Denied

[scogra]

I was able to “loan” myself the money from my 401k to pay for mine. It’s cheaper interest than financing surgeries and I am automatically taking out of my paychecks and won’t miss the little extra gone each week. Maybe you simplyseahorse or anyone else out might have this option available to pay for their surgery.

[Kristi7928]

Finally some good news. Emailed my surgeon's nurse and was asking about pre-op diet and she said there isn't one. Woo!!

I did get a letter today that they could not find my medical records for arms and shoulders. Redid the request and got specific for my primary and any PT from October thru January 2018. Hoping they get to Pierre this week.

[donnahellno]

Finally some good news. Emailed my surgeon's nurse and was asking about pre-op diet and she said there isn't one. Woo!!

I did get a letter today that they could not find my medical records for arms and shoulders. Redid the request and got specific for my primary and any PT from October thru January 2018. Hoping they get to Pierre this week.

Kristi, I am a new member here but I was just browsing through some of your story which you posted in this thread. I'm sorry you are fighting such an uphill battle.

One of my best friends was paralyzed in a car accident, and she and I were just discussing sleeve surgery the other day, but she said she had never considered it because she knew she wouldn't be able to have it. I know each case is different, but I am going to go do some research!

I hope they come around soon. It's a nightmare trying to fight an uphill battle while fighting another uphill battle.

[Kristi7928]

Donna - first off welcome. You are in a wonderful place for questions. As for your friend - there is not a whole lot of information regarding quads and paras having weight loss surgery. Even my surgeon when I first met him said - I've never worked with someone like you. I told him far from normal, but of all the surgeries I have had - this is minor. I hope after this uphill battle to get approved - everything else is smooth sailing.

If your friend wants to ask me questions just let me know. One of my friends from when we were Ms. Wheelchair together had it done and she was a wealth of good information from a paralysis POV. I'd love to help out if I can.

[donnahellno]

Donna - first off welcome. You are in a wonderful place for questions. As for your friend - there is not a whole lot of information regarding quads and paras having weight loss surgery. Even my surgeon when I first met him said - I've never worked with someone like you. I told him far from normal, but of all the surgeries I have had - this is minor. I hope after this uphill battle to get approved - everything else is smooth sailing.

If your friend wants to ask me questions just let me know. One of my friends from when we were Ms. Wheelchair together had it done and she was a wealth of good information from a paralysis POV. I'd love to help out if I can.

That is very sweet of you. She is not a member here, I don't know that she would sign up. But I was telling her about reading your post and she was intrigued, and of course said to tell you good luck she hopes you win! She mentioned that even if she were able to get the surgery she would be concerned about sores from loose skin folds.

I'm not sure, she might be dismissing the idea, too, because her injury was fairly high, and I know she has said before that anything below her line of injury (I know that's not the correct name, but I'm having massive brain fog at the moment) would be risky because she won't heal as well.

Also, I have never heard of Ms. Wheelchair. That's so cool! Did your friend have complications with healing after her surgery?

[Kristi7928]

That is very sweet of you. She is not a member here, I don't know that she would sign up. But I was telling her about reading your post and she was intrigued, and of course said to tell you good luck she hopes you win! She mentioned that even if she were able to get the surgery she would be concerned about sores from loose skin folds.

I'm not sure, she might be dismissing the idea, too, because her injury was fairly high, and I know she has said before that anything below her line of injury (I know that's not the correct name, but I'm having massive brain fog at the moment) would be risky because she won't heal as well.

Also, I have never heard of Ms. Wheelchair. That's so cool! Did your friend have complications with healing after her surgery?

Well, I already have pressure sores on my feet that are pretty bad and all but my podiatrist think it's my weight. My legs are heavy and four feet long and I am only 5'4'. Short arms - just a bad combo for a wheelchair. I'm hoping to prove my podiatrist wrong on this.

