A Date

There still is no answer to the second appeal to Aetna.  But I did see my surgeon today, and we set a date for December 29 for my surgery.  That gives Aetna plenty of time, and me plenty of time to accrue benefit hours and prepare for surgery (and time off).  This time through is much different than the first time I had surgery.  I know the surgeon professionally, and he knows I know what I'm dealing with, so our appointment was short and on-point.  He addressed some specific issues, I asked a couple of specific questions, and we talked turkey.  He is kind enough to come in on a Saturday to do my surgery, so I don't have to be on the main OR schedule that hundreds of my coworkers and colleagues will see.  He asked if I had a particular anesthesiologist that I prefer, and I told him no, that any of the anesthesiologists I work with will be just fine.  I had my labs drawn and an EKG, and that was about it.

We all expect Aetna to approve my request now since my BMI is now back over 40.  But this process has been quite frustrating.  They have very clear criteria for approval for revision surgery, and I met every requirement, but they denied me (twice) on different criteria.  I'm sure a letter from an attorney would change it, but that's ridiculous.

Meanwhile, I am thinking a lot about how my approach will have to change this time.  When I had my lap band surgery, I had a good mindset at the start.  I followed the rules, exercised as I was supposed to, and was patient about weight loss, which took longer than many people but was still within the expected time frame.  It did take about 18 months to lose 70 lbs, and the last 9 months I was running 10-15 miles per week.  This time, my exercise capability is a bit more limited--I'm not in grad school anymore, but I have a toddler and two jobs.  I'll have to figure out a way to make the exercise work.

Getting my brain in shape is more important, though.  There are some cliches in the world of WLS that hide a lot of truth within them.  One is that the surgery is on your stomach, not your brain.  Another is that the surgery is just a "tool".  A lot of people talk very non-chalantly about "emotional eating".  The truth is that appetite and hunger are controlled by multiple redundant mechanisms.  I believe one of the big reasons that the lap band failed is that it only addresses one of those mechanisms: it relies on a small sub-stomach (pouch) to register fullness by stretching that small pouch.  But the entire stomach is still there, producing ghrelin.  So there is no hormonal change to one's hunger.  Plus, all the mental and emotional reasons that we eat are not addressed.  That is why it is possible to eat small amounts of food constantly, or foods that easily pass through the pouch, and gain weight, even if one has good "restriction".  And if you think you can outsmart your brain in its attempt to keep you from starving, you have a much better brain than I do.

What I have learned in the past 5 years since having lap band surgery is that we humans are very well adapted to under-nutrition, but poorly adapted to over-nutrition.  Put us in conditions with very few available calories and our bodies work quite valiantly to keep us from starving.  But most of us in the US live in an environment with lots of available calories.  Rich or poor, there is calorie-rich food available all around for any budget.  In this environment, it takes a lot of resources, including money and plain-old "willpower", to resist this American norm:  work a lot of hours, live an otherwise sedentary life, eat cheap prepared foods (and drinks) with more calories than we expend.  Add in too much stress, too little sleep and too much stuff to do, and the obesity "epidemic" is no mystery.

My family is a great example of adaptation.  Before my father's generation, there were not a lot of overweight people on his side of the family.  His family have been farmers for many generations, and our body type is stocky and solid.  When my predecessors worked as farmers and ate the food they produced on their farms, they were solid and healthy and lived into their 90s almost without exception.  But starting with my dad's generation, there is a lot of obesity.  We aren't working the family farm anymore.  (My uncle is, but he is my uncle by marriage--married to my aunt. And he is very lean.)   Most of us do not do a lot of physical labor.  We don't produce our own food, or cook as much as the prior generations did.  And more often than not, we are fat.  My dad is the first person in my family that I know of to develop diabetes.  He also has hypertension and has had a heart attack.  He recently lost 100 lbs, and hopefully can keep it off.  (He has lost hundreds of pounds in his adult life, and always puts them back on.)  He wants to live to 100, but until this year it didn't look like he would make it to 70, which is in 2 years.

So, I hope to get more of a handle on the psychological reasons that I overeat.  One part is simply pursuing a less stressful, happier life.  Another part is working with someone experienced in these eating issues.  The last part is prioritizing my exercise so I am doing something active every day.  This all actually sounds enormously difficult to me.

One month to go!