GeezerSue

On another board, a frequent traveler has spent more time in ER's than in vacation hot spots. For any other lurkers...a willing radiologist (so there's an MD on board and for fluorscopy if needed), AN ONCOLOGY NURSE (because more than any of our doctors SHE can find the port) and noncoring Huber needle are your best bets for getting a well-executed unfill.

Just adding that the DS does not cause dumping. More poop every morning, for sure...but not dumping.

Melanie...let me rant for a moment about RnY. It is--after the first year or so--mostly a restrictive surgery, just like the band. I decided that since the most I ever lost with the band was about 35% of my excess weight, it would be the very definition of insanity (FOR ME) to do essentially the same thing and expect different results. That's why I went for DS (FOR ME). I know that Jossart is listed as a DS surgeon in SF, but so is Kaufmann in LA. Yet, Kaufmann essentially ignored my requests for the DS (and was a rude and arrogrant little twit in addition.) He said that banded with a BMI of 48, I "wasn't heavy enough" for the DS and tried to get me on board for the RnY. I am SO glad I went elsewhere. I am seven months post-op...I'm a "slow loser" because I'm not particularly compliant (revisons can be that way since we go into surgery #2 with attitude) and I'm down somewhere around 86 pounds, WHICH IS ABOUT 60% OF MY EXCESS WEIGHT!! I was back into 2X's and 3X's pre-op. I'm losing all over, but my belly was the biggest, so right now I fit best in maternity pants for the extra room at the waist. I wore a pair of Gap size 14 maternity shorts to go to an activity at the beach last week. So I have CLOSE TO a size 14 ass and thighs. Good luck on YOUR decision, but don't go for any surgery YOU are not convinced is right for YOU.

I've had most of them...at least the band and esophagus parts. But I regained my way back to MO. So, I had problems secondary to the band, which meant that the band had to go...and I qualified for wls. (My band had been self-pay in Mexico.) I think that you need to at least find out about the entire appeal process available to you...how it works and how to make it work to your advantage.

You go, Penni.

Jack, the RnY leaves about a 1-2 ounce stomach...a shotglass, more or less. RnY depends on SOME malabsorption even though with that tiny stomach it is a primarily restrictive procedure. The DS leaves a 4-6 ounce stomach, so it depends on SOME restriction, but is a primarily malabsorbtive procedure. (Both of those stomachs stretch over time, leaving the RnY person more dependant upon the good habits s/he will have formed during the first 18 months or so. The DS person will have lifelong malabsorption--and all the related plusses and minuses...she says as she swallows Calcium tablet #2 of the FOUR she should have taken today.)

