GeezerSue

When you look at the big picture (not those individuals who did well or did poorly), two to three years out, band and bypass people have the same general %of EWL. I do not want a bypass because, other than bypass patients, there ARE no animals whose mouths are bigger than than their stomachs. It's 20 cc's--four teaspoons--two saltine crackers. It's just, for me, an incredibly bizarre way to live...especially when the band will take you to essentially the same place. Cornell University just published (small group, but the DS is a more complicated surgery and there aren't that many surgeons or patients) complaring their Rny stats with their DS stats. The DS produced the highest percentage of long term weight loss.

A better guide to how people do overall is in the medical journals. I'm one who has regianed all of my weight, due to having all the saline in my band removed, due to damage to my esophagus and its functioning. I don't think the band is a BAD chooice, it just was not the right choice for me. I'm having the DS surgery. (BilioPancreatice Diversion with Duodenal Switch.) As you research, don't fail to check that surgery as well. Good luck with your choice! Sue

Hi, again. Rachele! How about you looked into DS because of me, but have decided to go with it on your own? Otherwise, I'd have to stalk you all the time because I'd feel totally responsible. Anne, generally, an unfill improves the dilatation. I think my dilatation is due to the dysmotility. Physics. (If it isn't in the stomach and doesn't come back up, it has to be somewhere.) I *THINK* the food will actually have a bigger place to land with the smaller stomach than it does with the band's "upper" stomach, but I'm not sure if that will cure the problem. Desertmom, the "success thing" is touchy. For ME, losing about a third of my excess weight was a good thing, but it didn't stay lost without causing me complications. For others, losing half of their excess weight is fine. (I have an age factor involved here, too...if not now, WHEN?) But, you are right in that--more and more--the literature refers to a sustained loss of 50% of excess weight as a success for bariatric surgery...and I want more help than that. But re smelling the roses...Blue Cross of California is no longer authorizing the band for patients with BMI's of =/+50. That's based on the math that a 50% excess weight loss for higher BMI people will leave them MO...and the comorbidities that exist DUE TO MO will continue to exist..which, to their bean counters, means that banding for BMI's of 50 or above is not enough bang for the buck. Desertmom, I'm hearing that you feel that the band was a WRONG step for you, in that you are taking the "blame." STOP!! It was the FIRST step. It was a conservative effort to rid yourself of excess weight without slicing and dicing your innards. It works (regardless of who is defining that word) for a good number of people and there is no reason to be blaming anyone--including yourself--for that choice. (My DS surgeon says that so many come to him for revisions and are blaming themselves for "failing" their first surgery, whatever it was. That garbage gets in the way.) Think of a troubleshooting flow chart. I use a Mac computer. If it gets hung up, I try to stop the procedure in progress (the diets, gyms, pills, shrinks, etc.). If that doesn't work, it's time to "force quit" the program (Band). If that ever fails, it's time to force a quit and restart of the computer (bypass or DS). Am I an idiot for not trying to quit the program (bypass or DS) at the first sign of trouble? I don't think so. I think it makes all the sense in the world to take baby steps. Again, thanks to all for the support. Sue

Wow! What wonderful support. •The band, as you know, is restrictive only. It can limit the amount of solid food you can eat at one time. •The RnY, (and I'm biased, so ignore me if you're wise) is both restrictive (the stomach is reduced to 20 cc's--4 teaspoons) and temporarily malabsorptive (after about two years the remaining intestine "learns" to absorb much of what the missing intestine used to absorb. That's when the weight regain begins. To me, it works like a kind of non-reversible band. •The DS is also a little restrictive (the stomach is reduced to 4-6 ounces) but it remains malabsorptive forever. So, the DS has the highest percentage of long-term excess weight loss...and the highest number of risks, including long-term metabolic stuff we don't even know about. OTOH...my 60-year-old cardiologist and I were discussing that the promise of long-term ANYTHING, when you are 60-ish and morbidly obese, is not necessarily a bad thing. Here's a link to a site started by a DS patient: http://www.duodenalswitch.com/index.html And here's a mention of some research at Cornell: http://global.med.cornell.edu/news/wcmc/wcmc_2005/10_14_05.shtml If anything I read made an impact, it was a post by Melanie M (the woman who started the DS board.) Scroll down to read her take about the DS as a tool. http://www.duodenalswitch.com/openbb/read.php?TID=3932 I know I will have to make some changes with the DS. But those will mostly--my friends tell me--be learning not to eat stuff that doesn't agree with my new plumbing. I'm glad that this wasn't received as a the-band-is-bad post. You guys are cool.

