PCP Change of Heart (or mind!)

[Guest guest]

Yesterday I had to see my PCP due to needing a refill of Zocor. As he

was checking my chart after the nurse had done the weighing, blood

pressure checking, blood taking, etc., he mentioned the LOMN I had

asked him to send to BC/BS of TN way back in May, which I had

actually written and faxed to his office, where his staff merely put

it on letterhead for his signature. He said he was very impressed

with the research I'd obviously done and my depth of understanding as

to what I felt would be right for me and my body. Further, he said he

was now recommending the BP/DS to his other MO patients based on his

own research into the sites I cited in the letter!

Another convert to our side!

--stella

[Guest guest]

Yesterday I had to see my PCP due to needing a refill of Zocor. As he

was checking my chart after the nurse had done the weighing, blood

pressure checking, blood taking, etc., he mentioned the LOMN I had

asked him to send to BC/BS of TN way back in May, which I had

actually written and faxed to his office, where his staff merely put

it on letterhead for his signature. He said he was very impressed

with the research I'd obviously done and my depth of understanding as

to what I felt would be right for me and my body. Further, he said he

was now recommending the BP/DS to his other MO patients based on his

own research into the sites I cited in the letter!

Another convert to our side!

--stella

[Guest guest]

> Yesterday I had to see my PCP . . . he mentioned the LOMN I

> had asked him to send to BC/BS . . . , where his staff

> merely put it on letterhead for his signature.

> He said he was very impressed with the research I'd

> obviously done and my depth of understanding as to what

> I felt would be right for me and my body.

> --stella

Stella;

That sounds great!

Would you mind posting the content of your LOMN (with personal

identifying info deleted out) so that others coming behind you

might benefit from your obvious convincing logic?

hugs,

gobo

[Guest guest]

> Yesterday I had to see my PCP . . . he mentioned the LOMN I

> had asked him to send to BC/BS . . . , where his staff

> merely put it on letterhead for his signature.

> He said he was very impressed with the research I'd

> obviously done and my depth of understanding as to what

> I felt would be right for me and my body.

> --stella

Stella;

That sounds great!

Would you mind posting the content of your LOMN (with personal

identifying info deleted out) so that others coming behind you

might benefit from your obvious convincing logic?

hugs,

gobo

[Guest guest]

At 20:08 +0000 7/18/01, gobo wrote:

>Would you mind posting the content of your LOMN (with personal

>identifying info deleted out) so that others coming behind you

>might benefit from your obvious convincing logic?

My letter was very largely cribbed from another member of this

list...Liane French. I believe it is in the files.

I will say that I did indeed do my own research about this procedure

and was thus able to discuss it intelligently with my PCP.

--stella

here it is:

May 16, 2001

BC/BS-TN

Health Services

801 Pine Street

Chattanooga, TN 37402

RE: Stella A. Sloop

Subscriber ID #**********

To whom it may concern:

Our patient, Stella A. Sloop, at 5'3 " height and 292 pounds,

has a body mass index (BMI) of 51. She has a hiatal hernia,

elevated cholesterol, and Type II Diabetes, as well as stress

incontinence, and hirsutism. She has attempted multiple weight

reduction programs, such as Weight Watchers, Atkin's diet,

Carbohydrates' Addicts Life Plan, Diabetics diet, and a low

cholesterol diet but was never able to achieve long term weight loss

success. It then was suggested that she investigate weight loss

surgery.

Mrs. Sloop has researched extensively the surgical options available to

treat her morbid obesity and co-morbidities. Along with myself,

Mrs. Sloop feels strongly that she would benefit most from the

Biliopancreatic Diversion with Duodenal Switch (BPD/DS) procedure.

This procedure is most effective for patients such as Mrs. Sloop,

who are in the " super morbidly obese " range (BMI higher than 50),

and provides the best chance at achieving a satisfactory percentage

of excess weight loss (%EWL) for the patient.

Dr. Hess of Bowling Green, Ohio, who initially devised the

BPD/DS procedure in 1988, published a clinical study in 1998 (Hess, et al.:

Biliopancreatic Diversion with a Duodenal Switch, Obesity Surgery, 8,

1998; 267-282.) concluding that the BPD/DS procedure achieves an

average of 80%EWL, which occurs at 24 month post-operative and

continues at a 70% level for eight years and beyond. For Mrs. Sloop,

this translates to a final weight of 159 lbs. -- well below the

" morbidly obese " range (By contrast, the Roux-en-Y procedure promises

only 55%EWL and a final weight of 202 lb. -- still almost morbidly

obese, and clearly not a satisfactory result.)

In Mrs. Sloop's case, the BPD/DS procedure is warranted in order to

give her the best chance to reach a healthy weight and reduce or

eliminate her co-morbidities, and to maintain the weight loss for the

long-term. Other benefits of the BPD/DS procedure that are not found

in the roux-en-y " pouch " procedure are as follows:

1.) Retention of the natural functionality of the reduced stomach. The

partial gastrectomy leaves the pyloric valve intact and functioning, which

means that there is no chance of post-operative problems which can

plague RNY patients: blockages of the stoma, marginal ulcerations,

narrowing of the anastomosis requiring endoscopic dilation, dumping

syndrome. All of these problems can occur repeatedly in RNY

patients; none of these problems can occur after the BPD/DS

procedure. Furthermore, the BPD/DS stomach is left large enough that

food can be properly digested before it is expelled into the small

intestine. This means that BPD/DS patients may see greater protein

absorption, and do see adequate production of intrinsic factor for

vitamin B12 absorption, benefits that are not enjoyed by RNY

patients.