OLD (previously-)banded person here. When I first started looking, Quebbeman had done about 30 bands and Cedars was the only other local option. To me, everyone else is still a "newbie" at this. Even other surgeons mention that Quebbeman is arrogant...pot-kettle? (I haven't met him, but I even found his office staff to be arrogant. And I'm USED TO Newport-Beach-caliber-arrogance, where he used to do all his surgeries.) I have found Cedars to be a monumental bureaucracy but once you get through the phone games and the who-calls-whom-back BS, the people have been very nice. I've never met Dr. Billy, but he is the MOST responsive US doctor I have encountered locally (although--obviously--Pleatman and Curry are responsive, even to the patients of other surgeons and pre-ops), and Billy's staff is very kind, as well. Like most wls practitioners, most of the locals do more than one procedure. LET ME OPINE HERE, BASED ON YEARS OF EXPERIENCE. Yes, you need a skilled surgeon, no doubt about it. Fifty band placements would be my absolute low-end cut-off. However, the band--unlike the other WLS-types--is mostly about the aftercare. (I'm currently seven months out from the "huge, life-threatening, organ-rearranging" DS surgery. I've seen my surgeon maybe three times since he pulled the drains a week post-op. With the band, by seven months out, I had already had about five adjustments and I had many more after that.) SOME people get the band and walk away, needing nothing more. MOST need several adjustments. SOME need many adjustments. A good surgeon can figure out which is which, so it's all about the aftercare. There are many surgeons who can properly place the band...but then they have NO IDEA what to do with the patient and her problems post-op. (Also, just my personal observation, but I think surgeons go into to a surgical specialty because they like doing their magic on people who leave them alone while they do it, having a follow-up to make sure it worked, and then moving on. At the risk of being rude to any surgeon reading this, I suspect that having the patient out cold is a job perq... The "counseling" part of LapBand follow up is NOT something most surgeons have trained in...probably because it just doesn't appeal to most of them. Submarine captains and aircraft fighter squadron leaders are good at what THEY do but would probably not do well exchanging jobs.) Now, about hospitals. Yes, both Kuri and Ortiz NOW practice in lovely hospitals...or so I'm told and I believe the people who are telling me. But, from what I've read, there is NOTHING in Tijuana that even vaguely resembles the many teaching--and other--hospitals we have at our disposal here. (That is why I went to Monterrey. I got Rumbaut's experience and a teaching hospital. Someone wrote that the hospital Rumbaut uses is where a US president who became ill or injured in that part of the world would be taken. But I haven't checked out that claim.) I had one guy in Brea who wouldn't do an adjustment without endoscopy. (ka-CHING.) At UC Irvine, the surgeon and staff were very comprehensive in everything but what I needed. That is, as I described the difficulty and the weird sensations, all they offered was that I come to a support group meeting so that I could hear from others how the living with the band felt. (This was after I'd HAD the band for three years and had been "successful" and then started having strange sensations and regaining all the weight. I KNEW how the band was supposed to feel. It HAD felt that way and then it started feeling DIFFERENT than that...and they--except for an on-the-ball-radiologist--could not diagnose the esophageal dysmotility I was having. Ya know...if I were doing this again (which I would not, but that's not what you asked)...and if I lived where you do...I'd probably go to Rumbaut (in Monterrey) again for his experience and the quality of the hospital and to Kuri (in Tijuana) for follow-up. The back and forth across the border is a PITA, but from your location, it's do-able. And Kuri almost never leaves town, so he is available for your emergencies. But I would call Dr. Billy first and see what the price difference would REALLY be. Good luck, Sue

Because I didn't want to go from one bunch of rules about what I "could" or "couldn't" eat to another, and because of other issues, I opted for the DS surgery instead of RnY. So did Rachele. Others have had RnY and VG. Learn all about ALL of the surgeries, pick the one that's right for YOU and fight for it if need be. Good luck, Sue

I live in Southern California and have been on several boards for about four years and was unfamiliar with Callery's name. So I looked him up on OH. Do you know how many lap bands he has actually done? That is a VERY important to your future success with the band. It's all about follow-up and and RnY surgeons tend to become a little frustrated with band patients who need far more ongoing support than bypass patients. It's a whole different ball game than the bypass and a surgeon who is used to bypass patients may find a band patient to be far too time-consuming. Also, I asked because the comment about not leading a food-centered-life kind of concerns me. It isn't about the food. Not really. It's about self-soothing and self-medicating and taking care of ourselves in the best way we could at the time...which was food. It's no longer a good way to get through the day, but it did serve a purpose. People often THINK it's about the food and stop with compulsive eating...and take up compulsive gambling or excessive drinking or compulsive shopping or way-too-may-sex-partners...or they even become trainers and start exercising in a compulsive way. Don't misunderstand, I'm not saying anything negative about his skills...I have no idea what they may be. But surgeons in general tend to have a "let's fix it and get out of here" kind of approach as opposed to...say...psychologists, who want to talk about everything. And the band is all about follow-up and our eating problems aren't really about food. They're more about dealing with life. I've corresponded with hundreds and hundreds--maybe more--of banded people over the years and I don't think I've heard of more than one or two who had a "losing too much" problem. And THEY simply substituted one eating disorder (compulsive eating) for another (bulemia.)