Hi, all.. I've had several inquiries and got lazy about answering them, so I hope you don't mind my making a lengthy Sue-Post. (Okay, not lazy, loaded, Vicodin...just let me say that you NEVER want to hear the phrases "urethral stenosis" and "urethral dilation" coming out of your urologist's mouth.) For the innocent...My band surgery was October 15th, 2002, in Monterrey, Mexico, with Roberto Rumbaut Diaz, a band pioneer surgeon and a band patient and a really nice, down-to-earth guy. Prior to banding, I went from my all time high of a BMI 52+ to about a BMI of 48 on the day of surgery. For the first several months, I did okay. I recall that for my mom's 80th birthday, I finally hit a BMI of under 40...I was not morbidly obese! But shortly thereafter, I started dealing with reflux. I had to sleep sitting up. I took various drugs, but they merely lessened the problem. One day, I was having Breakfast with my cousin (an RN) and her husband (an MD) and was able to eat only about two tablespoons of oatmeal at 10:30 a.m. and realized that THEY were looking at someone with a bizarre eating program...maybe an eating disorder. I hopped on a train (I just happened to get to the station seven minutes before departure) and went to Tijuana and had Dr. Kuri unfill me. My reflux immediately resolved. And my weight loss began to resolve. So I eventually went in for mini-adjustments. I had unfills for my panniculectomy surgery and for my breast reduction surgery. In between, I had small re-fills. In two or so years, I had a dozen adjustments. But then I started to feel like my food was bouncing around in my esophagus. It would happen once in a while, and then more often. Not every time, and not just after I had eaten too much. Sometimes, I'd be having a cup of coffee before dinner and the coffee would bounce around. Other times, it would be Water. One day, I could eat a considerable amount of foods. The next day, one stupid bite of oven baked fish, and that was all I could eat. Well...after you do that for a while, you tend to get a little nuts. Especially when well-meaning people start telling you you just have to "work your tool." And when a doctor who doesn't have a band wants you to go to a support group meeting so that you can hear other successful banded people telling you they ALL go through that, with every meal. (Yeah, right.) I finally got to the point that most of what I was eating was Soup and ice cream. Because it would usually go down. I decided that, since I was within ten pounds of my pre-op weight, I wanted to consider the DS. I had an upper GI done. My esophagus is widened. In doctor talk, it's "esophageal dilatation." I went to Dr. Ara Keshshian in Delano, California and told him my story. He said, "Are you expecting me to look surprised? This is NOT the first time I've heard this story." He told me that I needed to have my band emptied...but that he didn't have the needles because he didn't DO bands. So I went to Tijuana and saw dr. verboonen, as he was available right away. He, his partner, the lab tech and my husband watched as I drank the barium and it just sat there in my esophagus. Didn't move. When stuff that isn't blocked just sits, the additional diagnosis is "esophageal dysmotility," in other words, the esophagus is NOT moving the food toward the stomach. (Ignore doctors who tell you that EVERYONE does this.) So, I'm scheduled for an endoscopy, to make sure that I'm not dealing with erosion as well. If that checks out, I'll be having the band removed and DS surgery within the next month or two. So...wisdom? I learned when checking with European surgeons that band removal is a booming business there. One surgeon said that 20% of his practice is revising bands to Rny or DS. (Remember, bands have been there longer, so more people have had more time to encounter problems.) That doesn't mean I think they are a bad thing. I just think that the band is good for whomever it's good for...but that certainly is not everyone. In fact, my insurance began covering the band after I self-paid, but is no longer covering it for people with BMI's in excess of 49...because they lose the same percentage of excess weight which leaves them still MO. And older people have more problems. I was 55. Esophageal dysmotility or "dysperistalsis" is more frequent in older people. Adding the band may just make the problem appear sooner and with more vigor. Not here, but at another site where it is mostly newer people, the band-enthusiasm is not tempered by experience or reason. Here, there are old timers who have been through problems. For many, the band is the answer. For many others, it is not. I am one of the latter. Thanks for your time, Sue

As someone whose band is about to be removed...and who has posted there recently...let me tell you what happens to some banded vets. The VAST OVERWHELMING number of OH band posters are newbies. They are people who have just decided to get the band or who just got the band or who have had the band for a few months. They are extrememly defensive about their choice. If anyone says anything negative about their own banding experience, that person is suspected of being a troll, attacked on the board and receives hate email. At the same time, those people take great delight in mentioning how invasive and life threatening other surgeries are and even post links to problems that people with other surgeries have had, as though they take delight in those problems. It is sad that so many of the people who participate in that board are so very uninformed. I mean REALLY uninformed. And the format of the board promotes the "pop-in, post, disapear" format that you see. The band has is benefits. But it is not without problems. And only those boards which have long-time banded people who hang around for years, share both the plusses and minuses with the readers, as those members go through life with the band. Just like in the stats, some have NO problems...and others have REAL problems. To me, if you are in the categories of people who seem to have the best success with the band, it makes sense to go that route. If you are in the categories that do the worst with the band, you can still try that approach, but be prepared to go another direction is success (as YOU define it) eludes you. Good luck with YOUR choice!

