What if I lose too much weight before surgery?

First of all, let me introdcue myself and give a little background.  My name is Rebekah.  I'm a wife and a mommy.  I've struggled w/ my weight pretty much all of my adult life, ever since I had my first baby when I was 20.  My hubby is in the Army, and I have Tricare Prime.  I tried to get approved for the Lap-Band a little over 2 yrs ago.  My weight was barely there, but I had to have a comorbidity to qualify.  I KNOW I have osteoarthritis in my knees.  My dr thought so, too.  She had me get xrays done, but the dr that read them said he didn't see anything wrong w/ my knees.  So that killed my surgery dreams.  About 6 months after that, my right knee stiffened and swelled up on me out of nowhere while I was at work one day.  By that night I couldn't even walk.  I had an MRI done, and it showed degeneration and the cartilage was all chewed up.  But by this point I had gone on phentermine and lost around 30lbs, so now I had proof my knees were messed up, but didn't weigh enough.  Well, last year I had a surprise pregnancy.  lol  And of course I put back on all the weight I had lost.  A couple months ago I started phen again, but it's not doing it for me this time.  My knees started bothering me again which turned on a little lightbulb in my head...why not look into surgery again?  I found out, though, that the dr my insurance would send me to requirs a 2 week liquid presurgery diet which seems fairly common.  But my concern is, if I barely scrape by getting approved because my weight is borderline and lose weight on the presurgery diet, can they retract my approval??  I don't want to go through all that mess and hassle to get approved, do that diet, and then get the rug pulled out from under me.  I'm sorry this is so long, but I'm just so tired of being heavy.  I'm so very blessed to have a man that loves me the way I am and doesn't ever seem to notice the jelly rolls.  But I want to love me, too!  Anyway, any input you might have is certainly appreciated.  BTW, I am 5'7", and 235-240lbs.  Tricare says I have to be 100lbs over my "ideal" weight according to the Met Life table.  So for a small frame which I think I am, I would have to weigh at least 236 to qualify.  So when I say I'm barely scraping by, I am for real!

Are you sure it is 100 pounds overweight to qualify?  Most plans are a BMI of 40 or over with no comorbidities or 35 or over with 2 comorbidities.  Right now at 235, you are at 36.8, and you can go down to 224 to be at 35.  As far as I know, they go by your weight from the time of your original weigh in but I am not sure.  My insurance is Medicare and they dont' preapprove, so my approval was based on my surgery day - so I couldnt' lose too much in my preop diet or I wouldn't have qualified. 

Do you have any other comorbidities, just osteoarthritis wont' be enough with your BMI?  Do you have diabetes, hypertension, high cholesterol, GERD, sleep apnea, asthma?

 He he I was EXACTLY where U are ...well kind of - top weight 238 , height 5'9".  Only my diabetes got me surgery .....

then my doc in his great wisdom put me on a 6 week liquid diet pre surgery ...where i lost almost 40 lbs!!  I was DYING  before i went into the OR to see whether  id get weighed and rejected .. and whether hed even do the rny once he opened me up ...

He DID do an RNY but so proximal I am having a really really hard time now getting to goal , even maintaining my weight 15 lbs ABOVE goal GRRRRR 

Were i to do it again ...i would cheat on that darn  diet like MAD LOL. 

Yeah i had other trouble too being so light ...i ran into one of his patient counselors during the pre op process who thought i was an AFTER and whom i had to beg and plead with because she was gonna try to stop my surgery ......also the barium swallow ladies were scandalized i was so small and normal- weight looking and they said they were gonna take it upon themselves to stop it too by making some phone calls. Need;ess to say one of them was larger than i was.  

 I had to beg them too...calling upon my out of control diabetes and my blurry vision and neuropathy .... if they didnt make those calls i assure U it was still just out of pure laziness and a thousand foxhole prayers to GOD lol.  

Technically , the first weight qualifies U not the last ....so everyone told me .  I DID get the surgery ...but  there were many roadblocks along the way .   Frankly being a extreme  lightweight aint EASY . Many of the people U run into along the way are larger than U and feel there is nothing wrong with judging U for wanting the surgery .....like its some kind of illegitimate free ride or something . 

As a matter of fact thats kind of what the whole process FELT like ....like trying to sneak on the subway lol...without paying   

By the way  people here on OH in chat also wanted to call my surgeon ...and they are PERFECTLY capable of doing exactly that ( ive seen them  get someone fired for chatting from work  while the nasty B... es were chatting from work ( and calling his boss from work ) themselves!!   be careful who U tell Hun....

And yes my surgery gave me my health and my life back and  I am SOOO happy and grateful that I pressed on ......

Usually you only have to weigh a certain amount at your initial consultation, then sugeons want you to lose weight during your process. I had no co-morbitities and a BMI of 40 at initial consult, then lost 28 pounds before surgery.

