Apeal Letter for Comittee Meeting

[Guest guest]

Ok this is my Appeal letter I am faxing over to the committee meeting. What do you think? Is this ok?

My BMIKaiser 236 / 61 / 61 x 700 = 44.39NHI 236 / 61 / 61 x 703 = 44.58Mayo 106.2 / 2.37 = 44.81

My MesurementsHips : 46 in. Waist: 54Neck : 16.5 in.Chest under breast : 45 in.Thy : 16 in.Arm : 16 in.Calf : 16.5 in

photo -bio http://www.oregonorigins.com/wls.html

Individuals who are twice their ideal weight — or more — or who are at least 100 pounds overweight are considered severely obese. High blood pressure, heart disease, diabetes, arthritis and sleep apnea are among the most common and dangerous weight-related health conditions. Such chronic health conditions associated with severe obesity increase your risk of premature death and may signal a need to consider a surgical route to weight reduction.

I have already been diagnosed and am under treatment for Diabetes and Hypertention.I am not insulin dependant but I do take Metformin for the type of Diabetes I have.Diabetes, Obestiy, Hypertention, Cancer, and Sleep Apnea all run deep in my family.I want to make a change. I want to have a more productive life style.

Surgery can be an important part of treatment. But success also depends on my determination to change my eating habits and to commit to lifelong follow-up. Surgery doesn't replace the importance of diet and exercise in weight management. And this is not just a diet this is a life longchange. I will never be able to eat the same. And for me that is a good thing. I will be able to learn to eat all over again and be saticefied physicaly, and not as hungry anymore. I will have to make healthier choices and drastic lifestyle changes and be aware that it does not always end up a bowlof peaches as we all wish it would. And sometimes we don't loose weight at all, get sick, or even diefrom complications with our health or surgery.

Life after surgery wont be the easiest. I will still have to excersize, Learn to eat all over again,on a strict diet I will have to follow so I don't sabatoge myself, my health, or my life. Because My Success Is a success for my doctor and for other Obiest Women and Men that are also looking into this prosiedure as an option if all other options have not worked. And be very aware of my body to make sure nothing goes wrong like gallstones, dumping syndrom, hernia, loss of hair from not takeing in enough protien. I will have to eat small portions only 3 times a day and chew very small bites to a consistency of first step baby food so I don't hurt myself by getting a blockage,there for makeing it more difficult on myself and my doctor. I dont want to get any worse than I already am or any bigger, enough is enough I can't take no more. If I do I will die. I already know it. A person knows their body. I am the one that insisted the doctors check me for diebetes and sure enough I have it no matter how bad or mild it is. I was the one who insited they check my BP and I was right so now I take meds for both.

If I don't take my meds. My BP goes up to 166/ 104. I think that is the highest and it scared me. My head was pounding I felt flush, hot, swollen, tender and, nausiated. My chest was even fluttering like my heart was skipping beats then going realy fast and it was throbbing and slow. I could feel it with my hand so clearly. I was to scared to try to drive to ER by myself with my kids. My husband was at work but I did call the advice nurse and made my daughter stay close to the phone just in case. I took some asprin and a second hydrochlorothazide pill I useualy only take one as perscribed, layed down and tried to relax. Because the more scared I felt the more my blood pressure went up. Maybe it was a panic attack with Hypertention. I don't know I'm not a Nurse or Doctor but I know what happened and that was my last scare. I don't want to die. I'm to young. I have a child still in diapers and one school age that deppend on me, and I on them. They are my evrything. I don't want to loose out on their childhood. I would love to be able to frolic and play with them and be able to catch up without haveing chest pains, and panting like a dog. I can't keep up with my 3 yr old at all, and it scares me when we go places and he tries to run off. I actualy try to avoid that he once got away from me near a buisy street where I live luckily his daddy was there cause I could not catch him.

The medications are doing ok stableizing my BP. But the metformin delays me in the bathroom everytime I take it and dehidrates me I drink alot of water I carry a bottle of water everywhere I go all day every day and have one beside me at night because I am so thirsty all the time and at night when I sleep I wake up because my mouth is like sand paper my tung is dry and my thoat is course, my lips are even shrivled up. My husband useualy leaves the room at night to sleep on the couch because my snoreing and he sais I do stop breathing in my sleep sometimes. But not every night. I have had a study done but it was negative for sleap apnea.

