w-w-what?

Getting frustrated.  Last week I went to the bariatric office and got remeasured for my height.  My Nut Guy said my case would be resubmitted to the insurance company and he sent me off on my happy merry way.

I just called the PA b/c I got an email regarding my vitamin D levels that were drawn last week...and I pretended to not quite understand.......but really, I just wanted to get a status update on my case.

She said, "Oh, well, Dr. M has been out of town.  When she gets back she'll decide if we can resubmit this or not.  We don't think it'll make a difference because your BMI is still less than 40."

(39.3)

What?????

Huh???

Who is Dr. M?

Because that's not my surgeon!!!

So I asked.  She replied, "The diet doctor."  

Mmmkay, the invisible doctor who was apparently supervising my six month weight loss.  Whom I've never met.   ? ? ? ?

This is so annoying!!!

The PA told me she'd have one of the Nuts call me back when a decision is made.  

Are you freaking serious?????

So right now I'm hoping some doctor, whom I've never met, decides my case can be resubmitted.  Hello---the first one they submitted had wrong information.  It should be a no-brainer.   

Trying to have faith.  My red balloon is still flying high.  

   

hernia? not pregnant!

Okay this is bizarre.

Since mid-December it feels like I have a 28 month fetus kicking me on my right side, to the right of my belly button.  That's the only place I feel it "kicking."

I'm definitely not pregnant though.  I've taken a few tests just to be sure, so I don't look like an idiot again.

Oh yes, this happened once before.

Sidebar:  I found out I was pregnant with my first son at 20 weeks.  What?  How is that possible?  Well, before you decide I'm just as dumb as all those other people you see on TV (I am, actually) I'll shorten the story and just say the summer I got pregnant I was stressed out with a cross-country move from Denver to Pittsburgh.  Plus a friend's husband was diagnosed with brain cancer in May that year.  In August another friend was killed in a helicopter crash in Afghanistan.  So when I went all summer without much appetite and with frequent crying spells I chalked it up to stress and a major life change with moving and all these life events.  New city, new house, new job!  Turns out I was pregnant and didn't realize it until I felt a "mass" moving around in my tummy.

But back to present tense.  I'm definitely not pregnant.  So what is this feeling in my belly?  I don't think it's gas.....I feel it in once precise spot.

So what is it? It's in the exact same spot every time I feel it.  It feels exactly like a powerful baby kicking, not like the beginning of when you feel a baby move---more like further in a pregnancy.  This does not feel like the gentle tap tap tap of the early fetal movements you feel.  Typically I feel this a few hours after eating.  I don't feel gassy.

Could it be a hernia?  What I feel isn't painful.  Could it be adhesions from my c-sections?  It seems a little high up to be scar tissue though.

I feel it as high as my belly button but a few inches to the right.  If it were a hernia, would I feel a bulge?  Would it hurt?  I can't feel any sort of bulge........

another appeal submitted

So this morning my bariatric office let me come in and get my height remeasured.  I think they were sick of me calling and pestering the PA.  When I arrived the lady at the front desk said, "Name?"

"Lee Ann [Lastname]."

"Oh yes, we were just talking about you...."

Hmmmm.  Well....er.  Oh shit that's probably not a good thing, all the phone calls I've made...they are sick of me.

I was about to ask why when the office ladies started fawning over my 8 month old who was smiling and cooing from his stroller.  He's a little charmer.

Then we sat down and waited.

When they called me back I was relieved to see the cool Nut. Guy (as opposed to the Ice Queen Nut. who I referred to as something way rude in a previous post).

He walked me back to a room and there stood a nurse standing next to the height measuring thing, waiting for me.

My Nut Guy says, "We need a second witness."  He said it with an apologetic, "I'm really sorry Lee Ann," kind of tone like, "it's not my doing...."

I'm thinking, "What THE frick?  They are treating me like a criminal."

And then I prayed that whomever mounted that height thingy-ma-bobber cared about accuracy as much as I did.

I stood under it, trying to slouch.

The nurse barked, "Stand up straight."

So I did...held my breath....and prayed.

