About a week ago I got the letter from my current doctor... and I remembered why she isn't a favorite of mine. I've always thought she was a little too ditzy to take seriously.

She did what I asked in that I now have a letter telling The Board that I need surgery to control my weight. However, it kind of looked like a middle school child wrote it. It's full of grammar errors: missing punctuation; missing words; capitalized words in wrong places. It's sad really. I suspect she scribbled something out on paper then handed it to one of her flunkies to type up. I'm trying to suspress the urge to send it back and have it re-written. Doctor's should know how to write a formal letter, don't you think? I won't do that though. I don't want to rock the boat, let alone slow the process even more than it already is.

Anyway, I'm about to give up on getting the letter back from my previous doctor. I haven't heard a thing and while part of me wants to contact the office to find out if I will be receiving one, the other part of me doesn't want to hear that he won't be sending one. It's too stressful.

I'm thinking that I'll have to add much more detail in my own appeal letter to cover the gaps of not having the second letter. Plus, I'll be adding more research on comparisons between the costs of  having the surgery and the costs of health issues due to obesity. I should also call the insurance company itself to get any help on the letter... if they're willing to help. I have found a bunch of sites online on how to write the appeal letter. I plan on my letter being much longer than the examples; I want to cover every possible aspect, maybe even guilt them into giving me the surgery!

Over the next small hurdle, getting my doctor to write an official letter to the surgical/referral/bariatric board (at this point I'm not sure who is who) on my behalf and stating her opinion that I need surgery. I did find several sites online that provide sample letters that I can use to write mine, once I have the doctor's letter (and hopefully my previous doctor too).

Even though it's a step forward, all day today I've been feeling bummed out and grumpy. I have this thought in my mind that this is going to drag out forever, which is kind of funny considering I only started the process a week ago. It also feels like my time limit of 180 days to get the appeal sent will go by so fast, especially when much of that time will be spent waiting for something else to happen.

I tell myself to just chill out, take things as they come, deal with one day at a time. My brain has a hard time with that most of the the time. I need instant gratification in most things and dealing with anything health related has never provided me with instant gratification; more like a slow tortured existence with relief just beyond my reach. Granted I've had two previous major surgeries (brain surgery and breast reduction) that worked out wonderfully in the long run so I really should stop whining. But I want to whine. After dealing with my weight my whole life, I feel entitled to whine every once in awhile. I work through the frustrations because I know I am strong when I really need to be. Ultimately, the only one you can truly rely on is yourself, right?

Received my letter... not the one I was hoping for. Denied. Kaiser is denying my surgery because bariatric surgery of any kind is not covered under my plan. It's frustrating that they don't even look at my medical history. I knew this was a possibility but I had hoped my luck in life would pull through for this. But, alas, no.

So, I am now researching what I will have to do in order to submit an appeal to an "adverse benefit determination" within the next 180 days (starting tomorrow). I sent a message to my regular doctor to ask for her help. I'm going to send another letter to my previous doctor to see if he is able to help me too.

I am so frustrated, mad, sad, and overwhelmed with the "legaleze," or maybe it should be "medicaleze"of what needs to be done at this point. I am determined to have this surgery. I may have to look into getting it financed through a loan or through another medical center. I noticed through a beginning search that some people are turning to crowdfunding for their surgeries. Hmm...

As an FYI, during this whole process of getting accepted for surgery, this blog is going get into the down and dirty, nitty gritty, everything you may never have wanted to know about me. I feel that I need to help anyone that I can through the process, along with myself, and the only way to do that is to be completely honest about everything. You have been given your fair warning.

So lets go over my stats that I sort of listed in the previous post, and the history that accompanies each of them. The Kaiser requirements are in bold.