On Sept. 11 my blood dl was 205 and my BP was 140/88/103 this is a good day. Luckily for me because I have meds to keep it stable. But again it was a bad day. I got a call from my PCP stating she got a call from PB stating I will be getting another denial letter for the gastric bypass surgery. I can't say on paper how much this pains me. I did get defensive with her. I have tried so hard to loose this weight on my own just by diet an exercise. I can't do it. And if I sike myself up enough to try again I will just loose then gain it back plus more weight next time. I don't want to do that to myself no more. I want to change permanately and I feel the Gastric Bypass surgery is the right tool to help me get to where I can live my dream a more active, healthy , longer life in the long run. I weigh in at 236 lbs. I am 61 inches tall. I am apple shaped. I recently got a IUP it's another form of IUD because of the threat of cancer and my health. I was told my chances are very high that if I where to get pregnant my baby would have birth defects. By D. Thorn in OBGYN. I am only 29 yrs. old almost 30. I know I got to this weight on my own by makeing bad choices. But I need help getting it off. I need the gastric bypass to help stop the need or want for so much food and I will be restricted to eating things that are good for me. I know it is not an easy way out and it don't always work. But I have tried my way and it don't work. If it did I wouldn't be asking for this surgery. I have friends in a Kaiser group on Yahoo.com some that have had the surgery others are waiting for denial or approval. We all share our stories. I know the worst that could happen is a leak or death. I know the things that happen the most are loss of hair, gallstones, and dumping syndrome just to name the basics. I know other things may happen to like another surgery. And I know this can not be undone. That's why I want it most. I have no place to go but up or down. I'm at the bottom right now. I'm scared of dying of cancer, stroke, hypertention, or other obesity related diseases more so than from surgery. I am more scared of living a obeist unhealthy life getting sicker and bigger and trying to do this on my own failing every time only to get bigger. Living on pills like metformin, hydrochlorothazide, and prinivil. Like I already am. My grandmother takes these things and she is not healthy one bit. So I would like to know how someone could think I am any healthier than the average adult. When I feel sick as a dog. With or without the medications. I really don't know which is worse. I already know I can't loose this weight on my own.This is why I am asking for you to please consider approving me for this surgery or the OK to at least get a Indapendant Medical Review. So I can at least have a chance even if it is a slim to none chance a small chance is better than none.

Thank you for taking the time out of your busy day to read my appealI ask you please to consider giving me a chance at a more active and productive life.Sincerely,

Tina Marie RutherfordMR# 01941665574 Lakeville CirclePetaluma, California 94954 Home Cell

Obesity Related Conditions Before Surgery That I haveHigh blood pressure, Diabetes, Chest pain, Anxiety, Fatige, frequest infections of the belly skin, loose urinary tract

Things I could still getHigh blood cholesterol, Coronary artery disease, Heart attack, Stroke, Osteoarthritis, Sleep apnea, Uterine cancer, Colorectal cancer, Gallbladder cancer, Gallstones, Gout, Death

Thing in my family historyUterine Cancer, Diabetes, Stroke, Heart attack, Breast Cancer, Mobid Obesity, Gallstones, Sleap Apnea, Hypertention, Fatige, Anxiety

Things that could happen after Surgerybleeding, infections and respiratory problems. Generally the procedure requires a three to four day hospital stay. After I go home, I will need to follow strict dietary instructions. For the first few weeks after surgery, it may be difficult to eat anything without feeling uncomfortably full and my stomach will still be very tender. It will take six to eight weeks before I'm able to digest complex carbohydrates and protein, (such as chicken, pasta and dairy products) without vomiting. It will be difficult for me to digest large amounts of fat, alcohol or sugar. Most patients lose an average of 10 pounds per month and reach a stable weight 18 months after surgery.

Many insurance carriers are covering the procedure because it has proved to improve some obesity-related health problems such as diabetes and high blood pressure. Both of wich I have.

Links and Groups I frequently visit or am a member of.

Mayo Clinic : http://www.nlm.nih.gov/medlineplus/weightlosssurgery.htmlNIH : http://www.nih.gov/Kiaser: http://www.kponline.com , http://www.kp.orgClos : http://www.clos.netObesity Help Pacific Bariatrics : http://www.obesityhelp.comKaser Gastric Bypass Patients Support Group :http://groups.yahoo.com/group/gastric-bypass-support-kaiser-patients/Fit Day : http://www.fitday.comHMO Help : http://www.hmohelp.ca.gov/American Obesity Association : http://www.obesity.org/After Surgery Support : http://www.obesitysurgerysupport.orgVita Lady : http://www.vitalady.comAfter Surgery Supprt Grouphttp://groups.yahoo.com/group/OSSG-PacificBariatrics/Pacific Bariatricshttp://www.PacificBariatrics.com

[Guest guest]

You appeal letter seems VERY complete, Tina. If you are denied again, appeal through the Department of Managed Healthcare (Sacramento). There is a lawyer there who is a WLS patient himself, and he has encouraged everyone denied by Kaiser to appeal through the DMHC. He says the DMHC abides by the National Institute of Health (NIH) guidelines in determining the appropriateness of WLS, and they often overturn Kaiser's decisions on borderline cases. He said people appealing to the DMHC are almost always approved.

