Alexandra

Barbara!! You cheated!!

Hi Kasey, If the insurer covers the banding, they should cover the fills through at least the first year. Adjustments are a required part of the surgical followup routine for this surgery. That said, I don't know what the actual CPT code is for fills--there may not even be one yet because the practice varies so much. For example, there's a whole different pricing structure for one done in an office as opposed to one done in a radiology lab. Have you asked your doctor about this? If the surgical practice has done more than a few bands, they should know the ins and outs of insurance coverage for fills as well.

Jodie, I've got a couple of things to say. First, you may want to edit your letter here on the site to remove some of the personal identifying details. If you want me to do it or help you I'll be happy to. The text of the letter is excellent, but it's a lot of personal information and someday you may regret making it public. Secondly, you MUST get some Protein in! If today's menu is typical, your body is starved of the nutrients it needs to get healthy and stay that way. Overweight or not, fruit popsicles and crackers are NOT the basis of a nutritious eating plan. Last, I hate to burst your bubble (such as it is), but it seems that several things you're suffering from are not weight-related at all and therefore may not be helped by weight loss. I'm not saying they won't be--almost everything looks brighter from a lower weight--but chronic fatigue syndrome is not a result of being overweight. The time to take charge of that diagnosis is now, not at some future date after which you'll have a band. I'm sorry to be a wet blanket, but if you're fighting an employer's exclusion it's the employer who will have to make the decision. I hope you're appealing to them as well? United Healthcare simply has the employer's contract to fall back on and has no obligation of any kind to provide services the contract doesn't cover. I hope your days are brighter than they sound when you post here. The good news is that you're so young and have so much going for you in terms of smarts that I know you will prevail before too much longer. But for now the point I'm trying to make is that obesity surgery is not going to be the miracle cure you are hoping for even if you do get approved; it's a slow process and so is healing from the damage done. There are other ways to address your current challenges, and one of them is getting more protein!!

Absolutely the normal protocol is to not give any fills until at least 6 weeks out. I'm very surprised that an American doctor would take a different approach, but I guess that's their prerogative. At six weeks the patient will be on solid food and will be able to really tell how much of an appetitie s/he has; soft foods will move more quickly through the stoma and therefore won't give a correct idea of how the band is working. I know my doctor's practice has people stay on soft foods through four weeks postop in order to guarantee the best possible chance for complete healing before solid food is introduced. Cyndel, you are absolutely normal! Lots of people gain a little before the first fill. Please just try not to get too hungry; concentrate on finding protein-rich foods for Snacks because they will help you stay satisfied longer. Your fill will come soon enough and then you'll be on your way!

I have a theory about this. Restriction is a function of the band's adjustment, AND the response our stomachs have to it. I think that on the day of an adjustment the stomach wall thins out in response to the additional pressure. It takes different amounts of time for different people, but after some period of time the stomach wall may return to its original thickness, with the effect of increased restriction. That's just a guess, but so many people report fills "kicking in" after some period of time that there must be some physiological explanation for it. Why not mine?

Hi Cindy, Hi and welcome to LBT! I'm sorry you're having these problems. You're still very in early days, though, and your difficulties may still be attributable to healing and post-op sensitivity. Many people are still, at this point, on a mushy-food diet. If you're already on solid food your body may be telling you it's not quite ready for it. I had the same experience with food the first few times I tried it after the liquid phase, so you're not alone. My approach was to back off--the doctor's instructions are important but if my body wasn't ready, it wasn't ready! If you have any difficulties at all it's probably a good idea to stick with really soft foods until you're completely over the problems. And you don't really need a fill, not yet. MOST doctors won't even consider giving the first fill until at least 6 weeks out from surgery to be sure everything is all healed up nicely. If you're hungry, go ahead and take what you need to not be hungry. This period is about healing, not weight loss. If you were only banded three weeks ago you may still have healing to do; there's plenty of time to think about getting a fill after you're comfortably eating solid food.

Jodie, do you have a medical condition other than being overweight? Is it being treated? How long have they had the application at this point? YOU may think they have everything they need, but until they confirm that you just don't really know. Do give them a call and make sure. I know from experience that one tiny piece of missing information can screw up the whole thing if someone at the carrier decides it's required before they can proceed. Your 3-page letter is only ONE element of the whole file. Make sure they have whatever it is they want so they can get to making their decision.

Congratulations, Lisa Marie! I well remember that day when the approval came through, and all the fabulous dreaming turned into scary reality. But this is what you wanted and were waiting for, so it's time to get ready!! You may be apprehensive about getting back on to solid food once you're through the liquid phase; many people are. But you'll be amazed at that point at how well you feel, how your stomach feels perfectly normal, and that you're HUNGRY, and your fear will recede. Believe us, it all takes just a little time and practice. You'll do fine! :D

There's more to deciding whether a fill is in order than just whether you "can" eat a certain amount. When you get that first stop, you should really try to STOP eating and sit and feel whether you are really still hungry. Just because you are physically able to eat more is no reason to do so if you are no longer feeling hungry. If you get in that habit you may end up pouch-packing without even knowing it, and short-circuiting the signals that are telling you you've had enough.

