Day 1: Surgery Approved

Although getting here has been quite a journey in itself, we've chosen today as a new starting point. This morning, we got the unexpected phone call that Chris' gastric bypass surgery has been approved by his Medicare supplemental insurance provider.

To give a little bit of background, Chris has been sick since 2001.

I was out of town on business and caught a cold, which we thought Chris caught from me. Spring was preparing to turn to Summer and Chris still hadn't stopped coughing. We took him to a "doc-in-the-box" clinic on a Friday afternoon. They brought in machine after machine, then told us Chris' heart was enlarged. Who knew that was a bad thing? We were instructed to go directly to the hospital, where they'd be waiting for us. [Is this a good place to admit that we stopped at Taco Bell on the way? We had no idea how serious this was.]

We arrived and were taken quickly to admitting. The candy striper was taking our name, address, and pertinent information. A doctor handed her a small slip of paper with Chris' admit diagnosis. I saw "heart failure" on the paper and almost had heart failure myself right then and there. We spent all weekend at the hospital and then he was scheduled Monday morning for cardiac catheterization procedure, using dye to see his heart and system functions. They had already shaved his leg in preparation when the nephrologist hastily announced that they could not proceed. His kidney function was below 30% function and he could not tolerate the dye. So instead, he had a TEE (transesophageal echocardiogram) which he did not enjoy one bit!

Since then, he has been diagnosed with severe obstructive sleep apnea, a degenerating & arthritic disk in his back, gout, and eczema. He has had surgery to repair his deviated septum to help with breathing, and also a surgery to remove a gangrenous appendix which had ruptured the week before.

We know that his heart and kidneys (and therefore his other systems) are going to decline. The rate of decline is partially up to Chris and how well he cares for himself.

Chris tries to tolerate all the doctor appointments I set and all the pills I put out for him to take. These include:

• ALLOPURINOL 100 MG TABLET
  
• COLCHICINE 0.6 MG TABLET
  
• FLUOXETINE 20 MG CAPSULE (2/Day)
  
• FUROSEMIDE 20 MG TABLET
  
• LISINOPRIL 20 MG TABLET
  
• NEXIUM 40 MG CAPSULE
  
• REQUIP 1 MG TABLET (3/Day)
  
• ATENOLOL 50 MG TABLET
  
• ASPIRIN 81MG TABLET
  
• FLAXSEED OIL 1300 MG SOFTGEL
  
• MEN'S MULTIVITAMIN TABLET
  
• VITAMIN E 400 MG SOFTGEL
  

His kidney function had been stable with a creatinine clearance(ClCr) of 3.0, until our most recent annual appointment on Feb. 22. Now it's at 3.9 and he's having trouble with Potassium. So he got some new dietary guidelines. Dr. Mallea (nephrologist) also recommended looking further into the gastric bypass surgery because losing weight would be a BIG factor in slowing the decline of his kidneys.

So we started seriously looking into gastric surgery options. Lap-band vs. gastric bypass. Lots of research on treatments, insurance coverage, etc. We attended a presentation at the hospital and met Dr. Oakley (and listened to some thoughtful and some hilarious questions from other audience memebers). Our impression following the the meeting was that we needed to meet with a psychologist and also complete a six-month diet before moving forward.

We called the insurance company's special gastric bypass line. They said the 6-month diet and psych evaluation aren't necessary. So we called the surgeon's office and made an appointment. The meeting with the doctor was great. He was very nice and had a very good manner with us. (We've seen TONS of doctors and he ranks right up there with the nicest of them!) Then he had us meet with his insurance specialist. She told us emphatically that the insurance company representative we spoke with was wrong. We needed to work on getting a doctor for the six-month diet, and then we'd get the psych evaluation sometime in the fall. Exasperated by the differing information we've gotten, we asked her to just please submit a request for surgery based on what she has right now. This way, the insurance company can send us a denial LETTER and outline in writing what hoops we DO and DO NOT have to go through next.

This was on Wednesday, April 30th. And this morning, Monday, May 5th, Chris got two phone calls. One from the insurance company to let us know that they've approved the surgery and we'll have it in writing ASAP. The next was from the insurance specialist at Dr. O's office to schedule his appointments for a nutritionist, a pre-surgery support meeting/class, a pre-operative with Dr. O, and the surgery. We have a lot to do. He's going under the knife on July 1st.