• Hi, If you cannot get into the site, be sure to Contact Us. Please be advised that the app is no longer in use!

Appeal letter please review?

PurpleKylie22

New Member
My letter to the hospital programme /GP has been updated, I will take it in with me when I go to see my GP, but wanted to post the revised version incase you think there are any more changes I should make, or just think I have messed it up completely! hehe




Kathleen, I have taken your name from the letter enclosed which was sent directly to my GP, if you are not the correct person please could you forward this on and drop me a note of who it has been sent to.

The enclosed letter was sent to my GP as a rejection for her referral to the Obesity Clinic with a view to Bariatric surgery, I can see the reasons you have rejected the application however I would like to take this opportunity to explain my circumstance and to ask if there is any way you could make an exception in my case. My letter probably is longer than you would like and is required however if you could please take the time to read it through I would be very appreciative.

To start with I would like to tell you a little bit about me as a person and my weight. I am 25 years old and I weigh around 300lbs, I am rather short at 5ft 4 and so in total I’m rather round. My weight has been a life long issue for me, I have had an unhealthy relationship with food since I was 12, my mum broke her arm and she had surgical complications resulting from a cardiac arrest on the operating table in total she spent around a year in hospital and has been unable to walk ever since. My dad and I went through a phase of comfort eating and obviously my weight went up I never gave it much thought until I started high school, being one of the biggest people in school wasn't a very pleasant experience and of course my habit of comfort eating was in effect by then, so being bullied only led to me gaining more weight. Since leaving school and becoming a mum to 3 children, I have began to take control of my eating, I feel very strongly that I need to make a change now before it is too late and I am trying very hard to do everything right but still my weight continues to go up, I feel a Gastric Bypass would be the right tool to help me finally take full control and be in charge of my life.

After my second child was around 2 years old, I asked my GP about my weight, she said it was probably too soon to be focusing on and to give it some time. When he was 4 I was getting very depressed about my weight and my GP put me on Xenical. I had very little effect with it and eventually stopped taking it. When I was pregnant with my third child, a friend recommended I look into a Gastric sleeve procedure to help me, I did the research and found it quiet interesting, but was convinced once I had my third child I would do it, I would loose the weight I needed. Between having my second child nearly 7 years ago and now I have tried almost every type of diet I can find, I invariably loose a little weight then rapidly regain it plus a few extra pounds as well. For the past few months I have religiously researched the 3 main types of Bariatric surgery and I know in my mind that the best treatment for me and my situation is a Gastric Bypass. Coming to this decision myself was extremely difficult especially given the problems my mum had when underwent surgery for just a broken arm. I have read countless blogs of people who have undergone the procedure, I have watched many videos of the actual procedure being performed and spent hours watching one girls video blog of her journey through being accepted to 2 years after the procedure. I have joined a forum for people who are applying / are waiting and who have undergone various weight loss surgeries, I looked into the guidelines to see what I would need to do and I have met the NICE Guidelines. To be honest I was really disappointed and surprised when I received your rejection letter as during my trawling through the Internet to find out as much as I could about the procedures and guidelines I came across a document published by the Scottish Executive, November, 2004 In it is states that the guidelines to be followed are the same as NICE guidelines, if you wish to check this information, it has been released (ISBN: 0-7559-3859-3) It seems to be the most up-to-date set of Guidelines that NHS Scotland have released so I assume they are current and that all NHS trusts in Scotland are supposed to be following them.

I would like to you reconsider accepting my case, mainly due to my family history of heart disease. Not only did my mum suffer a cardiac arrest when she was just 35 years old, my father died of a heart attack when he was 47 years old. I am worried that given my current BMI of 50.5 (Super Morbidly Obese) I am at an increased risk of heart problems and I do not want my children to loose their mum at an early age. I am currently suffering from various problems that are likely to be weight related, back pain, hip pain, sleep problems, extremely sore joints i.e. knees and ankles, I have also began experiencing considerable numbness which I assume is down to poor circulation, I am beginning to worry about serve Arthritis as i get older due to the increased pressure on my joints. Not only is my weight causing various pains in my body it is also starting to affect my every day life, I am out of breathe just walking back and forth to the school, Getting in and out of the bath is becoming more difficult for me and I have almost flooded the bathroom more than once by slipping getting up and splashing water. I suffer from extremely low self confidence because of my weight and at times I do get very depressed about it., I try to avoid going out as much as possible and avoid meeting new people because I feel ashamed of myself. I have even brought a cross trainer for the house which I try to use to avoid going to the gym. Because of my back pain and breathing problems, I am beginning to have mobility issues, I cant sit well for long, I cant walk far, I never sleep well, I find it imposable to get in a position I can sleep in and I have spent hundreds of pounds on a new mattress so I know this is not the issue. To be honest, it is embarrassing that these things which are so normal and so simple for most people are becoming a problem for me.