They looked at each other.  When my Nut Guy grinned a big goofy smile, I knew it would be okay.  With surprise he said, "She is 62 inches!"

Whew!  I'm relieved.  So I'm not a liar after all.  Even standing up straight!!

Actually, I am a liar, because all of my driver's licenses say I'm 5 ft 4.

Anywho.  They are going to resubmit my case to the insurance company.  So I currently have two appeals that the insurance company is dealing with at the moment.  At the very least, I hope they see I'm not letting this go.  I'm fighting this denial until I exhaust the appeals process, which ends after 3 rounds of my own appeals (not counting the doctors' appeals).  The last round, if it goes that far, will be me facing a panel of doctors and making my case in person as to why I need and deserve this surgery.

Sweet Blogger Award...

Me?  I got an award?  Thanks Amanda!  And then I got nominated again by another Amanda.  You Amandas just made my whole day---Thursday and Friday.  :)


Ok, here's the deal.  I have to list five guilty pleasures and send it off to 3 fabulous and sweet bloggers I know and love...  here goes!



There's a picture that goes with this......buuuuut my mouse is broken and I don't know how to fetch pics without being able to right click with a mouse...so sue me.  Sorry!  


Five Guilty Pleasures:


1.  Yarn:
My favorite is 100% merino wool.  It's warm and soft.  I have a particular love of yarns that are dyed by hand---yarnies call these "handpainted."  Rich bright colors are my favorite.  I'm a big fan of all things pink.


2.  Vintage Valentines:
Blame it on my birthday, February 14th, but I just *love* this holiday.  I started collecting ancient vintage valentine postcards about 15 years ago when I happened across some at an estate sale.  They were postmarked in the early 1900's.  From one sister to another.  Hunting for them became a lot of fun.  I liked reading the sentiments handwritten on the back.  Usually they are written from one girlfriend to another....But then eBay was born and treasure hunting became easy.  Someday, when I have my "dream house," I want a little bathroom or guest bedroom with a ridiculous over the top subtle valentine theme with my favorite colorful valentine postcards framed and sitting around.  Chubby cheeked cherubs, cute kids and bright colors.  What's better than that?  My scanner isn't working so here are some ripped from eBay if you're curious....but trust me, my collection is betterrrrr.  :)
Postcard 1


Postcard 2

Postcard 3


3.  Fiestaware:
This bad habit started in or around 2002 when my husband I were in Seattle at Pike's Market and found this cute little Fiesta store.  They had these little fruit bowls that I thought were the perfect size for a snack.  Paralyzed, I stood there, hemmin' and hawin' over which color to choose, when finally my  impatient husband huffed, "Just get one in every color and let's just go!"  Brilliant!  He has a good idea every now and then.  So, ultimately, he is to blame for the "rainbow explosion" that occurred in our cabinets following our trip to Seattle.  


4.  Spartacus:
Yes, I just love this show.  The second season starts tonight.  Well, technically it's the Prequel.  If you haven't seen it, it's on Starz.  It's full of decapitations blood, guts, and gladiator glory.  Let's not forget nudity and sex.  Lucy Lawless is in it.  So there ya go!  But y'all.  It's an equal opportunity employer when it comes to the nudity!  There are lots of hot naked gladiators and yes, you will see penises naked men. 


You don't even need cable.  If you can instantly stream Netflix, you can watch it there for free.  That's what we do. 


5.  Musicals:  Although I don't know why I feel guilty about musicals....it's just that the tickets seem to get more and more pricey.  Then there's parking--downtown.  And babysitters.  Then you tack on dinner.  Before you know it, you've plundered your children's entire college fund for one night of pleasure.  Even my husband likes musicals.  I forced him to take me to Phantom of the Opera for my 21st birthday....I still remember he wore a Star Wars tie (and I still married him...).  He did not want to go but he was wearing the biggest grin when we left, saying, "Well you didn't tell me stuff would blow up!"  He's been hooked ever since.  He pouted recently when I declined seeing Mary Poppins.  My my my, how 13 years can change a man....

Avenue Q has to be my most favorite-ist.  If you can't laugh at puppets having wild sex, then it's not the show for you.


And now I need to nominate 3 people.