I had relfux with the band and I had my gallbladder. When I had the band out and got revised to the DS, the gall bladder was removed as a routine procedure. I had a few weeks of reflux but then it went away. So I had reflux WITH a gall bladder and a band and no reflux WITHOUT a gall bladder and band.

Don said that the cure part was a kind of easy guess. The band provided one more "hoop" for the acid to "jump through" on its way to the esophagus where it causes trouble. As far as the cause part of the equation, there was no generally accepted reason. Maybe there is now. Sorry!

The Centers of Excellence thing can be a real rip off. And far from excellent in some cases. For comparison purposes though, I thought you might enjoy the following billling I received for a fill for in 2004: They billed a total of $1573.07 I paid $251.30 (but they later refunded me $42.96) Insurance paid $637.54 So, some of the prices in this thread sound like a real bargain to me.

Generally speaking, the band can CURE reflux (GERD) for those who had it pre-op and CAUSE the problem in those who did not. (That info was from Don Mills about 3.5 years ago, when I suddenly started having reflux, about six months post-op.)

From the other side of the street...yes, lots of "totally committed" people have had problems and/or complications and had the band "not work" for them in one way or another. Check out the http://lapbandtalk.com/forumdisplay.php?f=78 and http://lapbandtalk.com/forumdisplay.php?f=79 Most, if not all, of these people were as committed as can be. If you really have spent a year "...seriously trying to get it off (limiting my food intake, exercising more, and drinking more water)..." then you might want to look into the other surgeries as well. BECAUSE, the band will help limit your food intake and the excerise and Water will still be your responsibility, but if doing those things have not worked for you without the band, I'm not sure why we would expect the band to change your results. It COULD improve on your limiting your intake...but only if you don't go for finding some other way to eat to your satisfaction. But since there is no malabsorption, that's about it. ON AVERAGE, the typical banded person who needs to lose 145 pounds will lose about 90 pounds. Some will lose all 145...some will lose nothing. A few may even lose MORE than 145 and a very few may even gain weight. Make your decision based on as much information as you can gather. Good luck. Sue

"...that people with H Pylori are never in pain. " Interesting comment. The bacterium h. pylori (aka helicobacter pylori) was discovered about 20 years ago by a couple of Aussie doctors who were NOT gastroenterologists. One of them--Marshall, I think, infected himself with the bacteria, got diagnosed with an ulcer, and then cured it with antibiotics to prove his point. I remember when he was on the talk show circuit...a funny little guy. I think they won a Nobel Prize in medicine...and they were NOT popular with the gastro-guys because they were "outsiders" who accidentally discovered the cure to the most prevalent problem in that field. (Smart-ass outsiders...) Anyway, h pylori and pain are FREQUENT companions. I don't know how many people scream in pain--but we all have different tolerance levels. I know that my brother-in-law (who wouldn't listen to his smart-ass sister-in-law) felt that HIS ulcer could not be cured with antibiotics and so he didn't try that approach...for another fifteen years. The man was awakened by the pain every night for fifteen years. H pylori and pain are OFTEN found together.

I have a question on the possibility of a later conversion to DS and/or the two-stage thing. The DS stomach is about 4-6 ounces. The RnY--and apparently the VG--stomach is only 1-2 ounces. The RnY is primarily restrictive with a malabsoption component. The DS is primarily malabsorptive with a restrictive component. The two-stage DS is the larger (4-6 ounce) restrictive part done before the malabsorptive part is done. Soooo...what happens when the patient has the teeny (1-2 ounce) VG stomach and needs to have the malabsorptive part added? I'm asking because it's hard to get in all the nutrients we need--considering that a large percentage of some of those nutrients pass right through the body without their calories or fat or nutrients counting--with a 4-6 ounce stomach. If, for example, I could eat only 1/4th to 1/6th of what I now eat, (I'd be crazy, but let's not go there right now), isn't malabsorption a dangerous thing to add to so limited a capacity for consumption?

As someone who HAD cervical cancer and a "modified radical hysterectomy" at age 30, I think anyone who DOESN'T insist their daughter have it--early--should be considered to be endangering that child. Things have improved in the past 30 years, but it was NOT a pleasant experience.

