Better Living Through Diet.

Hi…my name is Jaki Ryan, the Health & Weight Loss Coach at Dr. Webb’s office, Scottsdale Center for Women’s Health & Vitality Hormones for Men. I will be filling in here for Dr. Webb while he is at the Gender Spectrum Conference in California! We offer two weight loss programs. One is an updated, modernized HCG program and the other is a Lifestyle Weight Loss program. We offer complimentary consultations!

I’m excited to share healthy recipes and tips with you. My objective is to make eating healthier simple and easy. It’s a hobby for me, or maybe even a challenge, to convert old favorite recipes into ones that use healthier ingredients and less starchy carbs. Let’s face it, we are all watching our waistlines. I hang out on Pinterest a lot, perusing recipes. So, if you have a recipe that you’d like me to transform into a healthier version, please post it in the comments below!

Tip: Healthy fat is your heart-loving, fat burning friend!

Try to incorporate healthy fats into every meal. Some delicious options include anything in the coconut family including coconut oil, avocados, nuts, olives, olive oil, nut butter and seeds, and grass-fed butter.

In the following recipe, I replaced heavy cream for full-fat coconut cream. When spices are added, it becomes a savory delight and will provide a thick and creamy texture.  A simple way to reduce carbs and calories is replacing pasta or rice with a healthy vegetable, such as zucchini “noodles”, spaghetti squash “noodles” or cauliflower “rice”. These items provide more nutrients and fiber to keep you satisfied.

One can purchase a bag of raw cauliflower that has been through a food processor at Costco or many other grocers. Steam it, sauté it or toss a sauce over it or transform into a fried rice with a few additional ingredients. So simple. Similarly, poke a few holes in the side of a spaghetti squash and place it in the microwave for 10 minutes or you can roast in the oven. Allow to cool enough to cut in half.  Scoop out and discard the seeds. Then scrape a fork over the flesh and instant spaghetti-like noodles. Voila!

Beef Stroganoff

    

 

  • 2 tablespoons Kerrygold grass-fed butter (Costco)
  • 2 tablespoons coconut oil, divided
  • 1 large onion, diced
  • 8 oz. white or baby portabella mushrooms, thickly sliced
  • 1 lb. grass-fed ground beef (Sprouts, Trader Joe’s) or steak, sliced
  • 2 tablespoons no added sugar tomato paste (Costco)
  • 1 1/2 teaspoons thyme
  • 1 1/2 teaspoons rosemary
  • 4 cloves garlic
  • 1 tablespoon arrowroot powder (healthy thickener)
  • 5 cup beef stock
  • 2/3 cup canned Trader Joe’s extra thick Coconut Cream concentrate (or the thick cream that floats to the top of a can of refrigerated coconut milk)
  • 1/2 teaspoon sea salt
  • 1/2 teaspoon black pepper

 

In a skillet, melt the butter with 1 tablespoon coconut oil. Add the mushrooms and onions, and sauté until slightly softened and browned around the edges. Remove to a plate. Brown ground beef in 1 tablespoon of olive oil until no longer pink. Return onions and mushrooms to pan. Add tomato paste, thyme, rosemary, and garlic. Sauté’ for about 3 minutes to allow the flavors to develop. Reduce heat to medium. Sprinkle arrowroot powder over meat mixture and stir to combine until arrowroot is completely mixed in. Add beef stock and stir to mix in.

The sauce will begin to thicken as it comes to a simmer. Reduce heat and simmer for about 5 minutes. Remove from heat and let cool for a couple minutes. Stir in the thick coconut cream. Serve over cauliflower rice, sliced zucchini or spaghetti squash noodles.

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Basil Pesto Chicken with Mushrooms and Bell Peppers over Zucchini Noodles

Yields 4 servings

Quick and so flavorful. This Basil Pesto is jarred…what could be easier! And you will have plenty of pesto for several future meals. I used my favorite kitchen tool for this meal, the Spiralizer that I purchased on Amazon (link below). Several zucchinis are easily transformed into noodles. This recipe is low carb and full of healthy fat from the olive oil. Remember, healthy fats are your fat burning friend!

 

  • 1 lb. organic chicken breast, cubed
  • ¼ cup Costco’s jarred Kirkland’s Signature Basil Pesto (freeze remaining in 1/4 cup servings in baggies for another day)
  • 1 each red and green bell pepper, cut into 1” chunks
  • 8 oz. mushrooms, sliced
  • 2-3 zucchini, spiralized (This Spiralizer will turn any veggie into a “noodle”!)
  • 1 teaspoon coconut oil

 

In a small bowl, add chicken and basil pesto. Stir well to coat chicken. Place in refrigerator 30-60 minutes to marinade. Meanwhile, in a skillet over medium heat, sauté zucchini noodles 3-4 minutes stirring frequently. Remove noodles from the pan and set on a platter. Discard the zucchini liquid from the pan. In the same pan, heat to medium to medium-high heat. Add chicken to pan in a single layer. The chicken should sizzle! Watch closely as they will cook quickly, approximately 2 minutes on each side. Flip each piece to brown the other side to ensure even cooking. Remove chicken from the pan and set aside. Lower heat to medium and melt the coconut oil. Sauté peppers and mushrooms until tender. Stir in basil pesto chicken to combine and serve over zucchini noodles.

