Panniculectomy

Yep, it's a big word - and it was a new one to me.... until January.  That's when I was advised this was the procedure which would get rid of my excess skin.  Some doctors do an abdominoplasty (a "tummy tuck"), but that is more involved and I would assume more difficult to get approved through insurance.  A panniculectomy is strictly the removal of excess skin, whereas abdominoplasty (I've come to learn) has muscle involvement and sometimes some liposuction.

Now for the insurance part.  I'm all but pulling my hair out over this one.  I first saw the surgeon about this surgery on 1/8.  I was put on the scheduled for 3/7, pending insurance approval.  And there I sit - waiting.  I have asked friends to pray for patience as I wait to hear one way or another so I know what step comes next.  Well, push came to shove last Monday and the insurance company still showed my pre-cert request as "pending" so the doctor requested my surgery be pushed a week to 3/14, as it can take up to 15 days to receive a determination.  UGH!  My need for patience grows with each passing hour.  I cannot get my pre-op EKG and blood work until I get approval because they will not pay for the workup.  So I wait.  And wait.  And wait some more.

I got tired of waiting.  We had a snowstorm here on 3/7 so I called my insurance company, knowing my doc's office would be closed.  I was told that additional information had been requested the previous Saturday (say what?) by fax and they hadn't received anything in response.  I was told some vague information about needing more evidence of prior treatments tried.  Well, that was something I could get on!  With my Mom being a nurse at my gyn's office (and my gyn being the one to document the rash which is the medical need for me to have this surgery), I called her up and she got on it when she got to the office the next day - after the storm.  I received a letter from the insurance company on Thursday stating that they needed the pictures SNAIL MAILED in addition to the extra documentation.  I immediately picked up the phone and called "K" (the surgery scheduler) to see if this was something I needed to handle.  I left her a message, but didn't hear back from her that day.  So...more waiting.  Friday, K called me that she was on hold with the insurance company for an hour, transferred 3 times and eventually wound up in a voicemail.  When she got a return call, she advised them that she needed to email the pictures (I mean, c'mon people, it's 2018 - it should not be that hard!) and that I'd already been rescheduled once and they didn't want to have to do it again.  I let her know that I'd been in touch with the other doc's office and they had prepared documentation of other treatments used.  She gave me her direct fax number so there'd be no delay.

And then there's more waiting because it's the weekend.....

Monday rolls around and I lose track of time until the surgeon's office was closed.  So I picked up the phone and called the insurance company again.  Thankfully I've gotten some incredible people (shy one) every time I've called.  This was no different - if anything, it was better!  I got a wonderful Customer Service (CS) rep who said that my account still showed that they were waiting for information.  FOR REAL???  I'm supposed to have surgery in TWO DAYS and the requested information isn't there?  The CS rep stayed on the line and called Utilization Management (UM).  She helped me talk to her and the CS woman asked the UM woman if there was a place in their department where things sometimes got lost.  Sure enough, the UM woman found the pictures and documentation!  Praise God!  The UM rep said she'd send my case along to a nurse reviewer with expedited status, but that it could still take 48 hours.  I didn't have 48 hours!  When the UM woman hung up, the CS rep asked me if I'd like her to check on my case first thing the next morning.  It's like she was an angel.

After an incredibly restless night with very little sleep, I climbed out of bed and took the phone into the shower with me - because don't all important calls come through when you're in the shower?  Well not this one.  Sigh...  It's TUESDAY and I don't know if I'm having surgery the very next day.  I know that the hospital would call between 2 and 5 to let me know what time to show up the next day.  I also had an appointment that would have me away from the house from 1:30-5:00 and my anxiety was through the roof.

11:15 am (Tuesday) comes and the PHONE RINGS!  It's the surgeon's office.  I anxiously picked up the phone to hear K on the line saying that it was approved!!  The insurance company neglected to mention that the 15 day clock reset when the new information arrived.  Thankfully, the power of prayer is strong and it was put through in 18 hours!  I had a huge adrenaline rush and was super excited.  Then it hit - I'm having a massive surgery the very next day.  I'd put so much time and energy into getting it approved that the reality of it didn't hit until that moment.  Before I left the house at 1:30, the CS rep at the insurance company called and told me that it had been approved!  She gave me numbers that I needed and I was so touched and impressed that she followed through on what she said she'd do.  There is a time difference so when she called I did already know, but I didn't tell her that; I was just so impressed that she went that extra mile!  The Hospital did call and let me know that I had to be there at 12:30 pm.  It wasn't ideal, but at that point I would have shown up at 2 am or 6 pm (fasting, mind you) if they told me to!