I wrote a list of reasons I want a Gastric Bypass;
  • I want to live to see my children grow up, I want a healthy heart.
  • I want to be able to play with my children like most mums can do and to exercises without stopping every 2 minutes to breathe.
  • I want to be able to carry my toddler around as often as he wants and not have to put him down because its just too sore.
  • I want to be able to see someone for the first time and have them see me and not the fat girl most people see.
  • I want to be able to go places school/theatre/cinema and be able to sit down without worrying about breaking the chair.
  • I want to be able to find clothes that fit me.
  • I want to feel my age and be normal.
  • I want to just be me, I want a proper quality of life.


I do meet the NICE and the NHS Scotland criteria, I understand that a bypass is not an easy way out and I can assure you I did not make the decision to apply lightly, my partner and myself understand the long term complications, the risks involved and life long impact that this surgery would make, but I am asking you to please reconsider my case. I will jump through any hoops you may have and I will do my very hardest and do everything that you ask of me, but I need this surgery, I feel that Gastric bypass is the only option remaining open to me.

Yours Faithfully
 
Last edited:
Kylie, it's a good letter.

May I make a couple of suggestions?
* make the clear connection between your Mum's accident and surgery and the beginning of your unhealthy relationship with food.
ie BECAUSE of my mum's being in hospital so long, dad and I began to comfort eat.
* you say you've now taken control of your eating, yet you are still super morbidly obese. Is that true then (that you've take control of your eating?)
Would it sound better to say that you are TRYING to take control of your eating and feel very motivated to do so, and that you feel that a gastric bypass is the right tool to help you?

Also, have you any diagnosed medical problems which are weight related? That would again help your case. If you have, write them down. Will your GP back your appeal? It would be helpful if he/she would.
I wish you all the best with your appeal pet.
 
Hi, letter is good but personally i would add a little more around the depression side around your weight.
Becoming increasingly depressed, not wanting to go out anymore and will avoid mixing at all costs, weight causing mobility issues which is affecting your depression etc.

While you are aware that a gastric bypass will not magic away depression or your relationship with food entirely, you are 110% committed and convinced the bypass will provide you with the opportunity to be in control of what you eat, giving you opportunity to extend you life expectancy. In summary when I am in control of what I eat I am in control of everything. You feel most stongly the bypass is the only remaining option open to you after years of dieting with or without medication.


Only if you want to add this it may help.

Good luck babe.


Linski xxx
 
I wrote an appeal letter too

Thank you for your quick response to my request for WLS funding. I am however, understandably very disappointed at your refusal, and wish to appeal this decision.
The prime reason for my appeal is that my BMI is 50.8, not 49.5 as previously stated. This qualifies me for WLS funding according to your own criteria. When I talked to my GP and the form was filled in, my weight was checked, but not my height. My height is actually 5’6", thereby giving me a BMI of 50.8.

I have added below, other relevant information, which I hope will also strengthen my appeal.
Family history. My family, mother, father, 2 brothers and 6 nephews all suffer from actual or potential heart problems. We all have very high cholesterol levels, mine being 10.6+ without statins, and 5.6 with (still high). My parents died from heart attacks, one brother and 2 nephews have already had mild heart attacks in their late thirties, and one brother had to have a stent inserted as he had a blocked artery. My family was used as part of a Family Heart Study to detect early heart disease, at Leeds General Infirmary in 2002. I have shown that I have a high potential of suffering heart disease in the future, and that if my excess weight can be reduced quickly, this potential would be greatly reduced.
My weight loss history. I have never been slim, however I kept my weight fairly well under control by diet and exercise. I was a PE teacher for 15 years, and was very fit, but still had to constantly diet to keep my weight under control. When I was 35 both of my Achilles Tendons were damaged – I had to sit for 6 months, not putting any weight on my feet, having physiotherapy. During this 6 months I put on 3 stone. I didn’t eat anything different, but just could not exercise at all. I was unable to exercise fully after this time, and as a consequence I have been battling my weight ever since.
I have been yo yo dieting for as long as I can remember, years of slimming clubs, I have been a member of them all repeatedly. I have tried doctors diet sheets, and I have even tried hypnotism. I gave up smoking, and the weight increased yet again, and I have also tried Reductil to no effect.
I know what I should be doing, and I can lose weight, but I cannot keep the weight off for any substantial period, as I am now physically unable to exercise. I have been referred to a physiotherapist by my GP, but found that the excess weight caused severe pain in my joints. The surgery and following weight loss would help me get moving again, take part in exercise and not be housebound.