Laurie W.

Apeal Letter for Comittee Meeting

Ok this is my Appeal letter I am faxing over to the committee meeting. What do you think? Is this ok?

My BMIKaiser 236 / 61 / 61 x 700 = 44.39NHI 236 / 61 / 61 x 703 = 44.58Mayo 106.2 / 2.37 = 44.81

My MesurementsHips : 46 in. Waist: 54Neck : 16.5 in.Chest under breast : 45 in.Thy : 16 in.Arm : 16 in.Calf : 16.5 in

photo -bio http://www.oregonorigins.com/wls.html

Individuals who are twice their ideal weight — or more — or who are at least 100 pounds overweight are considered severely obese. High blood pressure, heart disease, diabetes, arthritis and sleep apnea are among the most common and dangerous weight-related health conditions. Such chronic health conditions associated with severe obesity increase your risk of premature death and may signal a need to consider a surgical route to weight reduction.

I have already been diagnosed and am under treatment for Diabetes and Hypertention.I am not insulin dependant but I do take Metformin for the type of Diabetes I have.Diabetes, Obestiy, Hypertention, Cancer, and Sleep Apnea all run deep in my family.I want to make a change. I want to have a more productive life style.

Surgery can be an important part of treatment. But success also depends on my determination to change my eating habits and to commit to lifelong follow-up. Surgery doesn't replace the importance of diet and exercise in weight management. And this is not just a diet this is a life longchange. I will never be able to eat the same. And for me that is a good thing. I will be able to learn to eat all over again and be saticefied physicaly, and not as hungry anymore. I will have to make healthier choices and drastic lifestyle changes and be aware that it does not always end up a bowlof peaches as we all wish it would. And sometimes we don't loose weight at all, get sick, or even diefrom complications with our health or surgery.

Life after surgery wont be the easiest. I will still have to excersize, Learn to eat all over again,on a strict diet I will have to follow so I don't sabatoge myself, my health, or my life. Because My Success Is a success for my doctor and for other Obiest Women and Men that are also looking into this prosiedure as an option if all other options have not worked. And be very aware of my body to make sure nothing goes wrong like gallstones, dumping syndrom, hernia, loss of hair from not takeing in enough protien. I will have to eat small portions only 3 times a day and chew very small bites to a consistency of first step baby food so I don't hurt myself by getting a blockage,there for makeing it more difficult on myself and my doctor. I dont want to get any worse than I already am or any bigger, enough is enough I can't take no more. If I do I will die. I already know it. A person knows their body. I am the one that insisted the doctors check me for diebetes and sure enough I have it no matter how bad or mild it is. I was the one who insited they check my BP and I was right so now I take meds for both.

If I don't take my meds. My BP goes up to 166/ 104. I think that is the highest and it scared me. My head was pounding I felt flush, hot, swollen, tender and, nausiated. My chest was even fluttering like my heart was skipping beats then going realy fast and it was throbbing and slow. I could feel it with my hand so clearly. I was to scared to try to drive to ER by myself with my kids. My husband was at work but I did call the advice nurse and made my daughter stay close to the phone just in case. I took some asprin and a second hydrochlorothazide pill I useualy only take one as perscribed, layed down and tried to relax. Because the more scared I felt the more my blood pressure went up. Maybe it was a panic attack with Hypertention. I don't know I'm not a Nurse or Doctor but I know what happened and that was my last scare. I don't want to die. I'm to young. I have a child still in diapers and one school age that deppend on me, and I on them. They are my evrything. I don't want to loose out on their childhood. I would love to be able to frolic and play with them and be able to catch up without haveing chest pains, and panting like a dog. I can't keep up with my 3 yr old at all, and it scares me when we go places and he tries to run off. I actualy try to avoid that he once got away from me near a buisy street where I live luckily his daddy was there cause I could not catch him.

The medications are doing ok stableizing my BP. But the metformin delays me in the bathroom everytime I take it and dehidrates me I drink alot of water I carry a bottle of water everywhere I go all day every day and have one beside me at night because I am so thirsty all the time and at night when I sleep I wake up because my mouth is like sand paper my tung is dry and my thoat is course, my lips are even shrivled up. My husband useualy leaves the room at night to sleep on the couch because my snoreing and he sais I do stop breathing in my sleep sometimes. But not every night. I have had a study done but it was negative for sleap apnea.

