Overweight and in desperate need of TRHR

[texasvet]

1hipIwonder I had a breast lift about a year ago, the surgery lasted about 3 hours, and recovery continued for about 6 months. I don't recommend having either procedure (hip or breast) too close to the other. A breast reduction is more involved than the lift and removes a lot of skin and breast fat. You won't want to raise your hands above your head or put much weight on your arms. (crutches, walker or cane) Your breasts will be tender for at least a couple of months. The recovery takes a lot out of you. Exercise involving arms or pec muscles will be limited. Wish you the best on your PPO and options it will open up.

 

[LibraryLynn]

I have not had my hip replaced yet, but I have a BMI very similar to yours, 1Hip. I have been hobbling around for over a decade while they treated me for everything under the sun, fully believing that I had muscle issues. Finally, after some aggressive pushing on my part (and a few tears), they took an xray of my hips. My doctor called with a catch in her throat and told me that she was so very sorry, but both of my hips are bone on bone with significant bone spurs. She felt terrible that they never took an xray (but I suspect we know that I don't have dengue fever because I had so many blood tests). Anyway, fast forward...I met with the surgeon at the end of September. We have a very well-respected orthopedic office and surgery here in my tiny town in Wisconsin. He said, yep, two new hips for you. He had me lie back, and I was expecting the lose weight lecture. Nope, all he said was that my skin looks great, and it should heal nicely. Not a peep about my extra pounds...I even said something about being fat, and he just brushed it off.
The moral of that story...find the right surgeon. My surgeon clearly believes that once every step is not excruciating, I will lose the weight. I certainly believe that because now I plan every movement out of the chair or I'm sorry.
We're here to support you, 1Hip. Keep looking until you find the right surgeon!
Lynn

 

[Poppet]

Yes, LL is so right, continue researching for a surgeon whom you have a good rapport with - weight is not an issue these days - do keep us updated - best wishes!

 

[1_HIP_I_wonder]

@texasvet, thanks for the information. I thought I would be able to have both surgeries next year, but, I am probably not being realistic. Your comment about the inability to put a lot of pressure on my arms really makes sense and I didn't think about it in relation to the Hip surgery.
I should probably concentrate on the THR first and then wait until the following year gpfor the breadt reduction.
Thanks again!

@LibraryLynn, thanks for the well wishes and I am glad there no mention of any weight issues, hopefully, you can have the surgery and be in your way to a pain free life. Thanks for the love!

@Poppet, how are you my friend? Thanks so much for always checking on me. I have found several OS in Baltimore that are on staff at Mercy Hospital and there is one I will seeing first week in January.
The Mercy Hospital Ortho Dept was in the World News and World Report as one of the best Ortho.Dept in the country, so, I amexcited to see if the weight will be an issue with him.

I will keep you guys posted.
Peace and Blessings,
Kim

 

[Poppet]

That is fantastic Kim, fingers and toes crossed for you - I believe it will happen this time xx

 

[Mamanordy]

I am what is considered obese with BMI of 38. However I've never been told by any doctor I wouldn't be a good candidate for surgery. I think a lot of why is that I have low to normal blood pressure and my lower part of my body is what is , well, fat (lol). I get around well. Well not now because i am in need of hip replacement and will be getting it in December. Don't let your weight stop you from finding the right surgeon that will do your hip with confidence and ease. We cannot lose weight after! Good luck!

 

[Poppet]

Just checking in with you @1_HIP_I_wonder - how are you hon?

 

[1_HIP_I_wonder]

@Mamanordy,

How are you and nice to meet you? I am so happy that you are going to have your surgery in December. I am interested in your meeting with the OS, was anything said to you about your weight?

@Poppet, hi! I am doing ok, still in severe pain and waiting for January to change my plan. I have good days, but, all of them involve pain.
Thanks for your support and keeping me in your prayers.

 

[Poppet]

It is so tough @1_HIP_I_wonder being in limbo. Severe pain is so exhausting, I feel for you x

 

[1_HIP_I_wonder]

Hi all, well,
I received the most devastating news I could have received. Those of you who have followed my thread know that my HMO wanted me to lose weight (about 30 lbs) before they will approve the surgery. So, I decided that I would change my plan during Open Enrollment to a PPO plan that will allow me more flexibility without the ridiculous restrictions of an HMO.
Well, OE came a few weeks ago and I was excited to read all the material and to get an idea of how much the PPO plan would cost me. I knew it would be more expensive than the HMO, but, I had no idea the plan would be $400 every 2 weeks. I was completely hysterical when I realized I could not afford to change the plan.
So, right now, I am stuck as to how I will ever be able to have my hip replacement.
As it stands now, I am using a cane regularly and I am bone on bone on my right hip.
So, I came to the only place where I knew people would understand my frustration and pain.

 

[Jaycey]

@1_HIP_I_wonder I feel so bad for you! The expense of insurance let alone reasonable care in the US has gotten out of control. And you are the proof! Hang in there my friend. I am a firm believer when one door closes another opens. We are here for you!