Yup...great surgeon and a real mensch. I didn't know he had moved his office. He USED TO pop out to the waiting room and eat band-friendly Snacks with patients' families between the surgeries...

We live at the beach (cheating!!) and we use the pool...a community pool. We started by just walking back and forth in the Water. Eventually we started swimming. Actually, water exercise is best for many people, especially the MO who might hurt their knees and such...I'm one of those. Do you have Y nearby with a pool?

Jeanette, That isn't a complication. Go back and read all the "stickies" about what to expect. Has your surgeon not provided information for you? http://lapbandtalk.com/forumdisplay.php?f=17

To THIS semi-lactose intolerant old lady, 16 ounces of milk is my WEEK's supply of what goes in my coffee. (I don't use it in any other context right now.) So, "moderation" can be very subjective. (I would be SOOO sick on 16 ounces a DAY.)

First, what Alexandra said. Then, no matter how people try to justify their actions, for me, it boils down to this: people either honor the agreements they've made in life or they just want everybody else to honor their agreements. In life, I try to avoid those who don't care for honoring their side of agreements. Also, the people I most often see (on another board, in particular) willing to "nudge" the facts are those who consistently support politicians who want to give MORE latitude to insurance companies and fewer services to the insured. If people want fully funded health care, they should pay attention to who they're voting for. (We have friends, a doctor and family, in Denmark, who are AMAZED at our low taxes...and WE are amazed that we PAY for stuff they receive as subsidized government services. We can either PAY for medical care in cash or we can PAY higher taxes which will cover that care...nothing is free.) Further, lots of people with BMI's between 30 and 40 have had LapBand surgery in this country. They just paid for it themselves. And, kind of like Alex said, no one is keeping them from having life-saving surgery, because they are not (yet) in a life-threatened situation. They're just being kept from having their elective surgery for a problem that is NOT (yet) life-threatening paid for by a policy that doesn't cover "elective surgery for a problem that is NOT (yet) life-threatening." And I went to Mexico and paid cash for the band...before anyone asks. (The DS was done in CA and insurcance covered it.) Sooo.. in general - is it ok to "nudge" the system this way? No, it's insurance fraud and the people doing it are actually criminals. Is there anything wrong with doing it? Yes, it's insurance fraud and that's a crime. What's the line between what's "ok" to nudge, and what isn't? If your weight fluctuates right on the borderline even on days you're NOT being weighed by the doctor..by all means, skip the diuretic that morning. Or eat Fritos the night before. And if you gain eight pounds every month with PMS, by all means, schedule your appointment for when you're having PMS!! But once you start LYING about your height and putting weights in your clothes, you are commiting a crime and I, for one, wouldn't mind watching you pay for that.

I have heard that Blue Cross of CA won't cover LapBand for BMI's over 50. I'd ask Dr. C to chime in on the enlarged liver part.

I think they use papaya enzymes. I never wanted to go in that direction, as I felt that my esophagus and stomach were ALSO meat...and I didn't want them tenderized. Just "my weird."

I got the band, kept it three years and then had it removed and got the DS. I would not have been happy with the bypass...mostly for the same reasons the band was not a good "match" for me...although the "match" wasn't the only reason I had it out. I don't think there is anything inherently "wrong" with any of the surgeries...it's just a matter of what works best for each of us. I'd rather hear an argument about why a given surgery was RIGHT for someone than what they think is WRONG with the other surgeries...because what's right and what's wrong depends on the needs of the person doing the choosing!! (Age, how long MO, other co-morbidities, current BMI, psychological health, history of other eating disorders or compulsive behaviors, reasons leading to obesity, likelihood of complying with follow-up and other things should all be considered prior to choosing a surgery. And with all that to consider, OF COURSE there will be different "best" answers.) If I had had the DS three years ago, I'd have been through the weight loss part already and that would be better than starting at Square One all over again, like I've had to do.