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Journey Tobeme

Ohhh the hoops we jump thru

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Hoops. I use to love hoops growing up. I am talking about the round things you spin on your body like....Click image for larger version. 

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ID:	20440 or one of my favorite Native dances Click image for larger version. 

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Those were the fun hoops.

Now days the only hoops I see are the ones I have to jump thru. Most recently those would be for surgery. I know each of you can understand this. So below are my hoops and my progress. I hope you enjoyed the pictures because they are the best things about this post.

Insurance: It took them 2 weeks to come up with this list haha
2 years pre op documentation of obesity DONE
3 Months DR supervised diet DONE
BMI over 40 DONE

Doctor:
Chest Xray DONE
Pulmonary Function Test DONE
Exercise Physiology DONE
Psychological Eval DONE
Emmi videos DONE
Before support group DONE
After support group PROCESS
PCP letter DONE
Labs PROCESS
Cardiac Testing PROCESS
Sleep Study PROCESS
Initial Dietary consultation DONE
Follow up monthly dietitian PROCESS
Goal weight 254 PROCESS
Money (my part) DONE
Insurance approval PROCESS
Eat meat PROCESS
__________________________________________________ ___________
INSURANCE APPROVAL: They are just awaiting the paperwork. My insurance case manager keeps tabs calling every 2 weeks to see what is complete and what needs to be completed. He is as anxious and excited as me lol. I was assigned my awesome case manager so he could push the pre-authorizations thru their system since so many were being denied.

AFTER SUPPORT GROUP: I think this one is pretty self explanatory

LABS: This is nothing bad. My iron is severely low. I knew it before my lab results. I will have an infusion once cardiac and sleep study are complete. We don't want to do it too soon. I will of course need another lab test to show the improved level. So this is a technicality that is easily resolved.

CARDIAC TESTING: Frustrating. I had to have an Echo, EKG and surgery clearance. My insurance sent me to a doctor who doesn't work with my surgeon despite being a floor below him. Before he will give me clearance he also wanted a Stress test (treadmill). It took awhile to get my original visit and Echo approved thru my insurance. Since I have never had any cardiac issues my insurance wasn't wanting to pay. So I had to wait another 2 weeks for my treadmill test. I did it yesterday. Now I am waiting to hear from my cardiology office this morning to let me know if he is signing off on my clearance. What he doesn't know is my surgeon just needs the results from the EKG and the ECHO. He will make his own determination. But we couldn't get thru the process without the hoops falling to the ground sometimes, right?

FOLLOW UP NUTRITION: I have to meet with her once a month until all other criteria has been met. The only thing I mind about it is it cost me $25.00 and 2 hours of time so I have to miss work. But otherwise I go in and she tells me how EAT YOUR MEAT (another post entirely)

EAT MEAT: I am a vegan. A fat one but still a vegan. I do not like dairy, nor eggs, nor meat. I haven't had the stuff in over 3 years. I have had to agree to consume these things from now and until at least 6 months post op. It is a struggle. Not ethically but I just don't like it. I have food issues and animal products consumption is one of them. My stomach turns at the thought of eating it. More in another post like I said a minute ago.

SLEEP STUDY: Beyond frustrating. I thought this would be the easy part. I went and had my sleep study. Insurance approved it easily. The catch for me was my co pay was $250.00. But it counts towards my very low out of pocket so no worries. I get a call from the doctor's office. It was his PA. I have VERY MILD sleep apnea. She said if I wasn't having the surgery they wouldn't even treat it. It is that mild. BUT since it has to be treated for surgery I find myself with lots of hoops. Option 1 Beg my insurance for another sleep study approval (not likely to approve considering how mild) so that the doctor can test our different machines to see if any will help. This will result in another $250.00 co payOption 2 Use a dental device which is commonly prescribed for this type of apnea. This was my choice but the greedy doctor says no he wants another study. Strange since his PA was the one who told me this is the most common treatment. Option 3 Pay myself for another doctor to give an opinion on the results and hope he will give the dental device. If money was no problem I would gladly do this. Option 4 Submit the sleep study and hope my surgeon doesn't feel it is necessary to do any treatment. The frustration will continue all week since my patient advocate is out of the office on vacation.

GOAL WEIGHT (254) Easier said then done. Remember the eating meat mandate? I gained 15 extra pounds. I will get into that in my post about giving up my plant based lifestyle. So I lost those 15 pounds to get back to my weight of record: 282. Weighing at home I show 278 now. Here is my kicker. I could drop the last 24 pounds rather quickly. But if I get below 250, the insurance criteria for my surgery changes to 6 months of diet. That would mean way longer to wait and out of pocket would start over. So I am pacing myself on losing the pre surgery weight until I get all the other issues resolved.

So I think that is it. I won't update this post as things come together. I will make a new post so I can update there. Thanks for reading and understanding the hoops aren't as cool as when we were kids.

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Comments

  1. Ladeegee's Avatar
    I had to do all of these too, except BCBS wants 6 months of nutrition counseling. But they do pay for it (thankfully). Since you're vegan, you should ask your nutritionist about beans and tofu. They have plenty of protein.
  2. Journey Tobeme's Avatar
    Ladeegee, I don't want anyone to think we shouldn't have to complete things. Quite the opposite, I think it helps people understand how much they will need to dedicate to this tool to change their life. I think the criteria is good if you have a great team working to get you clearance. I don't except at my surgeon's office.
    I just want to give a clear picture to those who haven't looked at criteria yet. I also wanted to highlight some of the struggles I faced meeting that criteria. I never thought cardio clearance would be an issue. I have NO heart/cardio issues. It is the cardiologist who is the problem. Same with the sleep study issue. I want to give a thorough detailing of my path to surgery.

    As for the nutritionist she is hopeless when it comes to plant based. She said there is no such thing as complete proteins in the plant world. Yet hemp seeds have more complete, more absorptive protein than any animal product except animal blood. Considering we keep seeds raw their nutrition isn't destroyed unlike cooked animal products. But I regress, she is just not open to it and I respect that. Their belief is beans should not be consumed more than once a week.