1.  Judi-- she makes me laugh.
2.  Sherry -- she was born the same year.  :)  And she's really sweet, funny, and has given me some great advice (so far....)  
3.  BG -- she was my first follower and I'm thankful.


Denial update:  My bariatric office called today to let me know they are willing to let me come in and get remeasured for my height....but they reiterated it may not make a difference because my BMI would still be 39.3 (still shy of 40) at 5'2".  So, I'm going in Monday morning.  At the very least, I want this on record that I was literally 4 pounds from qualifying outright.  I'm a big fan of accuracy.


My red balloon is still alive!  It's officially been floating for 4 weeks and 2 days.  Tomorrow is it's one month anniversary.  

Rainbows

Here is my new hat.  I almost never knit anything for myself.  My mom gave me this yarn for Christmas.

"It looked like you," she remarked.

Do I look like a rainbow on steroids?

:)

Ha, well, I know what she meant.  I love rainbows.  I can't help it.  And color!  If you open my kitchen cabinets you will find at least once piece of Fiestaware in every single color manufactured since 1936.  Probably about 40 colors.

Can you say, "Addict?"

It makes washing dishes fun y'all!  You might want to try it.

One time my brother came over when I lived in Colorado.  He went into the kitchen to get himself a drink.  He came back and said, "It looks like a rainbow exploded in your cabinets."

I'll take that as a compliment.

Anywho.  Here's my hat.  I started knitting it on January 7th--the day I got DENIED by the insurance company.  For some reason, the colors cheered me up.  I can't look at this hat without smiling.  It's just so......happy.

Oh and by the way.....my primary doctor submitted her own letter of appeal to the insurance company on Monday....so I'm hopeful.  I should hear soon.  If not---I have a new plan.  A sleep study!  Sherry suggested it.  I *do* snore.  A little.  Okay, well..... hardly ever.  But you never know.  At the very least I'll have the satisfaction of bleeding the insurance company out of more money for wrongfully denying me in the first place.

And OH YEAH!!!  One more thing.  My red balloon is still faithfully touching my ceiling.  It's a sign.  I just know it!

Here's the hat--  :)

my red balloon

Holy Helium!  I think this balloon has reignited my faith in God.  Don't laugh, I'm serious.  My son got this balloon on December 22 at a preschool Christmas party held at a Presbyterian Church.

We almost lost it.  As we were getting into the car that day, my son let go.  Somehow I caught it, amazing myself before realizing it was probably divine intervention (as opposed to my quick reflexes).

Aaaaaaaaand.....   Well....it is now January 17.  The red balloon is still afloat and kissing our ceiling. Just think--if I hadn't reached up and caught it when I did, there would've been a lot of tears and it'd be halfway to the moon by now.

Yes, I do believe we have a miracle on our hands.

Another Christmas miracle.  First, both my boys smiled for the camera.  (They are cute, you should probably click it).

And now this.

So cue me a heavenly Chanticleer song (click if you like acapella or just miss Christmas already).  

Most balloons fall to the floor overnight.  Not this one.  The ones we've gotten at Great Clips or Chick-fil-a sag to the floor by morning.  After I had my second child, that balloon survived an entire week.  But this one is different.

This red balloon is special.

I don't know what it's filled with.  At first I assumed just plain old helium but I'm starting to think it's filled with the Holy Spirit.

This balloon has kept on floating for 26 days!  It's a sign, I believe.  Call me crazy, my friends.  But this is God speaking to me.

Have you ever heard of a helium balloon living this long?  No, no.  Don't tell me if you have.  I want to go on thinking mine is special....

God is saying, "Have faith Lee Ann.  Trust me."

I'm desperately hoping this means the insurance company will approve me in Round Two. 

God is about to throw me a lifeline and grant me this surgery.  Right?  Right.

Or it could mean that the power is in my hands all along.  But I want surgery!  Please God, hear my prayer.  I don't ask for much.  

Faith.

Faith.

Faith.

I'm trying to have it.

Not just the kind George Michael sings about.  I mean real faith.  I'm starting to believe again.  I'm starting to remember that my word for 2011 was dare.  I'm daring to have faith again.  It's a hard thing to do when you're spirit's been a wee bit crushed by the Insurance Gods.