Keith and I arrived at the hospital early - in part because that's my personality and in part because we have to travel a road which is constantly under construction, unpredictable, and generally known for being horrible so it's always necessary to allow extra time when we travel on this road.  I gave my information to an admin person, went back to the room and spoke with the nurse who checked me in and then I changed into the gown and got my IV.  I reviewed a wide array of information with no fewer than 4 people (when did you last eat?  drink?  take <each> med/supplement/vitamin?  blah, blah, blah...).  They were all very efficient and things were moving smoothly.  Then people kept coming in asking if the doctor had been in yet.  I repeatedly had to say "no."  They called him and said he'd be over any minute.

He arrived and it was almost as if I heard a choir of angels.  He sat down and started to go over a list of questions I'd sent back in January.  If you've had surgery, you know they will draw on you so everyone is in agreement before the surgeon makes a cut.  He started to do that and then.... then he got to the sagging skin.  He lifted it up and the rash - the whole reason I need the surgery - was too infected for him to operate.  It's exactly where he'd be making the incision and the risk of an infection getting into my system (something I'd be dealing with for months) was too high.  There was no room for negotiation.  The risk outweighed the benefit at that moment.  I tried my best to not lose it in front of him.  He was visibly upset telling me.  I've known him for years and we've shared some very heavy conversations.  He said he'd put me on a 10-day course of antibiotics and an anti-fungal and advised me to take impeccable care of it until we schedule again for 2 or 3 weeks.  I asked for 2 weeks, but of course it depended on when there was a time slot available in the OR.

The nurse couldn't come in fast enough to yank out my IV so I could put on my street clothes and get out of there.  I just wanted to go home.  If you recall any of the story of my bariatric surgery, it was the same outcome of a failed attempt.  That time, however, I was under anesthesia and my blood pressure plummeted to the point where I nearly died.  The pumped meds into my IV for 40 minutes trying to get it back to a normal level, but it never leveled out.  When I woke up and was asked if I was in any pain, I was pleasantly surprised to say that I wasn't.  Only later did I find out why and I was devastated.  I had been working towards that day for 4 months and done 2 weeks of a liquid diet only for it to fail.  This was just reminiscent of that.

One thing the doctor hadn't told me at my initial consultation was that in his experience, only 1 in 30 or 40 people get approved for insurance coverage.  That's about 2-3%.  I'm not sure if it was the amount of information put in front of the reviewer or the content, but it worked!  I feel so thankful and so blessed to have had K and my Mom advocating on my behalf.

Let me say, if this is a procedure in your future or that of a loved one, please, see a doctor often and make sure there is consistent documentation of the issues your excess skin is causing.  Don't be discouraged by the numbers above.  Be consistent with getting those medical issues documented!  I'm convinced it's what made the difference...what had me in that 2%!

I hadn't gotten home yet and K had called, leaving a message that she put me on the schedule for 4/6.  I just had to call her to confirm.  When I did, she reiterated that the doctor was really upset and that she was shocked after all we'd been through to get the approval.

If you're a prayer warrior, I'd love any prayers for my patience during this time and as I struggle with understanding why the disappointment.  If positive thoughts are more your style, I'll happily take those!

So now I wait...again.  I'd like to think that I'm not waiting alone.  I'd like to think that anyone reading this blog is waiting with me.  I'd like to think that my little blog can be far-reaching.  The goal of my transparency with this little blog is to impact others.  I want to be there to answer questions, to offer encouragement - not only with my bariatric journey, but in general.  But if you know someone having bariatric surgery, or considering it, don't hesitate to give out my blog information.  Reach out to me.  Have someone with questions reach out to me.  If you've read my blog for any length of time, you'll see I'm somewhat of an open book with many difficult topics.  I try to be intentional with what I share and sit back and hope that it touches someone....better yet, lots of someones.  Make comments.  Ask questions.  Reach out.

A Fistula? Huh?

To get this out of the way:

A fistula is an abnormal connection between an organ, vessel, or intestine and another structure. Fistulas are usually the result of injury or surgery. It can also result from infection or inflammation. (as defined by the NIH)

Now, getting back to the topic at hand.  I did a test this morning which would rule out a fistula.  I got the results (something required to be done on my end) and called the doctor.  She said "hmmmm.... let me talk with <another doctor in the practice> and I'll call you back."  Ok?  She called back and said it would be rare for me to have a fistula so far out from my hysterectomy (years!) and that she would like me to re-do the test (which is no fun, by the way) and go to the office on Tuesday for her to do the final part of the test so she can see the results for herself.  Gee, this isn't nerve-wracking at all!

