options. I just wish the most obvious and glaring option wasn't- "Just Deal with It." "Manage your Life Long Issue...." I'm by nature, a fairly up beat Guy. I'm sure once I get a "Second Opinion," And they say- "No Problem, we'll just back off the Coumadin, Keep you on Lovenox till after the Post-Op bleeding potential problems, Then ramp you back up on your Coumadin, Just like all of the other surgeries," I'll be fine. Till then, I'm dealing with the meanest of little devils.... I always hear folks out here talking about their "Demons," And so far I've been free of them. No Emotional Eating Demons or such. But now I've got that little voice in the back of my head saying- "The excess skin wasn't a problem When you were 35 pounds heavier than today." "So? Who needs to be in medium shirts? Weren't you happy at the Large? Hey, it's not 4x! You can still buy size 40 to 42's of the rack! So what if you're in 34 to 36's now? Is the 'skin issue' worth it?" Yeah, that little Devil is mean to the bone..... Any ideas? Thoughts to shut him up? Thanks for reading my ramble.... Not the Greatest ending to a Valentine's Day... Hope you understand... Best Wishes- Dx

Hello Dx. Here it is the middle of the night with no one up to listen to you "ramble" except this one lone night owl. Ironically I will begin laying the foundation for my own panniculectomy in about 10 hours. With your permission I'd like to address a few of your questions and concerns. Firstly, please believe me when I tell you that I know how disappointed you are right now. After months and months of researching, documenting, and lining all those little mallards in a perfect precise line I was slapped with an iron clad exclusion for my WLS. Unlike you I shut down on the spot. I threw in the towel along with my fight and my spirit and gave up completely. I'm on a very limited income and the thought of self pay was something totally unimaginable. It took months for me to crawl back out of my hole and convince myself that I could make this happen.....and I say kudos to you my friend for "scouring the web for solutions for the next few days and weighing all of your potential options." Now I'd like to discuss "What other folk do traveling across country to "Check up" with their Drs." They don't call my town Smallville for nothing you know. There is a small Mash unit...........er, I mean hospital in a town about 15 miles away, but for anything more than a broken bone you'd best hope you can make it to the "big city" about 40 miles further out yet. Now the big city hospital is plenty good enough if I'm suffering a heart attack, but no one there was about to rearrange my insides and build me a brand new tummy. I had 3 surgeons picked out (had consults with 2 of them) and they were all located within a 9 hour radius of Smallville. The surgeon I decided on is located in Cincinnati which is aprx. 3 hours from my home. Of course I made several trips pre-op and when the big day finally arrived I packed a bag with enough belongings to last a week. I was dismissed from the hospital after 3 days but required to stay in town 4 more since I lived such a great distance away. I cannot offer you any advice on whether this surgery is worth the risks Dx, only you and and a trusted physician can make that call. But since you asked for thoughts I will tell you that the idea of re-gaining 35 pounds to make your skin fit better leaves me a little uneasy. I say that not because that 35 pounds will make you less healthy (like you said it wouldn't put you anywhere near a 4X) but because I don't know if I could trust myself to stop at the 35. I offer you my support and my confidence that you will exhaust all your options and make the most informed and best decision that is right for YOU. La

La, Thanks for putting up with late night whinning/moaning! Today is all new. Thanks for your support! Best Wishes- Dx

Wow Dx - lots to think about. Obviously a second opinion would be needed - despite any length of travel to get there. Perhaps phone interviews, information/questions via email, etc., would be the best choice until you find someone who feels confident in working with you. This first doctor does raise concern though - there are risks associated with any surgery, and you mention you've had 7 since being on this medicine. Did you have the same concerns going into those 7 operations - or is this the first time this concern has presented so heavily? I would imagine the risks existed for each. And I understood that a pure panni removal was one of the shortest & least invasive of stomach plastic surgeries.(?) Even that was not an option? I guess I would ask -- Does the disappointment lie in the fact that after all the time & research, this surgeon was the perfect solution - competent, experienced and convenient? Or does the disappointment lie in the thought that maybe it is better to live with this condition? I don't know you - but from the sound of it, you've traveled more on the rough road than a lot of people and yet have had more success than many. I am a huge believer in the notion that we only get one shot at this life and we should do all we can to make the most of it while we are here. Would this surgery dramatically improve the quality of your life? It doesn't sound purely cosmetic by any means. If so - keep searching. And I am an emotional eater - the demons strike me daily. Shut those voices off. You've come too far to backslide - I also would be afraid of not having the control to stop. Should you be forced to settle for anything less than the success you've earned? I hope you find your answer to all of this soon-- Kristin

Kristin, Sorry to just whine on the board, New day, new approach! Thanks for your support. Best Wishes- Dx

As a fellow coumadin user, I get your message. I take mine for prior DVTs. What's frightening at times is the realization that given changes in protocols, I would be hard pressed to find a bariatric surgeon these days: prior heart attack, DVTs, out of control diabetes, yada, yada, yada. My Bari surgeon told me that if he knew then what he knows now, he might not have taken my case. Boy does that give me the creeps! In any case, sorry to hear about rashes, etc. I have a butt-load of left-overs, but nothing so severe that it causes problems. Besides, I am not planning on taking my clothes off in public anyway (hold you applause, please). My PCP is not in favor of me having anything but life-saving sorts of surgical procedures. And just to be contrarian here, do not assume that because you can find a PS who gives you the answer you want you are getting the correct answer, one that is truly in your best interests. Nowhere Man/PH/Jay

Jay, Also not looking to go "topless" any time soon. Just whining/moaning about usual crap. Who says anything should be easy. New day, new perspective. I'm going after the Coumadin info. I know it presents a risk, but I won't be satisfied now till I know Why? How much? What are the possibilities? The Odds? Etc... If curiosity killed people like cats I'd be long dead! Best Wishes- Dx

I don't have any great words of wisdom. Just here to offer support. I know there are some great of great ps docs in Chicago who will work with insurance. Dr. Zachary - does tons of wls patient reconstructions. and is at Wiess Memorial, which is connected w/ University of Chicago. I heard him speak and he talked about his strategies for getting insurance coverage. It can't hurt to get a 2nd opinion. I always say, "if you don't ask - you don't get" & the worse that could happen is they would say no. as far as regaining - please don't go there, you have worked too hard, for too long, and been thru too much to give up now. (hugs)

**willow** Thanks for the support. In the light of morning, It doesn't seem as insurmountable of a problem. Just one that may or may not be resolved In the way I had hoped. Best Wishes- Dx

Hi Dx, i am so sorry you are so blue. How far are you from Lexington, Kentucky? We are about four or five hours past memphis. There is a wonderful group of PS that work closely with my bariatric group. Also, most of the hotels in the area give discounted rooms to hospital patients families.