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Italian Sausage Sweet Potato Bake

 

A healthy grain and gluten- free meal or side dish!  Packed with flavor, this hearty dish features sweet Italian sausage, sweet potato, onion and kale and is topped with parmesan cheese.

 

  • 16 oz. Sweet Chicken Italian Sausage links (nitrate-free, precooked), sliced in ½” round slices
  • 2 medium sweet potatoes, peeled and diced
  • ½ large onion, diced
  • 2 large handfuls of fresh kale, roughly chopped
  • ¾ cup parmesan cheese, finely shredded
  • 2 cups organic chicken broth
  • ¼ cup coconut flour
  • 1/2 cup canned full-fat coconut milk (Trader Joe’s)
  • 2 tablespoons coconut oil

 

In a large skillet, heat coconut oil. Add sausage, sweet potato, and onion stirring frequently to brown on all sides. Meanwhile, add broth and 1/4 cup of coconut milk to a small saucepan. Bring to boil then turn down to simmer. In a small bowl, add coconut flour and remaining ¼ cup coconut milk. Stir together to create a paste. Whisk paste into simmering broth. Once blended, stir in ¼ cup of cheese. Preheat oven to 350 degrees. Place sausage mixture into a small, square baking dish. Pour cheese mixture over the top. Sprinkle with remaining cheese. Bake 10-15 minutes until bubbly and the cheese is melted.

The many benefits of consuming organic coconut oil, coconut milk, and coconut flour:

  • Supports healthy metabolism
  • Supports thyroid function
  • Supports heart health
  • Strengthens the immune system
  • Assists in fat loss
  • Improves digestion
  • Improves skin appearance and elasticity
  • Improves cholesterol levels
  • Assists in killing off viruses
  • Helps kill bacteria
  • Relieves symptoms of diabetes

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Turkey Sweet Potato & Spinach Skillet

 

  • 2 tablespoons organic, unrefined coconut oil
  • 1 1/2 lbs. organic ground turkey
  • 1 red bell pepper, diced
  • 1/2 onion, diced
  • 1 large sweet potato, diced into 1/4″ cubes
  • 1/2 poblano pepper, diced
  • 3-4 cloves garlic, minced
  • 1 teaspoon Italian seasoning
  • 1/2 teaspoon each, sage, thyme, rosemary
  • 1 handful fresh spinach
  • Salt and freshly ground black pepper to taste
  • Optional: your favorite shredded cheese

 

In a cast iron skillet, melt coconut oil. Add ground turkey and cook until no longer pink. Meanwhile, preheat oven to 400 degrees. Add bell pepper, poblano pepper, onion, sweet potato, garlic, and seasonings. Cook until tender. Toss spinach into wilt. Season with salt and fresh cracked black pepper. Add shredded cheese and place in the oven for just a couple minutes to melt the cheese.

 

 

Insurance 101: Part 2

Welcome back to our blog! We hope you enjoyed Insurance 101 – Part 1, which introduced us to some basic insurance terminology. Now that we have covered the basics, today we will talk about insurance and surgeries.

 

Current Procedural Terminology:

This is also known as a CPT code. It is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies, and accreditation organizations. Essentially, it is a set of numbers and sometimes letters that providers and healthcare facilities use to bill your insurance company. Each procedure, medication, or order has a specific CPT code.

For transgender patients treated by Dr. Webb, the most common CPT codes we use are:

  • 58570 – This is a laparoscopic total hysterectomy, also known as LTH
    • This is removal of the uterus and the cervix
  • 58571 – Laparoscopic total hysterectomy and bilateral salpingo oophorectomy, also known as LTH with BSO
    • This is removal of the uterus, cervix, both fallopian tubes, and both ovaries
  • 57110 – Vaginectomy
    • In this procedure, the vaginal mucosa is removed (Look out for a future blog on this subject!)

 

INTERNATIONAL CLASSIFICATION OF DISEASE:

More commonly referred to as an ICD code. ICD codes are updated by the World Health Organization (WHO) every few years, and we are currently using ICD-10 codes. ICD codes are a classification of diseases and health conditions in the medical field.

 

Clinical Information for Gender Identity Disorder: A disorder characterized by a strong and persistent cross-gender identification (such as stating the desire to be the other gender or frequently passing as the other gender) coupled with persistent discomfort with his or her gender (manifested in adults, for example, as a preoccupation with altering primary and secondary gender characteristics through hormonal manipulation or surgery.)

