Health Insurance and Finding a Surgeon

I've had a lot of health issues in the last ten years, not only the ones already mentioned but also depression, insomnia, migraines, unspecificied stomach issues, and a lot more. As the song says, I'm much too young to feel this damn old. I've gotten used to calling doctors and insurance companies, saving copies of things, filing appeals and the like. My advice is: document, document, document. Save everything until you have the statement showing $0.00 in your hand, then have a shredding party.

I haven't been working full-time for a couple of months, so I am dealing with my spouse's insurance on this procedure. They were taken aback to find out they were my primary insurance, so that had to be verified recently. Then they told me the only bariatric surgery provider they covered was over 50 miles away. I watched a web seminar on his site and went to the initial appointment, thinking his practice was my only option unless I was going to self-pay.

Well, I didn't like the doctor. He wasn't listening at all, he didn't bother looking at my medical records, and he was ready to run a bunch of tests I'd had in the last couple of years when the results were present in the medical records he wasn't looking at. He was extremely dismissive. In effect, he said, "We do the surgery, we make you sick if you eat ice cream, you get thin, end of story. Bye bye." That approach did not do it for me.

I had recently read about another facility in the newspaper who had gotten some positive attention for their standards in minimally invasive and cutting edge weight-loss surgeries. They happened to be more conveniently located. My husband and I went to their free seminar, and it was fantastic. It was interactive, informative...I took pages of notes and was ready to sign anything and go to work for them, too, if they'd let me. The bedside manner of the doctors was like night and day from the previous surgeon. This particular facility emphasizes nutritional classes, follow-up care, nutritional coaching, support groups if you choose to participate in them, etc. I was really excited by their approach, because it actually sounds like it can work. They gave us information on how to finance surgery if insurance would not pay and that was that. Imagine my surprise when they told me they were a contracted provider with my husband's insurance! Glad I asked!

I then went to retrieve my medical records from the first bariatric surgeon--there were about 600 pages of them, so I was grateful not to have to accrue them all again. It also made it much easier to fill out the new facility's application accurately--they want every bit of medical history and then some. My intake appointment, as they call it, involved meeting with a lady who does billing and is the liaison with the insurance, and then a consultation with the surgeon. A lot of it was review from the seminar and other research I've done.

The surgeon I met with recommended gastric bypass for me because I have "what they call" classic metabolic syndrome, where I gain all my weight in the torso, also known as the apple body type or, as I once heard it explained, "egg on stilts look." (Apparently, there is a connection between which bariatric surgery might achieve optimum results for each specific body type.) I asked him if PCOS was still present when there were no longer ovaries, and he said, "That's a really great question!" I don't know if anyone knows that answer.

My particular insurance wants 6 months of a physician-supervised diet, two years of chart notes at a certain weight and BMI, the psych eval, the nutritional assessment, and a monthly visit to check in with the nutritionist. There are nutrition classes prior to surgery and after it.

Another thing I like about this facility is that they call the providers to find out what your benefits are initially, instead of you doing that. It sets a precedent with insurance, and a good one--insurance is always going to be more attentive to the provider. Still, you have to be loud if you want anyone to listen to you at ALL. Loud, persistent, with your headache cure of choice at the ready.

How Long Have You Been Fat?

I don't remember not being fat. More precisely, I don't remember not being called fat. Puberty and all its hormones seemed to do a number on me--as it does on everyone, to a greater or lesser extent--but I felt like a science experiment gone awry. 3 cup sizes in one summer, for instance. Men yelling at me out of cars if I wore a shirt that wasn't too big. Boys at school giving me smiles that begged for their mouths to be washed out with soap. It was terrifying to me. There was nowhere to hide. My dearest wish at the time was to be invisible, but between the ages of 12 and 16 felt like the most visible time of my life. I learned to wear baggy clothes, to make jokes, and to grit my teeth.

I lived with one family member who forced me to do situps until I felt sick and ate ice cream in front of me. I was eight years old at the time. I responded by stealing--money to buy food. I learned to hoard food and to stuff myself when I was able to eat, not knowing when I would be allowed to eat again or how much.

Doctors first became involved when I was about thirteen, first to find out if my accelerated cup growth wasn't abnormal. The diets began. Every stupid diet in the '80s, and there were many.

I tried smoking cigarettes to see if that would make me thin. It didn't.