Physical effects. High Cholesterol, painful arthritis in my knee and hip joints, where my hip is almost bone on bone at this time. I have been recommended to eventually have a hip replacement by my GP, but if I could lose a substantial amount of weight I am convinced that the operation would be safer if I still need it after weight loss, or possibly averted all together. I also have neck pain, and shoulder pain. I now have poor posture, can not stand or walk without support. I suffer backaches, am short of breath and suffer bladder incontinence.

Mental effects. Low self-esteem, anxiety, no confidence, no will power. I feel withdrawn from life, depressed about my weight problems, no interest in anyone or anything. I don’t leave the house, and I suffer anxiety at the idea of having to go out.
I am sure that all of the above information will result in a positive decision on funding for WLS Surgery for me, and I look forward to hearing from you in the near future.
Yours Faithfully

I won my appeal, but only on the fact that I need a hip replacement, no the reason. Try to be very factual about any illnesses you already have, and emphasise the fact that they don't meet the Nice or Scotland guidelines. Don't play on the emotional side - they will just ignore it.
Your list of reasons for wanting a bypass are all emotional - emphasise from a different point of view:
Healthy heart
Ability to exercise
Less pressure on joints and muscles to help prevent arthritis in later life.
Improved sleep patterns
Quality of life

Hope this helps
xxxx
 
Thank you Charis! I will do as you have suggested and make those alterations, I like to think that I have taken control of my eating, at least as far as I can myself at this moment in time, I still eat the occasional unhealthy food, but I when I feel like I can eat a horse I eat a big plate of veggies instead and I am eating so much healthier than I was before BUT I am still overweight and I proabily eat more than I should.
I dont have any medically digonosed weight related issues, its all mainely just pain which gets so bad sometimes I cant walk very well, but I self medicatewith Paracetamol and Ibupafen and put up with everthing else. Baths tend to help with the pain, but as you can read that isnt exactly the easiest thing in the world either.

The guy from SCOTS charity has told me that they have an automated response and so sending a letter would be pretty pointless, but he has tld me he will contact my GP and help discuss where we go from here, so I will take the letter with her and if she can go anywhere from there, I will ask her to include it for me, to help get my point across.

The only thing that really bothers me is that my GP seems tobe quiet good, but I have only seen her once. I had a great relationship with my last GP, but I moved out of the practice area and so I dont know the new ones very well and I dont know if she actually wants to help me or just wanted rid of me.
 
Just read all of the other answers - I think between us you will have a brilliant appeal letter lol
My GP wrote a covering letter with mine, and posted it off for me. It was sent to Derbyshire appeals, not the local Chetserfield one who made the original decision.

Good Luck xx
 
X-posted! Thank you Linksi and Veronica, I will definetly need to do a little re-wording before I go to the GP.
I honestly wasnt sure if I was better going with lots of emotion or none and I think I ended up with a little too much, but I want them to understand what this means to me and since I dont believe they have been in my situation I dont think they ever can.

Thank you girls, I really do appriciate your input :)
 
The problem is that they have read it all before - we all have similar problems, so the factual side is much more important. I was advised to keep the emotional side to the minimum, and it worked.
Can you send your appeal to the next level up from your local PFC? That might work, particularly if they have different criteria. Just a thought xx
 
Actually Vron, I don't completely agree with you the non-emotional approach. My letter to my PCT was quite emotional, albeit I focussed on the possibility that I wouldn't be around to look after my kids. It's a real issue and risk which needs to be taken into consideration.
But my letter also did the trick. The fact is, being this overweight is miserable and it does no harm to emphasise that fact.
Kylie, I hope I didn't upset you with the comment about your eating being in control. It's just that obviously it isn't as in control as it needs to be, or else none of us would need WLS!
I think you need a full and frank discussion with your GP to realy get to grips with all this, maybe make a double appointment?
And also do you need to have some x-rayes etc of your joints?
 