The ICD-10 codes related to Gender Identity are:

  • F64.0 – Transsexualism (As defined by the World Health Organization)
    • WHO definition: “A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one’s anatomic sex, and a wish to have surgery and hormonal treatment to make one’s body as congruent as possible with one’s preferred sex.”1
  • F64.1 – Dual-role transvestism
    • WHO definition: “The wearing of clothes of the opposite sex for part of the individual’s existence in order to enjoy the temporary experience of membership of the opposite sex, but without any desire for a more permanent sex change or associated surgical reassignment, and without sexual excitement accompanying the cross-dressing.” 1
  • F64.2 – Gender identity disorder of childhood
    • WHO definition: “A disorder, usually first manifest during early childhood (and always well before puberty), characterized by a persistent and intense distress about assigned sex, together with a desire to be (or insistence that one is) of the other sex. There is a persistent preoccupation with the dress and activities of the opposite sex and repudiation of the individual’s own sex. The diagnosis requires a profound disturbance of the normal gender identity; mere tomboyishness in girls or girlish behavior in boys is not sufficient.” 1
  • F64.8 – Other gender identity disorders
  • F64.9 – Gender identity disorder, unspecified

 

PRIOR AUTHORIZATION:

Also known as pre-certification. Your physician must obtain prior authorization from your health care provider before prescribing a specific medication for you or to performing a particular operation. Without this prior approval, your health insurance provider may not provide coverage, or pay for, your medication or operation, leaving you to cover some, or all, of the costs out of pocket.

 

Why Do Health Insurers Require Prior Authorization?

There are several reasons that a health insurance provider requires prior authorization.

Your health insurance company uses a prior authorization requirement as a way of keeping health care costs in check. It wants to make sure that:

  • The service or drug you’re requesting is truly medically necessary.
  • The service or drug follows up-to-date recommendations for the medical problem you’re dealing with.
  • The drug is the most economical treatment option available for your condition. For example, Drug C (cheap) and Drug E (expensive) both treat your condition. If your doctor prescribes Drug E, your health plan may want to know why Drug C won’t work just as well. If you can show that Drug E is a better option, it may be pre-authorized. If there’s no medical reason why Drug E was chosen over the cheaper Drug C, your health plan may refuse to authorize Drug E.
  • The service isn’t being duplicated. This is a concern when multiple specialists are involved in your care. For example, your lung doctor may order a chest CT scan, not realizing that, just two weeks ago, you had a chest CT ordered by your cancer doctor. In this case, your insurer won’t pre-authorize the second scan until it makes sure that your lung doctor has seen the scan you had two weeks ago and believes an additional scan is necessary.
  • An ongoing or recurrent service is actually helping you. For example, if you’ve been having physical therapy for three months and you’re requesting authorization for another three months, is the physical therapy actually helping? If you’re making slow, measurable progress, the additional three months may well be pre-authorized. If you’re not making any progress at all, or if the PT is actually making you feel worse, your health plan might not authorize any further PT sessions until it speaks with your physician to better understand why he or she thinks another three months of PT will help you.

In effect, a pre-authorization requirement is a way of rationing health care. Your health plan is rationing paid access to expensive drugs and services, making sure the only people who get these drugs or services are the people for whom the drug or service is appropriate.

If you are planning your initial consult with Dr. Webb and would like to know if your insurance will cover hormone replacement therapy or lower surgery, you can use the information provided in this blog to find out. Call your insurance company and choose the option for coverage and benefits. Sometimes you will speak with an agent and you can provide him/her with the CPT and ICD-10 codes we listed above. The agent should be able to tell you if the procedure(s) is a covered benefit and if there are any exclusions or prior authorization requirements. You also want to make sure there are no exclusions for Gender Identity Disorder so make sure you ask the agent about this.

The insurance agent will likely have limited or no information about pricing for the procedures, but that is something we will cover after your initial consult when you meet with me, Kim. We hope this helps you prepare for your consult, please comment below with any suggestions or questions!

 

References

  1. The World Health Organization. http://apps.who.int/classifications/icd10/browse/2016/en#!/F64.0

 

What should I bring to my first visit with the FTM surgeon?

You will schedule an initial consultation with Dr. Webb in his Scottsdale office to discuss your needs. This visit may just be about starting hormone therapy if you have just begun the transition appointment, or it may be a surgical consult if you have already been on hormone therapy and are ready to begin reassignment surgery.

At this initial appointment:

  • You should arrive about 30 minutes prior to your appointment time so you can complete your registration and paperwork before seeing me. You will fill out paperwork that will include a list of your past medical history, prior surgeries, your current health conditions, any medications you are taking and any drug allergies you have. If you are taking multiple medications, it is strongly encouraged that you bring a current list that includes the names and dosages for everything you are taking. Providing a complete medical history and medication list helps us determine if any pre-operative clearance is needed and helps us schedule your surgery faster and more efficiently.