2.) Retention of the duodenum in the food stream. Unlike other

forms of gastric bypass, the BPD/DS procedure does not completely

bypass the duodenum. The duodenum is where calcium, iron, protein

and zinc absorption take place, so BPD/DS patients seldom experience

dangerous deficiencies of these nutrients. By contrast, the RNY

procedure completely bypasses the duodenum, which seems to compromise

absorption of these nutrients to a greater degree.

3.) The BPD/DS's distal gastric bypass provides the best long-term

weight loss potential, with little to no late regain of weight, as noted in

the above-referenced Hess report. BPD/DS patients can reasonably

expect to reach and maintain a healthy weight, whereas other forms

of gastric bypass surgery see much greater failure rates and late

regain of weight.

All of the factors cited herein are compelling to Stella Sloop and

myself (as her primary care physician), and we feel that it is incumbent

upon her health insurer to consider these things and approve this

request for authorization, as it is clearly in the best interest of

the patient's long-term health and well-being.

By copy of this letter to Dr. Booth, I am referring

Mrs. Sloop to him for the above referenced surgical procedure.

Sincerely,

Dr. R. Warren, P.C.

[Guest guest]

At 20:08 +0000 7/18/01, gobo wrote:

>Would you mind posting the content of your LOMN (with personal

>identifying info deleted out) so that others coming behind you

>might benefit from your obvious convincing logic?

My letter was very largely cribbed from another member of this

list...Liane French. I believe it is in the files.

I will say that I did indeed do my own research about this procedure

and was thus able to discuss it intelligently with my PCP.

--stella

here it is:

May 16, 2001

BC/BS-TN

Health Services

801 Pine Street

Chattanooga, TN 37402

RE: Stella A. Sloop

Subscriber ID #**********

To whom it may concern:

Our patient, Stella A. Sloop, at 5'3 " height and 292 pounds,

has a body mass index (BMI) of 51. She has a hiatal hernia,

elevated cholesterol, and Type II Diabetes, as well as stress

incontinence, and hirsutism. She has attempted multiple weight

reduction programs, such as Weight Watchers, Atkin's diet,

Carbohydrates' Addicts Life Plan, Diabetics diet, and a low

cholesterol diet but was never able to achieve long term weight loss

success. It then was suggested that she investigate weight loss

surgery.

Mrs. Sloop has researched extensively the surgical options available to

treat her morbid obesity and co-morbidities. Along with myself,

Mrs. Sloop feels strongly that she would benefit most from the

Biliopancreatic Diversion with Duodenal Switch (BPD/DS) procedure.

This procedure is most effective for patients such as Mrs. Sloop,

who are in the " super morbidly obese " range (BMI higher than 50),

and provides the best chance at achieving a satisfactory percentage

of excess weight loss (%EWL) for the patient.

Dr. Hess of Bowling Green, Ohio, who initially devised the

BPD/DS procedure in 1988, published a clinical study in 1998 (Hess, et al.:

Biliopancreatic Diversion with a Duodenal Switch, Obesity Surgery, 8,

1998; 267-282.) concluding that the BPD/DS procedure achieves an

average of 80%EWL, which occurs at 24 month post-operative and

continues at a 70% level for eight years and beyond. For Mrs. Sloop,

this translates to a final weight of 159 lbs. -- well below the

" morbidly obese " range (By contrast, the Roux-en-Y procedure promises

only 55%EWL and a final weight of 202 lb. -- still almost morbidly

obese, and clearly not a satisfactory result.)

In Mrs. Sloop's case, the BPD/DS procedure is warranted in order to

give her the best chance to reach a healthy weight and reduce or

eliminate her co-morbidities, and to maintain the weight loss for the

long-term. Other benefits of the BPD/DS procedure that are not found

in the roux-en-y " pouch " procedure are as follows:

1.) Retention of the natural functionality of the reduced stomach. The

partial gastrectomy leaves the pyloric valve intact and functioning, which

means that there is no chance of post-operative problems which can

plague RNY patients: blockages of the stoma, marginal ulcerations,

narrowing of the anastomosis requiring endoscopic dilation, dumping

syndrome. All of these problems can occur repeatedly in RNY

patients; none of these problems can occur after the BPD/DS

procedure. Furthermore, the BPD/DS stomach is left large enough that

food can be properly digested before it is expelled into the small

intestine. This means that BPD/DS patients may see greater protein

absorption, and do see adequate production of intrinsic factor for

vitamin B12 absorption, benefits that are not enjoyed by RNY

patients.

2.) Retention of the duodenum in the food stream. Unlike other

forms of gastric bypass, the BPD/DS procedure does not completely

bypass the duodenum. The duodenum is where calcium, iron, protein

and zinc absorption take place, so BPD/DS patients seldom experience

dangerous deficiencies of these nutrients. By contrast, the RNY

procedure completely bypasses the duodenum, which seems to compromise

absorption of these nutrients to a greater degree.

3.) The BPD/DS's distal gastric bypass provides the best long-term

weight loss potential, with little to no late regain of weight, as noted in

the above-referenced Hess report. BPD/DS patients can reasonably

expect to reach and maintain a healthy weight, whereas other forms

of gastric bypass surgery see much greater failure rates and late

regain of weight.

All of the factors cited herein are compelling to Stella Sloop and

myself (as her primary care physician), and we feel that it is incumbent

upon her health insurer to consider these things and approve this

request for authorization, as it is clearly in the best interest of

the patient's long-term health and well-being.

By copy of this letter to Dr. Booth, I am referring

Mrs. Sloop to him for the above referenced surgical procedure.

Sincerely,

Dr. R. Warren, P.C.