Ok, make sure you're 100 pounds over for your initial consult. That's the weight that will go to Tricare for approval. Lots of legal ways to ensure you measure up. Drink lots of water, schedule your consult for later in the day, eat Chinese food with soy sauce the week or so prior and immediately before you weigh-in. Make sure they use the right body build on the MetLife tables to show 100 pounds excess weight to Tricare.

Use the time between the initial appointment and approval to research all the weight loss surgery options. Don't get in your head there's only one, there are several. Tricare covers band and RNY (gastric bypass). Do your research...I can't say that enough.

The 2-week liquid diet won't be used against you unless the surgeon is an idiot. Make sure you know the surgeon's program and Tricare's loop holes. If the surgeon or his office won't work with you to get you approved, find another surgeon. They're a dime a dozen.

--gina

  

 also dont be afraid to slump down down down and even wear a long skirt and bend Ur knees at the weigh in height measurement .  

Being measured a few inches shorter is often the differnce between approval and not ..... I threw my head forward ,bent my knees , they measured me as 5 ' 5" !!! 

Good luck Rebekah !! 

Yes, unfortunately, Tricare goes by 100lbs over w/ comorbids or 200% of ideal weight w/ no comorbids.  They don't consider your BMI at all.  Tricare only lists 7 comorbids they will consider...diabetes, hbp, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalmic disorder, and severe arthritis of weight bearing joints.  I do have asthma, but they don't care about that.  The only thing I have that will suit them is the arthritis.  I am one of those dreaded "healthy fat girls".  But due to family history, I am predisposed to many of these things and more.  HBP runs all over my family.  Mine usually sits around 110/60, though.  Diabetes as well.  My mom and 2 of my sisters (one after her RNY, one is still quite heavy) had to have their gallbladders taken out.  I feel almost embarassed sometimes mentioning to people I want the surgery because I do get the looks and "you are not big enough" comments every time.  They don't see what I really look like, though.  I hide my weight well.  I guess they figure since I don't have a big belly I'm not fat, but I carry it in my arms, hips, and thighs.  So gross.  I'm just so conditioned to consider what people think of me.  I would hate for people to think I'm taking the "easy" way out.  I know the surgery isn't easy by a mile, but so many people that don't need the surgery look at it that way.  I've tried so hard.  I really have.  In fact I'm one of those that feel like you shouldn't be allowed to have the surgery if you don't really try on your own to lose weight.  Like my sister...her surgery was handed to her on a silver platter.  She went from just thinking about surgery to having it in about 2-3 months.  No presurgery dr monitored dieting required.  No need to provide proof that she tried dieting on her own in the past.  I've definitely done my reserach on the types of surgery.  I actually think I would prefer the sleeve, but Tricare doesn't pay for that.  My only options are RNY or Lap-Band.  RNY kinda scares me.  I don't like the malabsorption and a lot of the other issues that come w/ it.  I'm not thrilled w/ the idea of something "foreign" being in my body, but I like that the band is reversible should that be a medical necessity somewhere down the line.  Anyway, thank you all SO MUCH for your input.  Definitely some great advice and ideas!  (Love the bending your knees to be shorter, lol!)  Hopefully I'll have lots to post about in the upcoming months!  :)

I'm on Tricare Prime too. I'm 5', was 208 pounds, with "only" about 85 pounds to lose. Because I'm so short, my BMI was 40. That was all the PCP needed to refer me to bariatrics. Of course, I also have some co-morbs but the magic number was 40. Is you BMI at least 40? I dont know why you'd have to have 100 or more pounds to lose to qualify.
By the time I'm done with my liquid diet, I expect to be in the 180s with "only" 60 or so pounds to lose. But they approved me, so I"m gonna go for it!

PS: I'm getting the sleeve. Why are there so many differences between what I"m doing and what other people are doing on Tricare Prime? Any ideas?

Are you getting it done at a military treatment facility?  I know it can be different then because you don't have to actually go through Tricare.  If your dr refers you for it, and the MTF offers it, then you can get it.  Like Tricare won't pay to have Lasik done, but some MTFs offer it, so if you happen to  live close to one, you luck out.  I know Walter Reed will do the sleeve and I think Ft. Campbell.  It just depends on if they have a surgeon there that is trained to do it.  They don't provide any bariatric surgery on Ft. Riley (where I live), so I have to see a civilian provider for it which means I have to go by Tricare guidelines.  Such a pain!

Don't worry I was borderline too. They will not retrack your approval. I lost weight before surgery. I was barely eligible but with comorbids I was able to have it done. My doctor told me not to worry about the preop diet and losing too much weight because the minute you start eating regular you would have put the preop diet weight back on the insurance realizes that the liquid diet weight is only temporary. You should be fine. Good luck. I was only 193 and 5 1 and 1/2. You will be fine. Take care and happy thoughts.