1. 100 lbs over ideal weight: I have been fat all my life, from the moment that puberty decided to rear its ugly head. The weight has wavered over the years, of course, but it has always been slowly but steadily going up. I'm currently at 326lbs. Ouch.
2. BMI over 40: My weight, height and age, 45, have my BMI at 52-55, depending on who's height measurement you believe. My last measurement, a couple of months ago, was 5ft 6in and that's the one Kaiser is currently basing my BMI on. Odd, I have never been 5ft 6in before. I think the nurse misread the scale. 5ft 4.5in to 5ft 5in would be more accurate. So, if I'm shorter, that means my BMI is that much higher.
3. High blood pressure: It's been a little high for years but has started going up to the danger zone for the last year. It makes sense because I've gained 30lbs in the last two years.
4. Sleep apnea: I've been using a CPAP for about six years. My husband told me that I was starting to stop breathing while I slept, on average 25 times an hour. He died right before I had my first appointment with the sleep center... like two days before. If he had died a week earlier, I would never have known that I had been putting my heart under so much strain. My sleep still isn't very good (rolling around trying to get comfortable) but my CPAP is like my security blanket; I can't sleep at all without it.
5. Arthritis: When I was very young, I think a fell from a tree or something and screwed up my left knee something fierce. At the time, my parents didn't believe that it hurt as much as it did and I remember crying because I could not bend it at all. I guess fat kids are supposed to bounce? After many years of it randomly going out on me and causing immense pain at times, I finally had it checked out. Advanced osteoarthritis. Joy.
6. GERD or other acid reflux issues: My stomach started trying to dissolve itself about 10ish years ago. I've been on Prilosec since then.
7. Low back and joint pain: After carrying around all the weight for so many years, everything hurts... all the time. Sometimes less, mostly more but it never ends. A couple of doctors have tried to convince me that it's fibromyalgia. It's not. I have no trigger points. I have all the other symptoms of fibro but without the trigger points its not fibro. I figure once I get the weight off, all the other symptoms will disappear. I'm willing to bet my life on it. Hence, the bariatric surgery.
8. Diabetes:My glucose levels have always been pretty good which is odd considering my insane addiction to all things sweet and delicious. I've never had the big glucose tests but it would be hard to believe that my levels aren't heading into the danger zone by now. I imagine that the test will be required at some point in the near future.
9. Genetically linked to cancer: Cancer in the family? Uh, yeah. My mom died last year after a decade and a half battle with breast-to-sternum-to-lung cancer. My dad died when I was ten from esophageal cancer. Both of his parents died from cancer: ovarian and colon. There are probably more in my ancestry but we don't have the records. If my weight doesn't kill me, I'm pretty sure cancer will. So far, weight is winning the race and I'm not prepared to let that happen. Cancer seems more dignified.

Now for some issues that are going on that most people don't like to talk about. The things that happen when you have far too much weight on your frame.

Boils. I hate boils. They seriously suck and I get them all the time, sometimes several at once. They are almost always anywhere around my groin, sometimes on my girly parts. Most of the time, they never come to a head but slowly and painfully get reabsorbed. And there is nothing I can do about them, according to the doctors. I'm hoping they will stop when I get thinner and the whole area can start getting a little more air.

Another thing that happens when skin can't breath: rashes. Itchy, nasty rashes. I can keep mine in control with powdering all my folds after each shower.... and sometimes twice a day when it's hot. This summer has been a real itchy pain. If they get bad, they can get painful and very stinky. Ever wonder why that morbidly obese person next to you smells... odd? It's the rashes. I'm obsessive about it and rarely have that kind of trouble but if I get any bigger, the rashes will take over like they do for every super obese person.

And then there are the toilet issues. If I get even a few pounds heavier I will not be able to keep myself clean with toilet paper. It's very difficult now because it hurts my body to bend that way, let alone be able to reach easily. I have IBS and a couple of years ago I installed a bidet attachment to my toilet because toilet paper itself was getting too painful. What the hell is wrong with America and not having bidets in every home? They are WONDERFUL! Not to mention, I now use toilet paper just to dry myself so I use a whole lot less then I was and when you have IBS, you only buy the good stuff. After watching so many episodes of BBC's Fat Doctor, it is agonizing to see how people suffer with not being able to keep up their own hygiene. Yes, you can buy tools (things that hold little wads of tp and have long handles for reaching) to help but I can't imagine them working very well. It's a good thing that I have a Mirena  (and no real period to speak of) because tampons are difficult to use too.