It's important to understand that "rare" is the kiss of death for me.  With one injury alone:

1. most people don't need surgery for this injury
2. it's strange that PT didn't work
3. surgery: finds 5 torn ligaments in my ankle when only one showed up on the MRI
4. post-op I thought I popped a stitch, so call the doc.  I get his associate who says to go in.  It turns out I had a large burst hematoma (a pocked of blood beneath the skin)  It's uncommon in your situation and to be directly under the incision, says the doctor
5. I go and see my doctor a bit later (I can't remember if it was no more than 2 weeks later, but I'd imagine it was the sooner part of that) who says that in all his years of practice he's never seen such a this happen (it was ugly, people, super nasty - I won't disgust you by posting a picture)
6. There's nothing else I can do (says the surgeon) but it's odd for it not to heal by now so you'll have to go to the wound care clinic.

This was all in December 2013 when I had my ankle surgery and had the rollator, so that's why I'm saying it was within a shorter period of time.

You get the idea?  Rare = my world

So, I did some research.  I know, I know, the internet is a dangerous place for research, but I try to stick to the NIH, Hopkins, Mayo - reputable sites.  They all basically agreed with my doctor, although she is amazing and I'd expect no less.  There are some pretty uncomfortable tests which could be done after I see my doc on Tuesday.  Surgery is a possible cure.  Yep, rare.  Sigh....

When Life Enters the Picture

There is no excuse.  None. At all.

However I'm going to offer one up anyway.

Life.

Life is crazy busy.  You know it.  It's true for you, too.  It seems to be true for everyone these days, doesn't it?  Work.  Cooking.  Shopping.  Movies.  Dinner out.  Family visits.  Friend visits.  Cooking for said visits.  Phone calls.  Life.

Personally, my life has taken a turn further into crazy with appointments and testing out the wazoo (I can't believe wazoo is a real word!).  I won't go into all the craziness of it all, but it's there.

My last post (embarrassingly nearly a year ago) was about a month after I fell.  I had had my MRI and was doing PT.  Ahhhh, such innocent days.  After PT was unsuccessful, the doctor and I decided it was best to schedule surgery.  Eeep, surgery!

Ok, I'll back up.  I go to the surgeon for the first time and he tells me that the type(s) of injuries I sustained rarely needs surgery.  I laugh at him because I had the same injury on my other ankle years ago and wound up having surgery.  I have the surgery in early December and was told that I needed to be non-weight-bearing for 3 weeks.  For someone the size of a hippopotamus that essentially means that I have to live upstairs for those 3 weeks.  To be clear, 3 weeks/21 days after surgery is Christmas Day.  Brilliant.  Someone morbidly obese... ok, I cannot use my weak upper arms to hold up my big-fat body with crutches.  I borrowed a Knee Scooter from a friend and that was a life-saver.  It took a bit to get used to, but crutches were absolutely NOT an option, I was thankful for this.  I had a really hard time going up and down the individual steps in front of the house and wound up crawling on my knees.  It wasn't pretty.

Moving on...  ok, so, I had the surgery on a Wednesday and had a quick check-up on Monday.  All looked good.  Monday night the pain was unbearable.  The doctor had already given me Percocet and Vicodin, but when I called him at the end of the day, he prescribed Dilaudid.  Ok, taken.  But OUCH!  I was still hurting in agonizing pain.  I called him after-hours and he said there was nothing else to do; I should go to the ER.  He also mentioned that he's never had anyone go to the ER for post-op pain.  Hours later, after a lot of groaning, MrB came up and said that I really should head to the emergency room.  Off I went.  They gave me IV Dilaudid and I remember nothing after that.

Changing the bandages was a multi-step process on the outside of my ankle.  Given my size it was a difficult spot to make sure the dressings were secure, so MrB helped me - a lot!  One morning it looked as if I had popped a stitch and called the office to see if they would fix it in the office or if I needed to head to the ER (again).  They said to come, so MrB drove me over to see the partner in the practice.  The bottom line of that adventure was that I had a hematoma which burst at the incision site.  A couple of weeks later I had another follow-up with my doctor.  By that point, the area was ugly absolutely disgusting!  After removing the bandages my surgeon said that he had never seen this happen.

Have you lost count?  That's 1) injury doesn't usually require surgery, 2) never had anyone go to the ER for IV pain meds; 3) hasn't ever seen this problem.

Moving on to #4.  The wound was infected and I wound up going through four rounds of antibiotics.  The surgeon has never seen this (I've come to expect hearing those words by this point), but the wound wasn't healing after some time and he had to refer me to a wound clinic.  Yup.  Is anything ever easy?  So, off to the wound clinic I go.  The clinic treated me with some medical honey and it cleared up after 6-ish weeks.

That's enough life for this post.  But yeah, life has kept me busy since I'd last written.