Question:
I'm 24 years old, and have Manic Depression. Can I use this to help get approved?r?

I have been obese for 20 of my 24 years of life. My PCP is supportive of GBS. I know that my insurance will deny my claim. I have no co-morbidities at this time. I do have rheumatoid arthritis and a immediate familial history of obesity, hypertension, diabetes, heart disease, arthritis(osteo and rheumatoid), and degenerative joint disease. My BMI is 46.4. I feel like my life-long weight problem is a major contributor to my mental illness. My insurance company will not even tell me what they accept for approval. Should I site the fact that my weight is causing and has caused anxiety, depression, and suicidal tendencies? Also that I'm unable to take stimulants for weight loss because of mania, and that my inability to restfully sleep is causing problems with controling my mania? The mood stabilizer that I take causes weight gain as a side effect, and I have gained 22 lbs in 4 months ( this is with exercise and dieting). As I've gained weight, I have noticed that I am cycling more rapidly. I am afraid that my disorder could also hinder my claim, because the insurance company (Providence HMO) might say that I'm not mentally stable enough to benefit from surgery. Should I shut up or bring it to attention?    — Tanis G. (posted on September 18, 2000)

September 18, 2000
I would distance myself from the manic-depression as a case for your claim. As you know, you have a chemical disorder which must be treated. That's not to say that depression and the other co-morbidities you cite cannot be used though. But the doctor and the insurance company want to ensure that you are stable, which you probably are. You said you're being treated by a PCP;if you are also being treated by a psychiatrist whom you could enlist for support, that would carry quite a bit of weight (no pun intended). In fact,it's probably critical, as rapid weight loss would impact your blood levels for the meds you have to take for maintenance. The keys you must arm yourself with are knowledge (this site is great for that), stability and persistence. Best wishes!
   — Lorri S.

September 18, 2000
Tanis, you DO have co-morbidities. Arthritis is considered a co-morbidity. And your inability to get a restful sleep may qualify as sleep apnea (do you snore?). Your BMI is within the range of acceptance. Good Luck!
   — Allie B.

September 19, 2000
Fisrt let me say that when you state that "your life long wt loss is a major factor in you having maniac depressive disorder" I wonder what you mean by that. Maniac Depression IS NOT caused by wt problems. It is a chemical imbalance in the brain. It has to be controlled w/ psychotropic meds, as I am sure you know. Yes, some of the meds DO cause wt gain. There are other meds that can be used that do not cause this problem, though. I found this out the hard way! I am post-op and when I was pre-op and stated that I have Maniac Depressive Illness I do not think that it helped me. One physician documented that he didn't think I was a good candidate for WLS cause of this. I DID NOT give his documentation to the surgeon going to do the surgery! I need to share something w/ you now. When I had the WLS I had to go off all meds and stay off them for a wk after surgery. My shrink said it probably wouldn't end up being a problem but IT DID!! Post-op I became unstable emotionally. I think due to the stress of surgery, etc and the anesthesia they gave me during surgery, my moods began bouncing all over the place. I was in a terrible predicament. My surgeon had never experienced a bipolar person having this problem before! I was told to take my meds for bipolar TWO DAYS POST OP. They gave them to me all together in a tiny bit of water crushed up!! UGH!! It made me very ill. I refused to take them after that. They tried to find a liquid "something" that would sustain me til I got home. Nothing really worked well. I found that I was unable to take ANY OF MY MEDS for at least 4 wks post-op due to the sensitivity of my new pouch. I FELT HORRIBLE EMOTIONALLY. Instead of cycling rapidly, I now was DEPRESSED ALL THE TIME. I cried, was very anxious and got very irritated at the slightest thing. It was NOT a pretty picture! I am now 2 mo. post op. I am still only able to take HALF of the meds that I was on prior to surgery. My moods are beginning to level out, FINALLY. PLEASE, if you do have the wls, make sure your surgeon knows what he will be dealing w/ post op, possibly. Mine had no idea whatsoever how to handle me in this area!! You may not go thru what I did. I hope not. When I was told I had to go off meds prior to surgery and for a wk after, I was scared but I wanted the wls so bad, I ignored the fear. I just "hoped" all would be well afterwards. Bipolar Illness is not an easy illness to deal w/ especially w/o medication. If you go off your meds there is no real guarantee that you will be able to get back up to your pre op level of functioning emotionally when you go back on the meds. TALK TO YOUR PSYCHIATRIST about this thoroughly. Share w/ him/her about my experience w/ it. When you get post op, you will be not only dealing w/ one illness but two. It is not easy to get better from the wls when you are battling the emotional turmoil of having to have come off your psych meds for the surgery, too. Some w/ bipolar illness say they have had little problems, afterwards. Unfortunately I did. I hope you don't. Think it over before making your decision. Have your psychiatrist close by if you do have the wls so that if need be, the surgeon can consult w/ them if need be when you are post op. As I said earlier, I was the first bipolar patient that my surgeon had and he had no clue how to deal w/ me post-op in this area.
   — kathy S.

September 19, 2000
Hi there, I also suffer from depression and have a lot of the family history that you have. I don't know if I would mention the manic-depression because this could be the insurance company's 'OUT' to refuse you, stating that you will not be able to mentally handle the changes post-op. As to what Kathy S. said, she has some VERY GOOD POINTS on medication. I spoke to my surgeon about my depression, he said NOT TO STOP my medication what so ever. That I will need to be stable during this transition in my life. As you probably know, it is very unsafe to stop any kind of antidepressants suddenly (I, unfortunately, found out the hard way) I would wonder if you could talk to your Dr. about maybe medications they could put in your I.V. while you are in the hospital. I don't know if they can do this, but it wouldn't hurt to ask. You have all my prayers for some enlightenment. Keep your chin up and greet the wourld head on!!!!
   — Patti S.