Friday, June 8, 2012

The Confessions of a Pissed Patient

Many of you are aware that I've been having some ingoing health issues...nothing horrible like some people face, but still exasperating, nonetheless.  Twenty-Two years ago, I had a gastric stapling done to lose weight.  My decision was never based on vanity, rather health, and I was nearing 300 pounds and wanted to end the resemblance to my father's side of the family, who by that time, were all dead.

So, now twenty-plus years later, I'm faced with scar tissue that impedes my ability to swallow normal foods and I'm living on junk I know I can eat without problem.  Last year, I was in the hospital three times in two months for dilation procedures, saw countless doctors, and after a recent hospitalization and heart scare (which preceded numerous very costly tests), I've been referred back to Vanderbilt to see a surgeon about having a revision.

One would think after four hospitalizations, seeing nearly twenty doctors, and suffering with chronic fatigue and stress, my insurance would approve the procedure, but NO...I'm being seen as someone seeking a gastric bypass, which in reality is the last thing I want, but seems to be the only solution to the problem.  In order to be approved, I have to see a dietitian, have a sleep study for sleep apnea, have a psych evaluation, and have my personal physician provide evidence of my attempts at weight loss for at least three visits, plus have him write a letter to the surgeon, stating that I'm morbidly obese and can't lose weight any other way.  I already had weight loss surgery, which decades ago was really serious stuff.  Now they do it in a non-invasive manner and you go home the next day.  Of course, the surgeon has already informed me that they most likely cannot do the surgery that way on me, so I'll have another stem-to-stern scar and require a longer hospital stay.  I can already see the dollar signs piling up, but clearly I have a problem that needs to be fixed.

I always viewed my surgery as a tool and not a cure, but no one told me that after so many years your body would become accustomed to the lower caloric intake and you would face regaining despite eating much less.  At least when I was fat before I could point to the Big Macs, fries and frequent thirty-one flavor trips I made.  Now, my husband can't believe I can gain weight on the amount I eat, but at this stage, it's not how much, it's WHAT!  No wonder I'm depressed.

Anyhow...I needed to vent, and my blog is the best medicine for that.  I hope you'll excuse the rant, but this whole thing has affected the way I view life, my interest in writing, and has brought back the panic attacks I thought were long gone.  Still, I know am blessed in so many ways...I just have to keep counting my blessings and reminding myself that I could find a lot of people who would gladly trade their problems for mine.  I'm working on being more thankful, and my friends top the list of what I'm most grateful for.


Kathryn R. Blake said...

Ginger, it sounds like you're caught in a real "Catch 22." The problem you suffer is caused by a previous gastric surgery, and to fix it you need to go through yet another surgery that your insurance considers a bypass rather than a way to repair your previous. Frustrating to say the least. Hope everything gets straightened out soon.

Todd and Christie said...

Fight, appeal, appeal, and fight. If you have to go to your state's insurance commissioner, do it. That's what the person is "there" for. I can't say how it is in Tennessee, but ours in California has helped us twice with things our insurance was was a denial, and another time, it was a request for a different physical therapist. We've had to fight so many things (including a procedure we wanted to have at Vandy) we have certain people on speed dial, lol. We generally win, but we do have to fight to get what we want.

Ginger Simpson said...

Yep, I'm definitely caught because I can't get the doctors to explain exactly what you said to the insurance company. It sucks, and I'm hoping I don't have to wait until it becomes an emergency. :)

Ginger Simpson said...

I would fight, but I just don't have the energy. Chronic fatigue sucks. :)

Tabitha Shay said...

Aww, Miz Ginger,
Here's wishing you well and that you get the surgery you need...Hugs...Tabs

Anonymous said...

Hi Ginger, sorry you're going through this. As someone who's been in similar situations, and has chronic fatigue syndrome - fighting will actually help the chronic fatigue by helping alleviate the depression. Sticking up for yourself in an unjust situation is good for the psyche and self-esteem, win or lose. At least you didn't lay down and take it.

My MIL had stapling done 26 yrs ago, and faced many of the same issues with eating you have. She had repeated dilation procedures, and still could only eat soft food with no real substance - all that high calorie junk that causes so many other health issues on its own. About 10 yrs ago, she had to have the gastric bypass because of further complications with the stapling. Medicare denied the procedure because of her current weight, under 200 lbs (she was over 600 before the initial stapling). Her surgeon finally figured out that by calling the bypass something else, and changing the procedure in some small, but meaningless, way, he could get it approved. So he called it a reconstruction rather than a bypass. The surgery was successful and she was able to eat many foods she hadn't been able to since long before her stapling.

Wishing you success with this - it's a difficult road to fight the insurance company, but necessary. Maybe if you fight and win, someone else won't have to go through the same thing.

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