Sue, what a wonderful post!! It's thrilling to see confirmation that the band can help those who are able/willing/committed to help themselves. Congratulations on all your wonderful success, and may there be many more years of enjoying life in the normal sizes!! :D

Kellie, quitting smoking is the hardest thing a lot of people ever have to do. But I'm here to tell you it IS possible, and once you're over these early days and the cravings have subsided, you will wonder how you ever could have done that to yourself. If you care enough about yourself to undergo banding surgery, you MUST care enough about yourself to quit smoking. In a few more days or weeks, you will start to notice the benefits of no longer polluting your respiratory system with smoke. You'll be able to breathe, smell, and taste better than you ever could before. Your clothes will start to smell like clothes, instead of like tobacco. And the day will come when you really DON'T want a cigarette at any time. Stay with it, girl, it really is worth it, and SO ARE YOU!!!

Fee, once again everyone's insurance is different and there are lots of reasons a carrier might not want to cover this surgery. Some plans simply flat out exclude coverage for obesity treatment of any kind. Some others exclude obesity treatment, UNLESS the patient has a diagnosis of morbid obesity (that is, a BMI of 40, or 35 with comorbidities), so proving that diagnosis becomes key. Yet other carriers will cover bariatric surgery, but only certain types--some consider the lap-band too new to be a covered treatment. (It was FDA-approved in the U.S. in 2001, and some carriers wait another 5 years or so before adopting new treatments in their covered benefits.) What is your situation? Do you know if your carrier will cover the surgery?

Jodie, where do things stand with your insurer at this point? Are you certain they have all the information they need to make a decision? There is NOTHING worse than waiting and waiting only to be told after a month that one document was missing. Stay on top of them to make SURE they are not missing any pieces. Once the file is complete they really can't take more than 30 days to make their determination.

Hi Fee, Everyone's insurance is different and there are many reasons you might have some out-of-pocket expenses. For example, if the doctor, hospital, or even the anaesthesiologist is not in your network you may have some out of pocket charges. In addition, the nutrional and psychological evaluations are often not covered by insurance at all. Your plan may itself have co-insurance and copay features that amount to a significant charge. If your doctor's office is, however, charging for additional services over and above the surgery and related services itself, they are very likely to be optional. Check the fine print and see what exactly you're being charged for and whether you have control over those expenses.

Everyone's experience with adjustments and head work is so individual that generalizations are pointless. I think the key is going in with a realistic understanding not only of what the band will and will not do, but of our own expectations of ourselves. Personally, before being banded my biggest concern WAS the long-term reality of living as a banded person. This is what I knew would be the hardest thing for me. Zoe, I know EXACTLY what you mean when you say "I think I have Lap-Band fatigue. I'm fed up with all the chewing, and I'm kind of bored with all things having to do with the band." I knew that would happen, and it has indeed, more than once. But that just means we're transitioning into the long-term life of a new normal. My old normal was not working for me, so I'm thrilled about this new normal. That doesn't mean I'm thrilled all the time about the fact that I will never again be able to chow down a giant sub, or that I have to carefully watch my behavior to avoid nighttime reflux, or that even healthy food like fresh pineapple can cause problems if it's too pulpy. But the alternative is a path that will very likely lead to a regain of 100 pounds so I am NOT willing to go there. Paula, I actually carry around my before pictures to remind myself where I came from. "Are you still losing?" is a question I get a lot, and I did have to learn to just ignore it. At this point I know exactly what I'd have to do to lose more weight, and I'm not doing it. That's my choice. Frankly, I don't want a day to come when I've reached some arbitrary number and say "I'm DONE!" because I know I will NEVER be done. Managing this disease for me has to mean a permanent approach, and one that does not include agonizing over a few pounds here or there. This is an excellent question to ask ourselves. But there's another option: If you lose only half of what you say you want to lose, will you be satisfied there? The answer really will tell us something about what we expect from surgery. Of course, the answer may change if and when we get there, and that's OK too. I asked myself this hundreds of times before being banded. Surgery seemed like such a huge step and the statistical predictions weren't very encouraging. But I knew that a life maintained at a weight of 250 would be a very different life than the one I was living, where 340 was the new "low" and it was only up from there. So that was my "goal," just to have a healthier weight and a possibility of a future with more control over my weight. And I'VE GOT IT, and more. The band is a disappointment for some, but IMO it's because their expectations are unrealistic. Real issues with emotional eating or psychological "demons" are not going to be addressed by the band or any weight-loss surgery. But for people who just want negative behavioral reinforcement, the band does a wonderful job. It's given me exactly what I needed, no more, and no less. I am not a size 8 because I am not willing to make "dieting" my life's priority, though I don't discount that possibility in the future. For now, being able to keep up with my kids and fit into theater seats and wear normal women's sizes is more than I could have ever wished for.