Sometimes my feet swell. I'm assuming it's water that gets trapped when I sit for too long. It hurts sometimes but most of the time it feels like I somehow got someone else's feet switched with mine. It feels like foreign objects stuck there. The water is probably pooling in my legs too but I can't tell through the fat.

So those are my physical issues... the mental ones will have to have their own post.

Getting Caught Up

It's been awhile since this little blog has had some attention so here we go.

So, maybe I should catch y'all up on why I decided to start blogging again... my decision to finally get bariatric surgery. YAY! I've been looking around the web, trying to find blogs, videos, whatever, about how people dealt with the very beginning stages of the process. I couldn't find ANYTHING! It's like they all jumped straight into "the night before surgery" and took it from there. That wasn't helpful to me and I'm sure there are thousands of others that are looking for the same thing. So I want to share my experiences from the VERY BEGINNING. What a concept!

In the the first few days of September, I logged into my Kaiser Permenente account to pay a bill. I saw that they added a cute little feature that would estimate the cost of just about any procedure a person could want and bases the costs on what each person's current benefits are. On a whim, I plugged in gastric bypass. I've wanted one my whole life. My jaw hit floor! I expected no coverage or coverage that paid very little of the final cost, as had been my history for many years. What I got was nearly full coverage and only my out-of-pocket maximum would have to be paid by me, which thankfully, is pretty low considering. WOW! I did a little happy dance. My mind swelled with thoughts of finally... FREAKING FINALLY I may get to let out the skinny me that has been hiding inside for 45 years and release her from my beached whale body.

I sent an email to my doctor, asking her what I needed to do. She looked at my stats again to see if I had everything that Kaiser required:

• 100 lbs over ideal weight? Check!
• BMI over 40? Check!
• At least one of the following:
• High blood pressure? Check! 
• Sleep apnea? Check!
• Arthritis? Check!
• GERD or other acid reflux issues? Check!
• Low back and joint pain? Check, Check!
• Diabetes? not checked but getting close
• Genetically linked to cancer? Check!

She was behind me 100%! YAY! She asked me to send her my diet history so she got put in the referral. I had to prove that I was a completely failure at commercial or  medically supervised diets, like Weight Watchers, Slimfast, Medifast, medications, etc. Uh, yeah... I have a some experience with that... since I was 10 years old. I sent her the list and crossed my fingers.

I didn't hear anything for several days. I started to panic. I started watching the Fat Doctor (BBC) on Hulu. I cried and laughed along with the patients in the show. I panicked some more. Then, I sent another email asking how long it would take to hear back. Her office sent me a long generic message telling me that after the referral board looked my records over they would send me a letter either accepting or denying my request. It scared me a little... especially the part about getting denied and then having them explain the costs of going to Mexico for cheaper, private surgery. No kidding.  I had been telling myself all week that there could be no possible reason why they would deny me and they said in a letter they send to everybody that I may have to go to Mexico. It was weird.

Which brings me to now-ish. Last night, I went on Kaiser's site for the billionth time in a week, reading and re-reading the requirements, FAQs, all the "what to expect after your surgery" and everything I could get my eyes on. I noticed something I had never really paid much attention to before. I'll let my post on Facebook take over from here:

I find a section for my "Personal Action Plan" which for all these years has never had anything in it. Tonight, it's been updated for a cholesterol, blood pressure and BMI tests in the lab. HOLY SHIT! Trying to stay calm, but could this possibly mean than they are truly considering me??? I'm restraining myself from running (waddling) out to the mailbox to check for the letter. USPS delivers the mail twice in one day right? Is it possible to cry, scream, giggle, jump for joy and run around in circles (and then have a heart attack) all in the same moment???
I think I need to start a blog... along with every other bariatric patient out there.

And there you go! My blog has been restarted and my adventure in bariatric surgery begins. Please keep your fingers crossed and send me all the good mojo you can muster to that this process continues and I come a much happier, healthier and lighter person.