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Thursday, August 16, 2012

Not Friends

My band and I are not friends.  I've finally concluded that.  Perhaps if I can get back to some reasonable level of restriction again, this will work for me.  But I haven't really had much benefit from my band since immediately post-partum (and the baby will be 2 next month).  I have been seeing the PAs at my surgeon's office.  My surgeon is down to just one surgeon, herself, and she has 2 PAs and the bariatric endocrinologist.  The PAs are both pretty new to practice, and do not look like they have ever struggled with weight.  I'm older than both of them, and I'm not even 40 yet.  Anyway, I have been in about 6 times since Sept 2010, and have had fills ranging from small to infinitesimal.  They give me very little information about how much is in my band or how much they are giving me--I think they don't want patients to fixate on the amount that is in the band.  But I'm pretty fed up.

Here's the thing that I would tell anyone else interested in a lap band.  You will need to see a surgeon who specializes in bands for as long as you have your band.  That sounds simple when you are looking into surgery.  Why would that be a problem?  But the chances are very slim that you will always live in the same place and have the same insurance.  Even if you have the same employer for the rest of your life, they change their insurance plans all the time.  You may start out with your aftercare covered, but later on that changes.  And if you find yourself without your fills covered, you are looking at anywhere from $150 to $300 or more per visit to adjust the band.  If you have complications during a time that you don't have insurance coverage (you may, in fact, never have insurance coverage, like a lot of people with this surgery), you may have to pay out of pocket for surgery to revise the band, replace the port, or remove it altogether.  There isn't a good way to predict what will happen in the future or how you will be paying for it.  These days you can't even predict whether you will have a job or a home, much less insurance coverage for bariatric procedures.

The band requires a lot of adjusting, and this takes time, and money.  I feel like every fill I have gotten since I delivered my daughter has done absolutely nothing.  I still get hungry after 2 hours.  I can still eat anything, and a lot of it.  I'm still gaining.  I'm not going back to the bariatric endocrinologist, because I don't think he has much to help me with.  The last time I saw him, he broke it down like this:  I can eat 1100 calories a day if I want to lose 0.5-1 pound per week.  AND I need to eat at least 75g protein per day.  If you take the general rule of thumb that surgeons use, a good quality protein source should have 10 calories per gram of protein.  (Of course, protein itself has 4cal/gram, but no one eats food that consists SOLELY of protein.)  So that would mean I get 750 calories of high protein food per day, and about 350 calories leftover for the rest of the day for fruits and veggies (they actually don't want me eating fruit at all, which I don't think is that healthy or sustainable).  I'm not willing to stop drinking coffee or to stop putting cream in it, so that is a few calories right there.  Basically, I don't find this plan sustainable.  He might be right, that this is what my body will require because of my specific metabolism.  He may also be right that I should be concentrating on weight training, not running at all, and taking L-carnatine supplements.  But basically this plan seems extremely bleak, and definitely not possible without a lot more restriction.  So, I'm going nowhere here.

The last problem is one I have alluded to, that my insurance doesn't like me going to my surgeon.  They pay at the out-of-network rate, but only with a lot of complaining, even though they are only asked to pay for the equivalent of an office visit.  I'm lucky they pay at all.  They want me to see the bariatric people at my employer, even though they don't actually do bands at all.  They have a nurse practitioner that manages their band patients, but they don't place them.  Still, I've decided to go this route, because I'm tired of the hassle with Aetna, I don't feel like I am really getting what I need at my surgeon's office, and because I am strongly considering revision surgery anyway, and that is where I would be able to do it.  So next week I go see the nurse practitioner for a fill, hopefully a decent one, before she goes on maternity leave.

Would I do this again?  No, I don't think I would go with something that requires such constant attention as the band.  It has just been too difficult between changes in employers, insurance, and providers, to get the consistent care I need, and frankly it's too hard to get to the office so often with a small child at home and a full-time career.  I still don't think I want a Roux-en-Y.  I'm not sure what the best solution is for me.  I just know that my body needs a frighteningly low amount of fuel per day to keep me at a healthy weight, and I can't do that on my own.

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