Anyone have to fight for DS?

I'm putting together research for a proposal for my surgeon to try to convince him to refer me to the DS specialist. I live in Ontario, how it works here is that our healthcare will fully pay for the surgery, but only if it is approved by the surgeon. Unfortunately, the hospital I am going through is fairly backward thinking and are not fans of the DS and 98% of people only get approval for RNY. To be approved for DS it usually has to be a revision or have a BMI of over 50 and I'm just under 42. I am wondering if anyone else had to argue with a doctor or insurance company to get approval for DS and what worked for them?

I have a couple of issues that I'm hoping will help me and I'm collecting research on them;
1) Genetic blood clotting disorder (Von Willebrand Disease) makes me more susceptible to anemia (have had several episodes) and DS has lower rates of anemia complications than RNY.
2) Migraines and IBS require me to take a tricyclic anti-depressant (nortriptyline) known to cause weight gain and due to this challenge I need the most efficient surgery for losing and maintaining weight loss (and I have a couple of studies showing 70-80% excess weight lost average compared to RNY 50-70% average)
3) Migraines, chronic headaches, traumatic knee injury and chronic achilles tendonitis require frequent NSAID therapy which won't be possible with RNY.
4) Recent research indicates return of diabetes in up to 40+% of people who initially go into remission with RNY, I am pre-diabetic with a strong family history (3/4 grandparents, father, and mother and sister during pregnancy) and want to avoid a future of diabetes complications. Continued remission rates are much higher with DS.
5) Recent research shows loss of pyloric valve causes hypoglycaemia in up to 80% of RNY post-ops (this paper was shocking, many people don't experience the symptoms due to low carb eating), very difficult to manage in the long-term and is thought to contribute to much higher rates of regain seen in RNY. Also, loss of pyloric valve causes dumping, which I do not wish to live in fear of. Dumping and RH are both rare complications of DS compared to RNY.

I'm also going to lay out that I am familiar with the post-op requirements and conscientious enough to faithfully carry them out. I'm also going to show papers calling the DS the New Gold Standard from Dr. Hess and Dr. Roslin. I'm also going to mention that in the US medicare will cover the patients choice of bariatric surgery upon approval, and in Quebec the province will also pay for DS if the patient meets the requirements for bariatric surgery in general (I'm a Prosecutor so I can try to push a precedent argument).

If anyone can think of any papers or arguments, or has a relevant experience to share I would really appreciate it! This is going to be an up hill battle and I want to be as prepared as possible.

Welcome!

Southernlady collected studies and such for her fight for the DS. She has many on her profile.
www.obesityhelp.com/member/southernlady5464/

Have you check out www.dsfacts.com ?

--gina

Yes, thank you - used many from DS Facts and have also done a general search on pubmed. I'm curious if others have cited these specific reasons and had success. I guess I'm looking to hear from people with some experience on whether there is a particular argument that is stronger from their experience, or if there is very recent research that can help support any of my listed reasons.
For example, the need to use NSAIDs for migraines is no longer considered sufficient in Ontario to have VSG or DS since studies indicate that RNY causes a reduction in migraines of up to 71%, BUT if you need NSAIDs due to arthritis, then you could be approved for VSG, or possibly DS. I'm taking the approach of trying to overwhelm them with the number of reasons, rather than severity of reasons, as I don't have one single issue that on its own is likely to get me approved for DS.

As Gina stated, I have many articles. My first surgeon was not willing to handle a LW for a DS, in fact he only does those over 50 BMI.

Then I went elsewhere and found a surgeon willing to do a lightweight but my insurance failed to cooperate. They approved the DS but only if I stayed in Tennessee...there is ONE surgeon in TN that does lightweights AND was in my network for insurance and that is my current surgeon. I was on my third appeal when he agreed to take me as a patient. He is partner's with my initial surgeon and THEY had to agree to let me change. So yes, I had to fight for mine.

I used the NSAID issue effectively given my history and it was shown in the medical charts that I had issues requiring NSAIDS. Make sure you get medical verification of the need for NSAIDS and that might be all you need.

Now, a reduction of 71% means almost 30% do NOT resolve. What if you are in the 30%??? And having other issues of arthritis shoulld be enough to pu**** your way.

Best thing to do is check the odd sources, esp for the diabetes or NSAID angle. Don't just look in pubmed or bariatric sources but consider the diabetes journals/society or the endocrinolgist society or journals. Also look at the Journal for Internal Medicine.

Another thing, do you already have episodes of Reactive Hypoglycemia? I did and was shown in a GTT given to me in the 90's so for me to get a surgery that could cause RH was downright dumb.

Good luck with your battle...I do hope you join us on the Dark Side.

Liz

Added a new article I found on NSAIDS on my blog here, see above link.

And added several new articles I found at Endocrinology Today on an Anti-Gheurlin vaccine (thos of us who had the VSG or DS have the gheurlin cut away), Vitamin D issues, and a Low Carb study. Those can be found on my blog: Liz' Weight Loss Journey

Liz

Good luck in your mission.  I guess I was lazy or just tired of being fat but I would have had any surgery, well, not a band, that would get approved just to get it done.  Looking back, I wish I had more options but between insurance and Drs local, there weren't other options but RNY and band.

What type of Vwd do you have? Anything higher than a 1 will sometimes void any type of elective surgery at all. If you suffer with the anemia even a few episodes, you will continue.
This may or may not hurt your case. I too have Vwd.

Thank you for the ideas everyone. I already have a surgeon willing to work with me, Dr. Gagner in Montreal, if only I can get a surgeon in Toronto convinced that I meet the requirements under OHIP (Ontario's provincial health insurance) to be referred to him. I've also been told that there is a chance the surgeon in Toronto would approve me for VSG but not DS and if I wanted to convert to DS I would have to self-pay for that portion. I'm talking to Dr. Gagner about that possibility this week.

My VWD is type 1, mild-moderate and I'm a good responder to DDAVP, so that won't be an issue for the surgery itself - I've had other elective surgeries and am scheduled for elective jaw surgery in February. The main issue for me is that it causes excessive menstrual bleeding which has lead to periods of anemia in the past, so I'd like to avoid any surgery that increases the odds of anemia and RNY is more likely than the DS to do that. I take iron 3 days a week right now and it hasn't been an issue in the past couple of years.

I am also Type 1 but dont respond very well to Stimate.(DDAVP) It almost did not allow me to have it at all to be honest. Good luck and if it happens please make sure to have that DDAVP several days prior.

I take the DDAVP by IV drip just an hour before surgery. I've already had it and been tested, I'm a good responder and they know the proper dose for me. The surgeon I'm hoping to have my DS with has worked with several VWD patients before.