2nd meeting with PCP

[Guest guest]

I had my second visit with my PCP today and I have real conflicting

feelings about it. He reiterated that Kaiser wants to see six

months worth of documentation from him and the nutritionist before

they will accept the paperwork for consideration. I understand that

and I'm okay with that. However, he said they are very strict about

approvals and that they want to see some serious co-morbidities

before they would consider WLS " medically necessary " . (Except for

my BMI of 52 and my arthritis, I'm surprisingly healthy - liver,

kidneys, blood sugar, BP - a little hi on the cholesterol but easily

controlled through diet.)

I reminded him that the Kaiser guidelines say " a BMI of 40 or over

with co-morbidities or a BMI of 50 without. " He agreed that's what

the guidelines say but that he's never been able to get anyone

approved for the surgery. I don't know if his poor success rate is

because Kaiser Mid-Atlantic really IS that difficult or because his

submissions are so lackluster that the evaluator senses it and

doesn't approve the surgery. I'm just not sure what vibes I'm

reading from my PCP. He doesn't say he's opposed and he

acknowledged that WLS is the only proven successful method to treat

morbid obesity. And in the next breath he talks about some of his

unfortunate patients who have had WLS and present to him with all

kinds of problems.

Anyway, he said when he sees me in 3 months, he'll order the rest of

the tests required for approval. I asked about a sleep study and he

wasn't sure Kaiser required it but he'd check the protocol and if

it's required, he'd order it as well. He went ahead and prescribed

Meridia. I've never taken this and would like to get some feedback

from folks on using this. I did 2 weeks of Phen/fen before it was

banned and then I did a pondimin/prozac cocktail that was really

unsettling. I meet with the nutritionist tomorrow.

I guess what I'm thinking is this: if I can be as successful with

weight loss by altering my diet and exercising as I would be with

surgery, I'm all for it. Who wouldn't be? I don't really want to

risk my life on the operating table but neither do I want to diet

and then gain back more than I did and find myself a year from now

WITH all the serious co-morbidities that I don't have now. We all

know how unsuccessful our *diets* have been. If I could eat what a

person eats after surgery without undergoing the surgery then I'd

surely lose the weight, too. There's nothing mystical about WLS.

The success people have is because they are satisfied eating

significantly smaller portions and if they try to eat more, they

dump or vomit. No hocus pocus there. But it's not something you

can duplicate in any other way without the surgery. It that were

possible, folks would have done it.

So I'm going to follow the " Lean for Life " plan during the six

months I have to document weight loss (it simulates the diet plan

after WLS but larger portions). I'm going to join the gym and work

out. I may even try for a couple more sessions with the

psychologist to see if I can understand my eating obsession and find

more positive ways of dealing with my stress. If, at the end of 6

months I've had a significant weight loss and I feel I can achieve a

healthy weight (AND MAINTAIN IT) without surgery, fine. If not,

I'll have my PCP submit the paperwork, add my own letter and see

what happens. I can be a very persuasive writer. And if they

don't approve me, I'll either resubmit or I'll refi my house and get

cash out to pay for the surgery. I'm not going to let my healthy

self (which I would think means I'm a *great* candidate for surgery)

become so unhealthy that I develop serious co-morbidities and then

have to confront Kaiser again. Why would I want to do that? Does

it really make sense to gain weight and become diabetic or develop

congestive heart failure before I can get approval?

But again I say, if you tell me to pick Door #1 which very nearly

guarantees reaching a healthy weight with only a small chance of

gaining it back and no risks vs. Door #2 which entails the same

guarantees but involves major surgery and risks, I'll take Door #1.

Who wouldn't??? But I'm skeptical and am afraid that Door #1 really

is a gag prize. I still have to get through these 6 months and I

would love it if I could walk into my PCP's office 3 months from now

weighing 45 pounds less!