On Sept. 11 my blood dl was 205 and my BP was 140/88/103 this is a good day. Luckily for me because I have meds to keep it stable. But again it was a bad day. I got a call from my PCP stating she got a call from PB stating I will be getting another denial letter for the gastric bypass surgery. I can't say on paper how much this pains me. I did get defensive with her. I have tried so hard to loose this weight on my own just by diet an exercise. I can't do it. And if I sike myself up enough to try again I will just loose then gain it back plus more weight next time. I don't want to do that to myself no more. I want to change permanately and I feel the Gastric Bypass surgery is the right tool to help me get to where I can live my dream a more active, healthy , longer life in the long run. I weigh in at 236 lbs. I am 61 inches tall. I am apple shaped. I recently got a IUP it's another form of IUD because of the threat of cancer and my health. I was told my chances are very high that if I where to get pregnant my baby would have birth defects. By D. Thorn in OBGYN. I am only 29 yrs. old almost 30. I know I got to this weight on my own by makeing bad choices. But I need help getting it off. I need the gastric bypass to help stop the need or want for so much food and I will be restricted to eating things that are good for me. I know it is not an easy way out and it don't always work. But I have tried my way and it don't work. If it did I wouldn't be asking for this surgery. I have friends in a Kaiser group on Yahoo.com some that have had the surgery others are waiting for denial or approval. We all share our stories. I know the worst that could happen is a leak or death. I know the things that happen the most are loss of hair, gallstones, and dumping syndrome just to name the basics. I know other things may happen to like another surgery. And I know this can not be undone. That's why I want it most. I have no place to go but up or down. I'm at the bottom right now. I'm scared of dying of cancer, stroke, hypertention, or other obesity related diseases more so than from surgery. I am more scared of living a obeist unhealthy life getting sicker and bigger and trying to do this on my own failing every time only to get bigger. Living on pills like metformin, hydrochlorothazide, and prinivil. Like I already am. My grandmother takes these things and she is not healthy one bit. So I would like to know how someone could think I am any healthier than the average adult. When I feel sick as a dog. With or without the medications. I really don't know which is worse. I already know I can't loose this weight on my own.This is why I am asking for you to please consider approving me for this surgery or the OK to at least get a Indapendant Medical Review. So I can at least have a chance even if it is a slim to none chance a small chance is better than none.

Thank you for taking the time out of your busy day to read my appealI ask you please to consider giving me a chance at a more active and productive life.Sincerely,

Tina Marie RutherfordMR# 01941665574 Lakeville CirclePetaluma, California 94954 Home Cell

Obesity Related Conditions Before Surgery That I haveHigh blood pressure, Diabetes, Chest pain, Anxiety, Fatige, frequest infections of the belly skin, loose urinary tract

Things I could still getHigh blood cholesterol, Coronary artery disease, Heart attack, Stroke, Osteoarthritis, Sleep apnea, Uterine cancer, Colorectal cancer, Gallbladder cancer, Gallstones, Gout, Death

Thing in my family historyUterine Cancer, Diabetes, Stroke, Heart attack, Breast Cancer, Mobid Obesity, Gallstones, Sleap Apnea, Hypertention, Fatige, Anxiety

Things that could happen after Surgerybleeding, infections and respiratory problems. Generally the procedure requires a three to four day hospital stay. After I go home, I will need to follow strict dietary instructions. For the first few weeks after surgery, it may be difficult to eat anything without feeling uncomfortably full and my stomach will still be very tender. It will take six to eight weeks before I'm able to digest complex carbohydrates and protein, (such as chicken, pasta and dairy products) without vomiting. It will be difficult for me to digest large amounts of fat, alcohol or sugar. Most patients lose an average of 10 pounds per month and reach a stable weight 18 months after surgery.

Many insurance carriers are covering the procedure because it has proved to improve some obesity-related health problems such as diabetes and high blood pressure. Both of wich I have.

Links and Groups I frequently visit or am a member of.

Mayo Clinic : http://www.nlm.nih.gov/medlineplus/weightlosssurgery.htmlNIH : http://www.nih.gov/Kiaser: http://www.kponline.com , http://www.kp.orgClos : http://www.clos.netObesity Help Pacific Bariatrics : http://www.obesityhelp.comKaser Gastric Bypass Patients Support Group :http://groups.yahoo.com/group/gastric-bypass-support-kaiser-patients/Fit Day : http://www.fitday.comHMO Help : http://www.hmohelp.ca.gov/American Obesity Association : http://www.obesity.org/After Surgery Support : http://www.obesitysurgerysupport.orgVita Lady : http://www.vitalady.comAfter Surgery Supprt Grouphttp://groups.yahoo.com/group/OSSG-PacificBariatrics/Pacific Bariatricshttp://www.PacificBariatrics.com