 

[texasvet]

1 HIP, you must be extremely frustrated... Since it's not the doctor but the HMO who will not approve surgery, have you tried calling them directly and tried to get an override on their decision? Is there an official procedure for requesting an exception to policy? I HOPE THIS HELPS!!!

The following info came from broken link removed: https://www.oakland.edu/upload/docs/UHR/Benefits/BMI%20Qualification%20information.pdf
perhaps your HMO has similar exception to policy data.

What is your policy for exempting members from the BMI qualification for medical reasons

HAP will consider exceptions to the BMI qualification on a case by case basis for members with:
 Underactive thyroid
 Steroid medications
Member’s physician will document the medical reasons a member cannot achieve the wellness target. Any exception requests will be reviewed by HAP’s Senior Medical Director, who will determine if an exception can be made.

Blue Care Network
BCN encourages members to work with their primary care physicians and BCN to find alternate activities if they have concerns that the programs or behaviors recommended are unreasonably difficult due to a medical condition or are medically inadvisable. In addition, medical exemptions may be made for applicable medical conditions provided a letter of explanation is received from the member’s physician requesting the exemption:
 Paraplegia
 Quadriplegia
 Steroid therapy
 Unable to stand on scale (MS,
MD, other)
 Behavioral health admission
 Physical/medical impairment
(such as rheumatoid arthritis)
 Cancer treatment
 Major surgery (such as hip or
knee replacement)
 Incarcerated
 Military (active
duty/deployment)
 Pending divorce (for noncompliant
covered spouse)
 Executive leadership approval
 Grievance approval

Priority Health
The member’s physician is given the discretion to make an exception for medical conditions that warrant an exception, but Priority Health does not provide a listing of such conditions. This is between the physician and the
member.
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[faster pussycat]

I'm in the UK so sorry can't help you re the costs, but I know from reading other threads that other people have overcome problems with insurance. What I do know though is what hip pain day in day out feels like, so I send you hugs and my hopes that you can find a way round this


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[bamagirl]

I have to agree with @texasvet . There must be some procedure for getting an exception. If not, you may have no choice but to really work on that nutrition and get those 30 lbs off. May seem like a big hurdle, but you will be surprised how fast it can come off even without exercise when you are significantly overweight. I was shocked when I first started a healthy diet a few years ago that I lost 7lbs in the first week and 30 lbs in one month. And I wasn't exercising at that time. Now can't say I stuck with it, but I did lose 50 lbs before scaling back and trying to make small changes. It has definitely been difficult, but I know it is my fault for not sticking to the healthy eating. Eating the wrong foods is a definite addiction for me! You really need that hip replacement. It will change your life.

 

[1_HIP_I_wonder]

@Jaycey and @faster pussycat ,
Thanks for the support. You want to hear the real irony? I have worked for this company for 13 years!

@texasvet, thanks for the information; I sm unsure if there an exception policy or not, but, I will definitely check with the health plan to see.

I am so thankful for this forum; I am determined to continue pushing forward.

 

[JackLaw]

At 50 years old I was told that I was too heavy for surgery (6'3", 330 lbs). The news was devastating and I spent the next 8 years in agony and trying to lose weight. It didn't happen and in fact I gained weight. Both hips were bone on bone and I dragged myself around on 2 canes. I finally went to a different doc and he brushed off the idea that I was too fat to fix. He was like an angel, he gave me two new hips and I am now recovering from surgery (just a few weeks ago). My weight will continue to be an issue until I get control of my eating, but I am filled with new hope. Insurance companies can be horrible and you may have to fight with them. I feel your pain, I know your frustration, I understand. Funny thing is that the surgeries were the easy part, the system and my own self-destructive ways are the real challenges. For me, losing weight is far more difficult than the surgery. But now, at least, I can ride a stationary bike (still not walking normally). I am working hard to rehab. I pray for strength, for you, me, all of us.

 

[1_HIP_I_wonder]

@JackLaw ,
Congrats on your new hips, at least you don't have to deal with that pain. We all struggle with various issues, I hope you are able to overcome your issues with food.
I am still trying to figure out a way out of my current predicament; somehow, God will make a way and make it happen.
Take care and stay blessed.

 

[Jaycey]

You want to hear the real irony? I have worked for this company for 13 years!

Unfortunately I had the same experience with my company. Absolutely no support through my surgery or recover (i.e. why couldn't I get back to the office in a couple of weeks) . Just keep at it @1_HIP_I_wonder ! This is now a major quality of life issue. You need your THR to aid in the loss of more weight - simple! Lots of fellow members supporting you!

 

[sfbionicat50]

@1_HIP_I_wonder. I agree with the others. Try for an override. Get your surgeon and PCP to write letters explaining how the surgery is essential for weight loss. Ask your company to support you in the appeal process with the insurer. If that doesn't work, don't give up on the weight loss. I lost 90 lbs after being told I needed THR. I did it without exercising because of the bum hip. It's hard, it's slow, but it can be done -- so don't give up!


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[1_HIP_I_wonder]

@Jaycey , that's part of why this is so frustrating. I gained 30 pounds within 3 or 4 months due to my Limited mobility. It's all in my medical chart. I know I can lose the weight once my hip is not an issue.