Okay...at the risk of setting you off again...you may not have lost an ounce. But don't panic. See...people get very dehydrated and, wanting to believe that they have already lost a bunch of weight, insist they have lost a bunch of weight, and then get all cranky when it "stops" or when they "regain." You got dehydrated from surgery. You MAY rehydrate and "gain" (on that stupid scale) every ounce...BUT it's all PRETEND. REALLY. The scale is bouncing around. It's fluctuating Water weight. There is no other way--short of amputation or childbirth--to achieve a 14 pound loss on a scale in less than a week. So...as you rehydrate...the scale may move upward. If that happens, REPEAT AFTER ME: THIS IS MEANINGLESS. You just need to back away from the scale and have a responsible adult take care of it for a while. (NO. I cannot do that. But it's still a good idea.)

thin AND sin? I'll be nght there Hey, Donali. Hey, Lisa!

If this doesn't work for you, let me know. http://thinforlife.med.nyu.edu/assets/LapBand-in-the-USA.pdf When you open the pdf file, search on "african" The AA patients had the lowest weight loss in the study, but there were only five African-American patients in the study. Sue

Yeah...in the original band research...the FDA trials...AA's had a lower success rate than other ethnic groups. I remember it. I'll go look for it.

You know what else...food is merely the mechanism OF THE MOMENT by which we demonstrate that we are nuts. Plenty of people have wls and start drinking or gambling or complusive shopping or discover an out-of-control libido. It's always a good idea to remain vigilant against the NEXT manifestation.

I sure haven't. But I'm certifiably weird.

Far be it from me to be argumentative (that's a joke), but right now, it's an "experimental/investigational" denial. And that can be overturned, because it's hogwash.

I think yo should appeal the denial they gave you. You MIGHT slip in between policy changes! Sue :::currently preparing to battle BC re approval for DS:::

Blue Cross of California (not BC/BS) just changed their policy, based on new research that show that banded people with BMI's over 50 generally do not lose enough weight to get out of the MO category and get rid of the comorbidities that are so badly impacting their lives. I think I posted about this somewhere (but I guess not here.) Wherever it was, everyone wanted to argue about it. But after looking at large groups on follow-up, there were not enough people who started with a BMI's of over 50 and got to BMI's under 40. Of course, the stats, two or three years out are the same for RnY. But they GET to a lower weight before the weight rebounds. So they can blame the RnY patients for the weight regain. The study I read "blamed" the band. I don't want to rain all over your parade, but even if you beat the "experimental" denial (which I think you have a good chance of doing), you may still have THIS hurdle to deal with.

Those are the three. I don't think any one of them is bad. You might want to compare post-op follow up (ask at all the boards...except, of course...any of the fan-club boards), accommodations, and finally prices. I picked Rumbaut. He HAS a band; he did the pre-FDA trials; he did junior high in Ohio so his inglés es mejor que mi español.

Alexandra, my dear, you are NEVER wrong. And if you are, you're never wrong here. "Desat" refers to oxygen desaturation. You wear that little pulse-ox thingy on your finger while you sleep and the machine records and prints your O2 levels. I think that would be a very reasonable primary screening thing. People whose O2 levels never drop to below 92% or some other figure could be sent on their merry way. Let's work on legislation or something. The testing is not only expensive AND an overnight excursion, but the crap they use to glue the electrodes to your scalp ought to be illegal. And the VA pretty much just SANDS them off your skin, with alcohol-soaked emery paper or something.