 

  • You will also complete a HIPAA privacy notice form and a financial policy agreement. You can download the forms on our website or we can mail/email the paperwork to you if you prefer to fill it out ahead of time. We have copies of all this paperwork at the office if you prefer to fill it out when you arrive at the office.

 

  • You will also need a note from your counselor in support of your surgery, or in support of beginning hormone therapy. Your doctor can fax the letter to my office at 480-425-8701. It is best to have the letter sent to my office about a week prior to your appointment to ensure we have received it in time for your visit.

 

  • If you have seen another transgender surgeon and have a future surgery planned, you should bring a letter from that surgeon(s) so that I am aware of the surgery you have planned. This helps me determine how to proceed with surgery and/or treatment that will make it easier for your doctor and any future procedures.

 

  • Bring a copy of your current insurance card and your driver’s license. We will scan copies of both cards for billing purposes. It is very important to inform my office of any changes to your insurance and/or contact information so we can provide you with accurate information when checking your surgical benefits.

 

 

How do I prepare for surgery?

If you are planning either a hysterectomy, a vaginectomy, or both hysterectomy and vaginectomy:

  • Follow the above instructions for your initial consult.

 

  • Bring a letter from your counselor in support of your surgery. You may also have the letter faxed to my office ahead of your scheduled appointment.

 

  • After the initial consult and the decision to proceed with surgery, you will be scheduled for a pre-operative appointment in my office. You will see my RN and me to discuss the details of your procedure, preparation for the night before surgery, and what you can expect during your recovery. At this appointment, you will have an opportunity to discuss the details of the surgery and any questions that you may have.

 

  • Please feel free to bring any family or support members to any of your appointments in my office.

 

  • If you smoke, it is best if you can quit before surgery. Smoking can delay your healing time after surgery.

 

  • You may need to stop some of your medications 10-14 days before surgery. If you are traveling from out of town, you may contact Kim, my surgery scheduler, if you have questions or concerns about which medications you need to stop prior to surgery.

 

  • You may contact Kim regarding your travel and hotel needs. We are working with some of the hotels near the surgery center and can help you find a hotel that is convenient for you.

 

  • Do not eat or drink anything for 8 hours before your scheduled surgery time.

 

  • For a hysterectomy, you do not need a bowel prep. If a vaginectomy is to be performed, we will instruct you on a bowel prep at your pre-operative appointment.

 

 If you have any other questions or comments, feel free to leave a comment below! You can also contact Kim, who can be reached by phone at 480-291-6348 or by email.

 

 

What should I consider when looking for an FTM surgeon?

Picking a surgeon to perform your lower surgery can be challenging and it is very important to do your research before selecting a surgeon. You should choose a surgeon with at least 10 years of experience performing lower surgeries. The surgeon’s surgical training is also extremely important. Many gynecologists may perform the surgery, but very few have the expertise and reputation that is earned from years of experience performing the surgeries on transgender patients.

It is optimal to find a surgeon that is sensitive and aware of the specific needs of a female to male transgender patient. It is best to also have staff at the surgeon’s office that are available for questions and to help you schedule and prepare for your surgery. You also want to select a surgeon and surgical team that can work with your transgender surgeon that may be performing other surgeries at a later date.

You should also find out some information about where the surgeon operates and has privileges. Make sure that the surgeon is affiliated with a credentialed hospital that is able to provide overnight care for your hysterectomy and vaginectomy.

Also, inquire about the post-operative care the surgeon offers and if the surgeon will be available to you after your surgery, while you are recovering. All these criteria will help ensure you get a skilled surgeon that is able to achieve a successful surgery with minimal complications during your recovery period.

Why should I come to Scottsdale and choose Dr. Webb as your surgeon?

  • Webb has more experience performing the laparoscopic hysterectomy and vaginectomy procedure than anyone else in the United States. He also has more experience doing these procedures together than anyone else in the world.
  • Webb’s procedure has a lower complication rate.
  • Webb has an excellent, experienced team that he works with to perform the hysterectomy and vaginectomy. They have many years of experience working together and they use the most advanced equipment. No other doctors outside of this team are necessary for this procedure, so costs are lower.
  • Webb and his team will take care of you from the initial consult all the way up until you are ready to return home. They will provide you with personalized service and a warm, friendly atmosphere, from the Surgical Center and at his office.
  • You will meet with Dr. Webb before the surgery to answer all your questions and address any concerns you may have about the procedure. He will also have you schedule a post-op visit so he can see you before you leave town, to ensure you are doing well with your recovery process.

If you have any other questions or comments, feel free to leave a comment below! You can also contact Kim, who can be reached by phone at 480-291-6348, or by email.