But if a helium balloon can live for 26 days, who knows what can happen?  God is good.  That I already knew.  The balloon just reminded me of it.

Anywho. 

So, when my two year old pulled the balloon to his mouth yesterday and grinned, "I pop it Mommy," I screamed, "NOooooo!" like a lunatic...

And by now you understand why I then grabbed a pair of scissors and chopped the string so short that he cannot possibly reach the balloon without asking me to fetch it for him....

Yes, I have gone a bit mad...

I will not have anyone popping my red balloon.

  

Can anyone see this pic? It's a hat I'm knitting. Sent from my iPhone

denial update

After spending wayyy too much time on the phone with the insurance company and my bariatric office, I found out why I was denied.

I know you guys see my weight and think I'm "tiny" but I'm not.  I'm only 5 ft 2.  I'm a roly-poly.  Or I was when I started.

1.  My starting BMI was calculated at 37.9---which was wrong for two reasons.  First, my height was incorrectly measured by 1 inch.  Second, they accidentally used a weight from after I lost 8 pounds under their supervision.  DUH.  So, if the math is done correctly, my starting BMI was 39.3.  So I asked the PA at the bariatric office if I could come in and get remeasured for my height (I have two other official measures from outside offices that have me measured legitimately at 62").  I was hoping I could get measured again and my paperwork could get resubmitted with the correct information. The PA said, "Sorry, there's nothing I can do."  What?  Why???

I'm an occupational therapist and when I made errors on insurance claims I fixed them and resubmitted.  Why can't they??!!  I want to know!  I'm seriously considering emailing the surgeon directly.  What do you guys think?

I am not trying to fudge numbers.  I am five foot 2!  This makes a big difference.  Perhaps it was my ponytail that day that caused the measurement error, I don't know.  But I'm not 5 ft 3.

2.  I need to have a BMI of 35-40 plus 2 co-morbidities OR a BMI of 40 to qualify outright.  The doctor at the insurance company who reviewed my chart and denied me said my co-morb of high BP and high cholesterol weren't "serious enough."

Yes, I got a copy of the denial letter and that is what it said.  Word for word!

I'm really frustrated and feel it's unfair.  I did some calculations and if I'd weighed only FOUR POUNDS MORE when I started this process, I would have had a BMI of 40 and would have qualified outright (been fat enough!) and no doctor could have sat behind a desk and judged the "seriousness" of my co-morbidities.  That seems hugely unfair to me!

It was summer time!  I should have worn jeans instead of those super light weight capri pants!  I should have gone in the afternoon instead of morning.  I should have eaten a big gigantic meal.  Or two or three.  And drank a lot of water.  Maybe even have cheated and worn a 5 pound ankle weight to be really really sure.  What the heck??!

But I'm an honest person.  Unfortunately for me.

My PCP is working hard on an appeals letter.  I also have a bladder disease called interstitial cystitis (IC) which she believes contributed to my weight gain because of all of the medicines I take to manage my symptoms and pain of that disease.  I went to see her on Friday and she pulled out journal articles that support her stance that the medicines I need (for the rest of my life) all cause weight gain but are necessary to manage my symptoms and allow me to work and have a life.  (This is a serious & very painful disease.)  She is going to base my appeal on that.  The insurance company feels if my blood pressure were "really serious" I'd have been on "triple therapy" to manage the BP instead of one medication.  She is also going to base the appeal on the fact that I wasn't on "triple therapy" for the high BP because that would aggravate the symptoms of my IC to be on diuretics and whatever else triple therapy entails.  Even when I was on Procardia for my BP, it still wasn't in the optimal range for BP, it was still about 130/85, and wasn't treated further, b/c of the reason I just said.  

I'm hoping it will work.

But I'm getting used to the idea of being a little chubby forever....and trying to learn to love myself as I am.

I'll still working out but.......I know I have an appetite problem that is beyond my control..... and too many calories is too many calories no matter how high quality the food is.