As for my friend - she didn't have any issues healing the incisions, however she did get too skinny and ended up with pressure sore on her bottom and both hips and was in the hospital for a year. She maintains in the 160 area. I think she is taller than me, but a good thing to know ahead of time to watch out for. Never in my life have I ever had to watch out for being "too skinny" but I promised my Lupus doc that once I got down around 150 that we would take it from there. If I'm not too bony then possibly shoot for 140 or 130. My wheelchair guy is also watching out for me as well. I have a whole team of doctors rooting me on and also looking out for my best interest on my journey.

I have had my stomach cut open twice - the second time the doc followed the scar so I wouldn't have two and both times it healed fine and that's way below my injury level. Actually both those surgeries I went home early from bouncing back so well. From what I have seen of posted photos these incisions are small compared to my stomach one.

Ms. Wheelchair America is a state and national pageant. Not all states are involved. It's hard finding women that want to public speak. And finding enough women to do a local pageant. The national pageant was fun, but overwhelming. However, you meet some many wonderful advocates and end it with some amazing friendships! There is also a Ms. Wheelchair USA. Similar but I think they do a swimsuit category. No thank you. ;-)

[donnahellno]

Well, I already have pressure sores on my feet that are pretty bad and all but my podiatrist think it's my weight. My legs are heavy and four feet long and I am only 5'4'. Short arms - just a bad combo for a wheelchair. I'm hoping to prove my podiatrist wrong on this.

As for my friend - she didn't have any issues healing the incisions, however she did get too skinny and ended up with pressure sore on her bottom and both hips and was in the hospital for a year. She maintains in the 160 area. I think she is taller than me, but a good thing to know ahead of time to watch out for. Never in my life have I ever had to watch out for being "too skinny" but I promised my Lupus doc that once I got down around 150 that we would take it from there. If I'm not too bony then possibly shoot for 140 or 130. My wheelchair guy is also watching out for me as well. I have a whole team of doctors rooting me on and also looking out for my best interest on my journey.

I have had my stomach cut open twice - the second time the doc followed the scar so I wouldn't have two and both times it healed fine and that's way below my injury level. Actually both those surgeries I went home early from bouncing back so well. From what I have seen of posted photos these incisions are small compared to my stomach one.

Ms. Wheelchair America is a state and national pageant. Not all states are involved. It's hard finding women that want to public speak. And finding enough women to do a local pageant. The national pageant was fun, but overwhelming. However, you meet some many wonderful advocates and end it with some amazing friendships! There is also a Ms. Wheelchair USA. Similar but I think they do a swimsuit category. No thank you. ;-)

I'd only be interested in the swimsuit category if creativity counted. Like if you could dress your chair up like some sort of boardwalk vendor, or something. I've always been weirdly modest, even before putting on a ton of weight. Usually don't wear shorts, or short skirts, and by "short" I mean less than ankle length. Not from any kind of religious or judgmental stance, just because I'm personally more comfortable. In any case, I'm sure that was a really wonderful experience. Did you sign up or were you nominated/picked?

I'm not sure if it matters, either, since her paralysis is from physical injury to her spinal cord? I'm really showing my ignorance there, but I could understand either way. She said she had a hard time getting her doctor to okay a tattoo, just because of concerns with healing. Again, I don't know enough to know whether it's something specific to her type of injury or I'm just making things up.

Is there anything you can do to ease the pressure sores on your feet? Do you have to have specific wound care on them regularly? And do you get awful nerve spasms when you have an injury like that, too?

Lupus, too? Girl I am sorry. What a headache. I have fibromyalgia, but at first they thought it was rheumatoid arthritis, so every day I consider myself so lucky that it is JUST fibromyalgia and not something more serious. I might feel like hell every day, but physically things are fine so I just keep swimming. I have another friend who has lupus and she lost so much weight because of it. It's scary how serious it can be.
If you ever need to do some venting, I'm here.

[AnnieG]

Since Kristi is a friend outside the forum, I've spoken in general about her issues with my bariatric doctor. He has Paras and quads he's done. His take was your primary care person sets the stage and documents how you need it, and what you've done.