Hi Loopylou, I can't answer the question about flying, but bingeing behavior is something you will need to take a close look at. Banding will provide LOTS of negative reinforcement against that behavior--if you eat too much or too quickly the food will have to come back up simply because it cannot go down. But that's not true of ALL foods; soft foods like pudding or ice cream can usually be consumed in preband quantities if we want to. The worry is not so much that you're going to damage your band or stomach--although repeated overeating can result in an enlarged pouch or slipped band--but your emotional attachment to food may prevent you from really accepting the new behaviors the band forces upon us. Any weight-loss tool can be sabotaged, so you really need to work on the emotional aspects of overeating as well in order to get what you need from the band. That said, your "I am hoping that the band will make me slow down and have to stop much earlier" is exactly what I used to say. I didn't bolt my food out of emotional needs, just long habit, but the effect is the same. And YES, the band helps slow me down and makes me stop eating long before I would have otherwise. Yet it's up to ME to be satisfied with that early stop, and to realize that my band is controlling my portions because I have proven unable to do it myself. Learning how to do that took time and acceptance, and a determination to find other things to do when my brain still thinks I should be eating. The physical barrier to overeating does nothing for overcoming the mental or emotional drive to eat more than we need, and that's the "head work" we all have to do. It can be done, indeed, but it's not something that happens overnight.

Part of being banded is learning about a new kind of "full" and how it feels. You're correct in thinking that the key is to chew better so that things don't get stuck, and when you do that you'll be able to eat solid proteins and healthy foods with no problems. There will come a signal, when you're eating, that one more bite will be one bite too many: that signal varies from person to person and often we don't recognize it until after some trial and error. But the point is that even when you're eating carefully you will get full on way less food than before. If your band tells you to stop eating, then STOP EATING and feel what that sensation is in your stomach. That sensation is FULLNESS, even though it may feel different than the Thanksgiving-meal-stuffed feeling you may have been used to. The whole point of being banded is that it trains us to feel satisfied on less food, but that training takes our cooperation. You're still at the very beginnings of the learning curve; restriction is something we learn to love over time. Your current fill may not have provided enough restriction to really produce the feelings I've described above, but you are on your way. So take it slow, chew carefully, and really do try to listen to the new signals your tummy is sending you. There is a LOT less room in there than there used to be, and your job is to be aware of what it feels like when there's enough food in there.

My doctor's practice is one of the busiest banding practices in NJ, and they have been doing it since 2000 when they were in the FDA trials. They do ALL of their fills under fluoroscopy in the radiology department, because it allows for precision adjustments. In fact, just this week Dr. Abkin has been handing out a copy of a published article stating that better results are being shown when adjustments are done this way rather than "blind" (i.e., in a doctor's office). It may be expensive, but the upside is that fewer fills will likely be needed since they can actually SEE what effect a certain amount of Fluid has on your band. It's definitely worth it.

Soy milk has all the benefits of milk without the animal fat. That's basically why it's touted as being a wonder food. I'm not convinced, though based on DeLarla's experience I might just have to taste it. I've been repulsed by the very idea of soy "milk" for years! I don't drink that much milk as a rule, so I don't think there's any big benefit from switching from my 1%. (Possibly my disinterest stems from MY powdered-milk days, courtesy of a non-custodial dad who never kept fresh milk for visiting children. I remember pouring mine off a 26th-floor apartment balcony!) Plus, there's some indication that in people with hypoactive thyroids soy is counter productive. (Off to read the other thread on that subject right now...)

Hi Lisa, One thing you can start doing is working on your diet history. Most doctors and ALL insurance carriers require evidence that surgery is the last resort, so they all ask for a history of diet attempts. See if you can come up with a chronological list of the programs you've been on, how old you were at the time, how must weight you lost and when/whether that weight came back on. You can also ask you PCP's office to comb its records for notes on visits where your weight was discussed, and if there aren't any make that appointment now! A letter of support from your PCP will also be needed, so maybe you can do a draft of such a letter they could use. I know it's nerve-wracking! I attended my seminar three years ago this month. It's amazing how time flies!! Which doctor are you contemplating?

Yep, I agree. It's reflux. The very definition of reflux is just material coming up through the esophagus instead of going down, and it can happen to us when we're lying down and especially when we're sleeping since the muscles relax that normally keep food/fluid down. And gravity works against us too. Just because you have no discomfort from food before going to sleep does not mean it's not going to happen. Your pouch really has to be empty, so try not to eat or drink anything for 3-4 hours before going to bed. But you probably need a slight unfill too, if that doesn't help.

Sorry, DeLarla, I know nothing about Corti-slim or anxiety, really, at all. Did it help you eat less?

I had surgery on an outpatient basis on Wednesday and was back at my desk job on Monday. No worries.

I'm in Morris County, NJChick. So who did you decide on for your surgeon?

This is very interesting, Jodie. I'm sure we've all felt a bit insulted or ignored from time to time in ways that probably relate to our weight. But I would caution us to be aware that outright discrimination is a different animal. I can't say I've ever felt truly discriminated against in any meaningful way, and I've been significantly overweight all of my life.