The way the process works in scotland from what I can tell is different to England, my GP referred me to the hospital for the process but the hospital exists as itself, It is its own trust, so as long as the hospital accepts me, there doesnt need to be any one else involved and since the hospital programme didnt accept me there is nowhere else to turn to, at least that is pretty much all I can gather.
 
Charis no you didnt upset me! :D I have much thicker skin than that - I saw what you have said and I think you are right, in my mind I have "fixed" my eating problems, but in reality I think I have just started the process, but until my tummy learns to eat less, I will be stuck in this position. I eat healthier, but surgery would give me the boast I need and force me to learn portion control e.t.c

I think a double appointment would be best, I am actually extremly concerned about heart issues, my grandma and dad both died young and my mum had a heart attack in surgery, so I would like to at least get my cholesterol checked and see what I can do there. I dont know how far they would go in relation to my joints hip/back pain and I doubt they would give me x-rays, but I need to sort out better pain managment for that. My Old doctor gave me very strong painkillers (Co-dyhydromol or co-dyhydrocodine I think), but they made me dizzy and sick so I gave up and stuck to over the counter meds which arent helping as much as I wish they would.
 
Kylie
I found this for you to look through. It gives the criteria for your area and also alot of other information that might help your argument.
http://www.scotland.gov.uk/Resource/Doc/35596/0012569.pdf

This is 2004, but shows on the site as the current document.
Even though you go to the hospital and they decide, there are still national guidelines that they should be following, and I would have thought that you would have a strong legal argument for the surgery if they are doing there "own thing", particularly with such a high BMI.


I would suggest somewhere you put something like " I have worked through my eating patterns and am very aware of the problems. I now need surgery as a support tool to help me continue progressing to a healthy weight."

Also can you ask your doctor (if he hasn't already) to test for diabetes to see if you are borderline - if you are that should go in the letter too.
Could he also test for Sleep apnea - if you have that, you would almost certainly get the surgery.

Hope this all helps xx
 
Hi Veronica, I have seen that already which is how I know NHS Scotland use those guidelines, but NHS Grampian seem to use their own.
I havent been tested for Diabetes, but I did do home tests with one of the Accu blood things, I got a new one quite cheap and my blood lvls are perfect. I dont seem to have any problems at all, I spoke about sleep apnea before and the doctor pretty much dismissed me. I will ask her about it again, but I have a feeling if I go in with too much, she just wont be interested.
I am not having a very good day today so I apologize if I seem negative, I feel like I am just going to be going in loops for the next god-only-knows how long...

Think I need a bit of a break down before I can look at this again. I will make a doctors appiontment on Monday but Im not likely to get a double appointment for a few weeks, so I will have time to work out exactly what I want to request.
 
Sorry you are feeling low - I know exacly how you feel and i sympathise. I nearly gave up at this point, but am glad that I persevered. Just keep thinking that it will be worth it in the end

Hugs

Vron xxxxxx
 
I sure hope so. I am just about to update the letter at the top and then I think Im going to take a break for a few hours, so have a re-read if you get chance to at some point and feel free to post any comments :)

Thank you
 
Letter has been Revised

I tried to take into account all that you girls have told me, I hope it sounds ok :)
 
Lol Kylie - I thought I would give you a break, but you got right on it lol. Good on ya !.
anyway this was my effort, but just ignore if you are happy with your now - just wanted to take the pressure off you a bit.

Kathleen, I have taken your name from the letter enclosed which was sent directly to my GP, if you are not the correct person please could you forward this on and drop me a note of who it has been sent to.

The enclosed letter was sent to my GP as a rejection for my referral to the Obesity Clinic with a view to Bariatric surgery.

