Dissembling In Order to Save My Life

One of the biggest lessons cancer taught me is that it comes in many different forms. When a woman is diagnosed with breast cancer, it is simply not  just cancer. There are many different types of breast cancer, and once the type is determined, doctors can decide how best to treat it.

I was diagnosed with estrogen receptor-positive (ER+) breast cancer. One of the possible causes of my cancer could have been the fact that I was overweight. It has been determined that there is a correlation between obesity and cancer, particularly in women, and especially when menopause hits us. Weight gain during mid-life can be detrimental for a wide variety of reasons, but particularly because our hormones are in flux. Once our estrogen production slows down and eventually ceases, we tend to pack on the pounds. And once those pounds show up, they can be extremely difficult to get rid of.

I was pre-menopausal when I packed on a significant amount of weight, and lo and behold, I was diagnosed with cancer. Coincidence, or proof of fact? I will never be completely sure. What I am sure of, however, is that now that I am menopausal, my chances of developing cancer again are greater because I’m still carrying around too much weight. That is the primary reason why I want to have weight loss surgery.

Last week was another frustrating phase in my pursuit of weight loss surgery. I paid a visit to a sleep medicine clinic in one of the local hospitals to be assessed for sleep apnea. I am quite sure I do not have the condition, but lo and behold, the doctor I saw thought otherwise. He told me that excess weight, diabetes and high blood pressure are all risk factors for the condition. Okay, so I am at risk. I don’t, however, exhibit any symptoms at this time. Losing weight would likely prevent sleep apnea from ever developing. My only problem at the moment is near-chronic insomnia, brought on by menopause, and caused by the estrogen-suppressing drug Tamoxifen, which I take in the effort to minimize the risk of my cancer recurring.

The doctor, a very pleasant Indian-American gentleman who talked about his dislike of lake-effect snow (he spent 10 years living in Buffalo, NY), stuck a tongue depressor in my mouth and told me that I have a “narrow airway”. Next thing I knew, he was ordering a sleep study, which will require me to spend a night attempting to sleep in a strange bed, and attached to machines that will monitor my nocturnal patterns. I was nonplussed by this hasty diagnosis since I don’t snore, and if I wake up, it is not because I am gasping for air; it’s usually because I have to pee like a racehorse.

Following my visit, I posted about my aggravation on Facebook, and in the responses I found that some of my friends, and their spouses, use C-PAP (continuous positive airway pressure) machines when they sleep. I am very glad that these apparatuses help my friends sleep well; I would definitely use one if it were necessary. The thing is, right now I don’t believe I am in need of one.

Later that same day, I received a phone call from the weight loss surgery case manager my insurance provider assigned to me. Since I started communicating with this person back in December, 2015, I made it very clear that I would likely have significant difficulty losing an estimated 5 percent of my body weight (about 14 pounds in my case) prior to surgery. I explained that it wasn’t  because I didn’t want to, but because I am behind the 8-ball due to medication and menopause. During this most recent conversation, the case manager said something quite stupid and ignorant to me (I’m paraphrasing): “I have to admit that I questioned your motives for wanting this surgery; after all, you’ve had cancer.” I attempted to explain the type of cancer I had, and why I thought surgery would help me, but I could tell she was lost. Said case manager promised to contact me again in a few weeks. The likelihood of me answering that call is slim to none.

The immutable truth I am now confronted with is that there is little interest in the particulars of my situation. The absolute bottom line that will ultimately get me approved for surgery is losing about 20 pounds. The insurance company told me 5 percent of my body weight, as I mentioned, but the people at the hospital told me, “lose as much weight as possible.” Well, yes, I would, but realistically, it is a mountain I am not sure I can climb.

My week ended with a visit to my oncologist, to whom I vented about my situation. I explained that preparing for weight loss surgery is akin to being on an assembly line, which is the antithesis of being treated for cancer. Weight loss surgery requires a series of steps that must be completed before you’re rolled off that line and into surgery; kind of like what goes into building a certain model of an automobile. Everyone plays a specific role in readying the patient for the final step of having his or her guts rearranged. It has become obvious that, unlike cancer treatment, the terms of this process are non-negotiable. Despite every hoop I have, and will have to jump through, if I fail at losing the weight, I will not have the surgery. This left my oncologist and I shaking our heads, since we both understand that my difficulty losing weight on my own will greatly increase the chances of my cancer recurring.

I’ve come to realize that not many cancer patients seek to have weight loss surgery after successful treatment. I am an oddball in that respect, and it is proving to be a problem. I can talk about how certain cancers can be caused by obesity until I am blue in the face, but the weight loss surgery community I am dealing with seems to go spontaneously deaf whenever I mention it. Moreover, the health insurance industry, in its infinite wisdom, does not consider cancer to be an official comorbidy that would qualify someone to receive weight loss surgery. Granted, I do not weigh 600 pounds at present, and my life is not in any imminent danger. Ten years from now, however, things could be very different.

My oncologist and I agreed that I have to make every possible attempt to lose the required amount of weight prior to the surgery. Not getting the surgery is not an option. My health and my future depend on it. I am fortunate to be in the care of a physician who is not only empathetic and devoted to his patients, but who also understands that medical care is not a one-size-fits-all proposition. Given my unique set of circumstances, forcing me to lose a certain amount of weight prior to surgery might not be the best course of action. But, unfortunately, it looks like I don’t have a choice.

Please don’t think that I am looking for special “diva” treatment, or for ways to circumvent the process. What I am looking for is recognition of a specific set of circumstances that don’t fall into the current cookie-cutter or assembly line protocol. Since it looks like that won’t be happening anytime soon, I will have to dissemble in order to save my life.

Losing weight is challenging under the best of circumstances, but when you factor in cancer, hormones, and aging, the deck is most definitely not stacked in your favor. If only the American health care industry could operate in a more intelligent, compassionate manner, rather than constantly kowtowing to stockholders, we would all be much better off. Personally, I’d be much better off if I had about $40,000 in the bank. This is one occasion where throwing money at the problem would most likely solve it.

In the meantime, I am being held hostage by my insurance provider, and there isn’t a damn thing I can do except starve.

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