Thanks for listening to me complain and I promise to get off this topic eventually.

phew.

okay, i can breathe again.  the pity party is over my friends.  thanks for hanging in there with all my whining.  :)

i'm back to myself & am working on a game plan.  i've been making phone calls to every doctor i've visited in the last 7 years who has blood pressure & cholesterol records in the last seven years and have been requesting records.  it's hard.  i've lived in dallas, denver, and now pittsburgh.  i can't even remember some of their names for heaven's sake, so i had to cross austin off the list all together, LOL.

i've started writing my appeal.  i'm still waiting for my official denial letter to come in the mail from the insurance company.

one of my friends in california is married to a cardio-thoracic surgeon.  he's pretty cool so i emailed him and asked him for advice on how to put together a kick ass appeal.  he didn't know.  DAMN.  what good are my connections?  lol.  but he said he'd tap the brain of his buddy---the director of bariatrics there at his hospital.  sweet!  i hope he doesn't forget.  anything will help.  i am not above pestering him again if i haven't heard anything by next week, lol.

for those of you who have been denied and successfully appealed-----what kinds of information did you include in your appeal?  please tell me!!

and in other news....the scale is stuck.  i've been hitting the gym faithfully and continuing eating right and the scale is not moving.  yesterday i did a weight lifting type class for the first time (in a few years that is).  it was pretty good.

SCALE???  do you hear me???  i have been good!  i have been eating right and going to the gym!  lower your number.

whatever.

thanks for all your comments yesterday.

i'm still just feeling a mixture of rage and despair.

where is all that fight i had in me?  a few weeks ago i would've said, "bring it on!"  it's gone.  i feel so defeated.  i can't stay on topamax forever.  my fingers and toes are constantly tingling.  my brain is fuzzy.  the appetite has been tamed but that's the price.  i'm tired of it.

my husband won't even discuss the option of self-pay.  he just graduated with his master's degree (nurse anesthesia) and refuses to consider taking out a loan or saving up to pay for it ourselves.  he says "he" won't pay for it.  ummm hello i worked too...up until the birth of our second child recently.

i resent it.

i fear this could be the unraveling of what used to be a fairly good (great even!) marriage.  i just feel like i don't matter to him.  i don't think $15,000 is all that much money in the scheme of things.  it's about the cost of a car.  a cheap one at that.  our marriage will go down the crapper for the cost of a car payment.  that's fucking awesome.

denied.

My PA called while I was on my way to the gym.

I got denied.  The insurance company denied me.  WTF.  My starting BMI was 38.1.  I have high cholesterol and high blood pressure.  Or I did.  Then I lost 25 pounds.  I was on medications but I'm good now.  But the doc who reviewed my case felt my co-morbidities were not "all that serious."

WHAT THE FUCK.

I am so pissed.

I parked my car and cried for a minute.  Walked into the gym and ran on the elliptical for 45 minutes and wiped a way a stray tear every now and then.

Shopped at Trader Joe's afterward.

Came home.

Bawled my eyes out.

Tomorrow:  The appeals process will begin.

my free training session

When my husband and I signed up at the gym a few weeks ago, we got a free training session.  Mr. Trainer Boy scheduled us for 10am yesterday morning.  He asked us to come prepared with 3 goals.  Homework, yes, that's right!  He said we'd be weighed and measured and then he'd do a free session with us.  I had some major anxiety issues with getting on the scale.  "Ugh!  But I know I'm fat," I whined to my husband.  He just groaned, gritted his teeth, and listened to me complain.

Then yesterday morning, right before our scheduled training session, my husband had to cancel, leaving me ALL ALONE to face this training session and GETTING ON THE SCALE trauma all by myself.  Why?  Well, he took our baby to the doctor two hours before the free training session.  We thought that would leave my husband plenty of time to make it to our appointment.  It wasn't.  He called at 9:30 telling me to go ahead without him.

Stress!  My old self would have panicked and canceled.  But I've decided to change and face my fears.  Alone if I have to.

So I went....not knowing what to expect.  Mr. Trainer Boy started by asking me what my 3 goals were.  I asked him, "Do you really want to know my goals?  Or the results I'm hoping for?....."

Er....huh?

I wasn't trying to bust his balls.