To start with I would like to tell you a little bit about me as a person and my weight. I am 25 years old, weigh around 300lbs, and am 5ft 4 tall. My weight has been a life long issue for me. When I was 12 my mum broke her arm. She had surgical complications resulting from a cardiac arrest on the operating table in total she spent around a year in hospital and has been unable to walk ever since. This began my unhealthy relationship with food, and my dad and I went through a phase of comfort eating and obviously my weight went up. I never gave it much thought again until I started high school, and being one of the biggest people in school, it wasn't a very pleasant experience. Of course my habit of comfort eating was in effect by then, so being bullied only led to me gaining more weight.

I then had a family, and when my second child was around 2 years old, I became very concerned and depressed about my weight, and asked my GP for help. She said it was probably too soon to be focusing on it and to give it some more time. 2 years later, I was still very depressed about my weight and my GP gave me Xenical to try. It had little effect and eventually I stopped taking it.

When I was pregnant with my third child, a friend recommended I look into a Gastric sleeve procedure to help me, I did extensive research and found it very informative, but was convinced once I had my third child I would manage to loose the weight I needed. Between having my second child nearly 7 years ago and now I have tried almost every type of diet I can find, and on each would invariably loose a little weight then rapidly regain it plus a very extra pounds as well.

For the past few months I have religiously researched again the 3 main types of Bariatric surgery and I know in my mind that the best treatment for me in my situation is a Gastric Bypass. Coming to this decision for myself was extremely difficult especially given the problems my mum had when under surgery for just a broken arm.

Having looked into the NHS criteria, I know that I have met the NICE Guidelines for Bariatric Surgery. I checked NHS Scotland and confirmed that they also use NICE guidelines, so having met the required criteria, I made the very difficult decision to go and see my GP to discuss my options for surgery. My GP agreed and referred me for funding. To be honest I was really disappointed and surprised when I received your rejection letter as during my research on the Internet I read a document published by the Scottish Executive, November, 2004. It states quite clearly, that the guidelines to be followed are the same as NICE guidelines. If you wish to check this information, it has been released (ISBN: 0-7559-3859-3) It seems to be the most up-to-date set of Guidelines that NHS Scotland have released so I assume they are current and that all NHS trusts in Scotland are supposed to be following them.

I would ask that you reconsider accepting my case for the following reasons:
Health

  • Healthy heart – prevention of future heart disease
  • Ability to exercise – to maintain my weight loss
  • Less pressure on joints and muscles to help prevent arthritis in later life.
  • Prevent possible diabetes
  • Improved sleep patterns prevent sleep apnea
  • Quality of life.
Personal

  • My family has a history of heart disease. Not only did my mum suffer a cardiac arrest when she was 35 years old, my father died of a heart attack when he was 47 years old.
  • I am worried that given my current BMI of 50.5 (Super Morbidly Obese) I am at an increased risk of heart problems and I do not want my children to loose their mum at an early age.
  • I am currently suffering from various problems that are likely to be weight related, back pain, hip pain, sleep problems, extremely sore joints i.e. knees and ankles, I have also began experiencing considerable numbness which I assume is down to poor circulation.
  • Not only is my weight causing various pains in my body it is also starting to affect my every day life, I am out of breathe just walking back and forth to the school, Getting in and out of the bath is becoming more difficult for me
  • I want to live to see my children grow up
  • I want to be able to play with my children like most mums can do.
  • I want to be able to carry my toddler around as often as he wants and not have to put him down because its just too sore.
  • I want to be able to see someone for the first time and have them see me and not the fat girl most people see.
  • I want to be able to go places school/theatre/cinema and be able to sit down without worrying about breaking the chair.
  • I want to be able to find clothes that fit me.
  • I want to feel my age and be normal.
  • I just want to be me.
I understand that a bypass is not an easy way out, I understand the long-term complications and life long impact that this surgery would make, but I am asking you to reconsider my case. I will jump through any hoops you may have and I will do my very hardest and do everything that you ask of me, but I need this surgery.
 
Doctors app for appeal booked!

Thank you Veronica. :)

I got around to doing it today, the kids have been off school ill, doctor is on holiday next week, so I have a double appointment for the 21st. No doubt I will be posting again before then asking for advice as to what I should actually ask, but generally, I want her to send through an appeal and I would like my heart "health checked" and sleep apnea tests. I also think I need to see about proper pain killers as my back / hip are very sore.
Im not holding out hope, honestly I cant see it happening, the "rules" here see to be un-wigglable, but I will just have to hope.
They have to update the rules to the rest of the UK at some point, right?
 
Back
Top