I lived with another family member in my teens who did not allow me to eat with the rest of the family. I had special diet food, most of it frozen and all of it tasteless. He tried to put me on a doctor-supervised diet where I counted calories--1200 a day--and threw a scale at me one day after I got on it at his command and it read 150. It was an old metal scale, and he was a big man, but I ducked and it missed me.

When the bariatric surgeon asked me what my goal weight was two days ago, I said, "180. In my dreams, 150." He told me, matter-of-factly, I could probably weigh 120 after all was said and done, depending on how hard I was willing to work. I don't remember weighing anywhere near 120; it was probably about the fifth grade. I still can't get that number out of my mind; it is like being told, "Oh, yeah. You can go to the moon."

I became bulimic when I was about fifteen. I abused laxatives and diuretics, felt sick all the time, exercised constantly: aerobics, swimming laps, walking. I binged and purged. Calories, fat grams, and numbers on the scale lined my prison walls, and I never got thin. I never even got average. There's nothing quite like starving yourself for days, the loudest sound in the universe the ferocious growl of your echoing stomach. You're dizzy with hunger, and teenage boys are mooing at you anyway.

After about three years, I gave up on bulimia. I had gained 30 or 40 pounds. I was about eighteen years old by this time. I gave up, period, and concentrated on day-to-day survival.

I continued to gain weight through my 20s and 30s. In my 20s, I remember thinking things like, "Well, I'm okay, and if this is as fat as I'm going to get, that's fine." It started to hurt to walk. I couldn't find clothes to fit me without mail order. I didn't care; I was just trying to get through college and find myself in the world. It took me eight years to get a four-year degree. I dropped out four times, but I went back five times. I got the Bachelors degree when I was 28. I started a Masters program a few months later, ten days after marrying my first husband. I dropped out of the Masters after one quarter; it was just not where I wanted to be and I needed to get into the job market.

My first husband and I tried to have a baby, which required fertility drugs because I had PCOS (polycystic ovarian syndrome). With these drugs, I could get pregnant, but not stay pregnant. The body mimics pregnancy on them, so the taker is in for a roller-coaster ride of symptoms. I had an ectopic pregnancy and several miscarriages within a couple of years and was never able to achieve a live birth. I had a myriad of other female problems, including a cancer scare, and ultimately underwent a full abdominal hysterectomy at the age of 32. The first reaction of many people was to say, "Oh, you'll lose weight!" I don't know what planet they were receiving transmissions from or why they thought I even cared about my weight right then, as I was busy grieving, not only the fact that I could never have children, but my eventual divorce and the loss of my closest friend of 25 years. It was hard to find reasons to get out of bed in the morning for a span of time that seemed endless.

My weight never decreased after the hysterectomy. In fact, it shot up another 20 to 40 pounds and has hovered in that range ever since. Once I had my PCOS diagnosis, which came with type II diabetes, high cholesterol, and sleep apnea, I changed my diet drastically--for the better. I did more aerobics, used a treadmill, swam laps, bought a recumbent stationery bicycle. There were times I could lose as much as forty or fifty pounds, but it would not stay off for more than a few months.

I met and married my second husband at the highest weight I have ever been. He sees the person I am, having been blessed with that all-too-rare gift of knowing that people are who they are on the inside--a concept many pay lip service to, but do not really practice. He is an average-size person who is horrified by the actions and comments of other people regarding my weight, many of them strangers. He has seen me struggle, feel physically crappy all the time, and try to sleep normally or even find a comfortable seated position. He has heard me say "I shouldn't eat that" more times than he can count--several times a week. He sits across from me in restaurants; he will order fries and a milkshake, I will order a salad and water. He has seen me struggle with depression when I have so many reasons to be content. He is one of them.

It was not his idea for me to pursue bariatric surgery; I was dead-set against bariatric surgery for many years, but have researched it all along, because I believe in knowing what I'm arguing about. He would like me to live a long time and to be around so we can be together, and he supports whatever I choose. He is the cook in our house, and for the past two years, I have eaten better food than I have ever eaten. Fresh, organic, the works. It has affected my weight not at all.

I recently turned forty. The thing that distressed me about the number 40 was not vanity or the loss of youth--I never really felt young--but the notion that our time on this Earth is limited and I would like to enjoy whatever is left of mine a lot more than I am.

That's how long I have been fat. That's why I am doing this.