Each state governs insurance companies, and Medicaid (not Medicare) differently. Apparently the actuarial information on insurance recoupment vs break-evenis part of the issue. With Medicaid, your state accepts or refuses monies based on whose the predominant party's take on people with need, without private nsurance.

Kristi is a warrior-girl, fighting a tough system. I believe she'll be approved. Because she's not backing off.
Prayers!

[mandyjdc]

Hoping for the best for you Kristi. I can't even imagine everything you're going through. Keep fighting, girl! We're all here for you!

[Kristi7928]

Thank you Mandy.

My foot doc and my infectious disease doc might be putting a monkey wrench into my plans. My wounds are not healing and that might mean IV antibiotics. I won't know much until Tuesday now. My ID doc is coming over to the wound clinic to see them with bandages. I just got a letter from Cigna now denying my MRI. They are worried about bone infection. So I'll have to get an xray first, then the MRI and then see what the course of action will be. If they decide on IV treatment that's usually 6 weeks so that's going to put me into July at the earliest for surgery. I don't know if my surgeon would operate if I'm on IV treatment. He's at the other hospital. I will ask once I know we are going with that plan.

And then Jason Witten retired from MY Dallas Cowboys. I tried to watch his retirement speech at work and started to cry so I stopped. I'll watch it tonight. I'm slightly attached to him! At least he's going to Monday Night Football so it's not like I won't ever see him again. :-)

I'm sorry Temptations, but I'm beginning to hate the month of May!

[AnnieG]

. Bummer! But when you are old(like me) timing seems to work likes it's meant to. I'm sorry you're going through so much.

[donnahellno]

Waiting with everything up in the air is the worst. It is so frustrating!

I'll send all my best vibes your way, and I will cross all my crossables.

[Kristi7928]

When it rains it pours. My grandpa passed away on Saturday. Took a nap and didn't wake up. He would have been 86 on May 15th. He's with my grandma now and that makes me happy. I know he missed her.

Insurance denied the MRI on my feet so my docs did a bone biopsy on each foot. Kinda glad, I didn't want to sit in that loud machine. ID put me on keflex and flagyl 3x a day. I'll probably lose a few pounds as I get very nauseous with antibiotics. And flagyl has a side of effect of no appetite. At this point I'll take any weight loss I can get. My ID doc is going to come to wound clinic to see me so I will miss less work and easier to see over a photo. He'll decide on IVs probably Tuesday.

I have a port and get it flushed monthly - thought we solved the scale issue, but it was a hoyer. Going to ask the infusion center if I can just hop on one of their beds when they are flushing my port, then I can send the weight to my wls nurse and she can put it on a header and fax it to my primary all so Medicaid is happy. Pain in the butt just to get a weight when I have a perfectly good scale at home. I'll still weigh weekly at home to track progress before and after surgery.

I am calling Medicaid tomorrow to get an update on where we are at - if any closer or not. Just so ready. Maybe my grandparents will send me some good Medicaid news. <3

[donnahellno]

Kristi, I am so sorry to hear about your pap! At least it was peaceful. <3

It sucks that there are so many hoops to jump through! Especially just to get a freaking weight recorded. A bone biopsy sounds like it could be really rough. Was it?

Has your doctor tried any appetite suppressants? Vyvanse, Qsymia etc... I know they aren't an option for everyone but for some they can help.

I'm starting on one tomorrow. And I am waiting to hear back from the surgeon's office, to get my appointment time. Very nervous about that.

I hope you get some good news soon.

[Kristi7928]

I can't feel my feet for the most part. I feel my right more than my left. He did the left while I was talking with my other doc. Tried to not watch when he did the right. They just need a little tiny bit of the bone.

I don't overeat, more so do not make the right choices. I had my second dose of antibiotics and it made me nauseous around lunch time. I had left over pork fried rice and I got most of it down around 1:30. Appetite is ok right now - the metal taste in my mouth not so much.

Called Medicaid today, but had to leave a message. Hopefully she has an update for me soon. I'll try Monday if I don't hear anything before the weekend.

Good luck with your appointment. I hope you get an amazing doctor and staff. That helps so much on the journey. :-)