It's just that I'm an occupational therapist and we're trained to write goals that are MEASURABLE.  So to say, "I want to increase my flexibility...." Well that is NOT GOOD ENOUGH.  That's not measurable.  How do you measure flexibility?  Well, in rehab, it's easy.  We use goniometers to measure the range of motion a joint has.....but I doubt that's what he had in mind.

"Ummm.   Uh.   Well.....   I guess I'd like to know the results you're hoping for...,"  he stammered.

[He was probably thinking, "This girl is freakin' crazy."]

So I launched into my explanation of how my goal is to get to the gym 3-4 times a week come HELL or HIGH WATER dammit.  And how that's not easy when you have two children ages 2.5 and under.  One or the other is usually sick.  Especially in winter.  So that's my ONE goal, because I can measure it.  And I'm going to work hard while I'm there.

The results I'm hoping for?

Increased flexibility.  Increased core strength (and after 2 c-sections, Dear Lord, I need help!).  Increased endurance.  Toned muscles.  And MOST OF ALL---a 50 pound loss.

Goals?  Results?  Semantics, yes I know...... Good grief, I'm such a bitch.  I wasn't trying to be.  I'm sorry Andy.  Yes, that's his name---Mr. Trainer Boy.

So then came the scale........The dreaded stupid scale.

It said 189.  I made sure to tell him I'd lost 25 pounds on my own recently, God forbid he think I'm just here for some impulsive New Year's Resolution.  Then came the body fat % thing.

Back in September, my body fat % was measured for free because I'm participating as a research subject on how WLS reduces the rate of endometrial cancer (that's the hypothesis anyway).  On September 28, I was 47.6% body fat.  Yesterday, I was 39.1%  Woo Hoo!!!  I'll take it.  That's progress baby.

So then, Mr. Trainer Boy busts out his calculator and says, "That's 73 pounds of fat.  So you're about right.  You need to lose 50 pounds."

Well no shit.  Ummm, thanks, Andy.

But HOLEY BUCKETS, I went home and busted out my calculator.  I did some calculatin'.  If I subtract away ALL 73 pounds of fat that would leave me at 116 pounds.  But everybody needs some fat.  So I need to add some back.  20% of 116 pounds is 23 pounds of fat.  So I add that back---that equals 139 pounds.  Yet, the BMI chart will still say I'm very close to "Overweight."  Did I do this right?  Is my math off?  Can anyone confirm this?  Or tell me I need to go back and redo 6th grade?

According to Wiki, this Body Fat % chart was developed by the American Council on Exercise.

Description	Women	Men
Essential fat	10-13%	5-8%
Athletes	14–20%	6-13%
Fitness	21–24%	14–17%
Average	25–31%	18–24%
Obese	32%+	25%+

So these percentages just prove that I have every reason to be happy with 142 pounds....with some strength training I can probably be fairly lean at that weight.  Not overweight like the BMI chart had me believing for so many years.  My bones & muscles must be extra dense or something.

Three months after surgery I go back to get my measurements taken again at the hospital (for the research study).  I can't wait to see the progress I make.  I actually LOOK FORWARD to getting on the scale and seeing how far those numbers have gone down.  :)  I'm still waiting with bated breath, crossed fingers, crossed toes, and crossed eyes, hoping to get approval from the insurance company....

Oh, and did I mention Andy gave me a great workout?  I'm a little sore today.  Feels good.

P.S.  I'm serious.  Can one of you Math Whizzes check my math?

paperwork submitted :)

My family has been in town visiting from out of state for the last several days so I have to make this quick.

I had my LAST WEIGH IN this morning!!  Now my paperwork is being submitted to the insurance company.

According to the surgeon's scale I lost a total of 25 pounds since August 12---from 215 to 190.  In December I only lost 3 pounds.  Dang holidays!  Buuuuuuut I'll take it.  Usually I gain 5, so losing 3 is a victory.

The nutritionist told me that my insurance company is typically pretty quick and that if I haven't heard something a week from today to call my surgeon's office and let the PA know.

OMG, so now I feel like I'm 39 weeks pregnant all over again.  Time is standing still.