Maybe not...but when I told my husband's cardiologist that I was sure I didn't have sleep apnea because I had no symptoms, he told me he didn't have any patients with (what he guessed was) my BMI, (it was about 50 at the time) who DIDN'T have sleep apnea. I don't know. Maybe he said it to scare me into scheduling the test. (His partner was my pulmonologist and he had been recommending it and I had been fighting it for months.) But I had the test and it was positive, and while I was SURE I didn't have sleep apnea, turns out it was severe. And earlier this year I went to the VA and ended up seeing one of those "just passing through between real gigs" doctors who decided to spend some time on the west coast and get paid in the process. He, too, was a cardiologist and, of all the stuff I've got going on with my out-of-shape-ness, THAT was the one issue he decided to discuss with me...for about forty minutes. He didn't go off on diet and exercise and my weight. He spent most of forty minutes on sleep apnea...which is a REALLY long visit at the VA. He got me back up to the sleep clinic and retested in record time, and I'm back (with my weight regain) in one of those stupid Bi-PAP machines. Anyone--fat or thin--can have sleep apnea. But I know that I've read that a higher percentage of people with more severe sleep apnea are heavier people. I was first screened with a pulse-ox and I kept an overnight journal...maybe that's a cheaper way to go. People who don't repeatedly desat during the night might not need more expensive testing. (Because no one who doesn't need that goo in their hair should have to go through that...ugh.)

Horgan is one of the most respected band surgeons in the country. His bedside manner occasionally comes under attack, but I know that for people with complications who have gone to him to fix other surgeons' errors, he is quite compassionate.

Good call. She probably wouldn't be filled. Which could mean that it's not band related (probably the case)...or could mean that the band itself--even unfilled--is causing the problem and the solution is more complicated than just unfilling. But worth keeping an eye on.

Rumbaut place my band three years ago. I'm having it removed, because I'm having complications TOTALLY UNRELATED TO HIS SKILLS. It is just not the right surgery for me. (I posted in DeLarla's thread.)

I just had the adenosine nuclear stress test, which is like having a heart attack, I'm told. there is no treadmill involved. It was time consuming, and--as promised--the last part was pretty much like having an elephant land on your chest while your veins all try to explode. BUT...it doesn't last long. HOWEVER, THE sleep APNEA TEST IS CRITICAL!!! This is meant to educate, not terrify. While this patient had RnY, the outcome could have been the same with ANY SURGERY. http://www.obesityhelp.com/morbidobesity/information/showcomplarticle.php?ID=1033479097

At the risk of being my reliable cranky self, I wouldn't go for an online diagnosis. While I supose anyone who has posted could be right, so could this article from the medical journals which states: INTRODUCTION: Patients are frequently referred for chronic cough. The causes are various. CASE REPORT: We report two cases of chronic cough that occurred after laparoscopic adjustable gastric banding for treatment of morbid obesity. In both cases, the computed tomography scan showed an important oesophageal dilatation. The cough disappeared after the band deflation. CONCLUSION: Oesophageal dilatation after laparoscopic adjustable gastric banding is a new cause to be included in the aetiology of chronic cough. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12910122&query_hl=7 Print out the abstract, take it to your doctor and ask if your cough could be band related. Reason is, if it is being caused by esophageal dilatation (widening of the esophagus) and if it is caught soon enough, an unfill seems to cure the problem and leave you with a healthy esophagus. If symptoms persist, you don't want to take chances. Sue

NO! But I am in the process of getting my band removed and having the DS (Biliopancreatic Diversion with Duodenal Switch) if all goes well! "Why?" you ask. (I can hear you.) The band is restrictive. After a year or two post-op with the bypass, when the body kind of overcomes the malabsorptive thing, the bypass is restrictive. The DS--although a more extensive surgery and although requiring a far more skilled surgeon--leaves you with a larger stomach, an intact pyloric valve, the ability to eat most kinds of foods (although each person has different tolerances and bowel issues may ensue if those are not discovered and honored), the ability to take NSAIDS, and a bunch of other reasons, including malabsorption that continues beyond the two year mark. (That also means that enormous effort to make sure nutritional needs are being met must be observed.) AND...(I should start a new thread, huh?)...because the band has caused and is causing me physical problems. I am one of the 11% of banded people whose esophagus stops working (it's supposed to "massage" the food on through to the stomach) once we are banded. Yesterday, under flouroscopy, two surgeons, a lab tech and my husband and I watched as I drank barium with a completely unfilled band. It just sat in the esophagus. Lump-o-barium, if you will. I had to wash it through with Water...and remember the drink is a liquid. You can imagine what solid food does. So, I've seen a DS surgeon. He wanted all of the saline out NOW, to provide a little relief to the stomach. As soon as the insurance says "Go," I'll get unbanded and re-routed. I'm scared--because I'm not half as dumb as I look. But I need to get rid of the band and I really feel a push to have another wls surgery before I "age out" of that possibility. (I'm too close to 60 for comfort.) In answer to your question, no bypass. But I would have a wls called the DS. Sue

Just read up a few responses! He is not only "Inamed certified," he is one a a very few surgeons who GOT Inamed's band approved in the US. He's beyond certified.