GeezerSue

1: Obes Surg. 2004 Mar;14(3):399-406. Related Articles, Links _ The influence of laparoscopic adjustable gastric banding on gastroesophageal reflux. de Jong JR, van Ramshorst B, Timmer R, Gooszen HG, Smout AJ. Department of Surgery, University Medical Center, Heidelberglaan 100, CX-3584 Utrecht, The Netherlands. jr.dejong@hccnet.nl BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) influences gastroesophageal reflux. METHODS: 26 patients undergoing gastric banding were assessed by a questionnaire for symptom analysis, 24-hour pH monitoring, endoscopy and barium swallows, preoperatively, at 6 weeks and at 6 months after operation. RESULTS: Gastric banding had minimal effect on heartburn scores, but regurgitation and belching scores increased significantly during follow-up. Use of acid-reducing drugs decreased significantly at 6 weeks and increased significantly at 6 months. Pathological reflux was present in 13 of the 26 patients preoperatively. At 6 months pathological reflux was found in only 6 of these 13 patients, but 4 of the 13 patients with preoperative normal reflux patterns had developed pathological reflux. 6 months after the operation esophagitis had disappeared in 6 patients and was increased in 9 patients. In 9 patients, a pouch was found at 6 months. Pouch formation was significantly correlated with the presence of pathological reflux, esophagitis and the use of acid-reducing medication. Preoperative presence of a hiatal hernia did not influence pouch formation or pathological reflux. CONCLUSION: LAGB decreases gastroesophageal reflux if there is no pouch formation during follow-up. PMID: 15072663 [PubMed]

I guess I like my posts so much I'm putting them all in here twice!

There are 5cc's (5 mL) in a teaspoon. So 1cc is one-fifth of a teaspoon. You can picture 0.1 cc as follows: take a teaspoon, pour of four-fifths (80%) of it. That's 1cc. Then pour out nine-tenths (90%) of what's left. That's 0.1cc.

oops

There is a school of thought that says that real live sugar is better for us. I imagine you've already considered and dismissed that concept for very good reasons. Depending on who's measuring, a teaspoon is only +/-16 calories and, for some, far more satisfying.

...so today I got the saline removed for the plastic surgery. Met Donali for dinner. Ate reasonably. Came home and ate unreasonably and feel borderline sick. You kind of had to sort of expect that. AAARG. Sue

The one in her avatar (whatever THAT means) is of a woman who weighs MUCH more than she does. The photo is lovely, of course, but donali is lovlier. Sue

the lady from Phoenix whose name is NOT Bianca ot Bianca. Oh, yes, and the two ladies in Miguel's van...I'm sorry. It was a long day and I have misplaced my recall of your names. I was so nice meeting you at Dr. Kuri's and I hope you did decide to drop in here! Sue

Surgery date is May 27th. I'm so freaking nervous.

Aha! Then, unless you talk to youself aloud while dining alone, it could be that you swallow a little before the food is really well-chewed, so that you can keep up with mealtime conversations. I do that all the time. At home alone, I can take a bite, and chew a long time, and wait for even longer times while I play on the computer. In group dining situations, I think there's an invisible social-pressure -related tendency to try to keep pace with the group.

Actually, it was really an attempt on his part to reassure me, along the lines of "it's not your fault you don't already weigh less, you should have had the bypass," kind of thing. And, it was spoken by the Surgical Fellow (an optional step, after intership and residency for someone who could be on his own but wants more PS experience) not the actual Plastic Surgeon. Ya know, Donali, he's probably very typical of doctors. Young, bright, head of the class kind of guy, and the doctor he mentioned who stopped doing the band is one who is in a university teaching situation, so the Fellow understandably defers to him as a reliable source outside the Fellow's area of expertise. What the expert didn't mention is that the "bad" results were the result of US doctors NOT doing what the successful foreign doctors had done. The learning curve on the band is so steep (which is why you and I focus on experience) that the doctors who had "bad" results after fewer than 50-80 patients really didn't give it a chance. I feel bad for their patients. I wonder how many were talked into RnY's just because the doctors didn't know what to do or what to expect. Oh, well.

Sasser virus? If so, you'll need a patch. http://www.microsoft.com/security/incident/sasser.asp

He's trying to convince me that the LapBand doesn't work. His buddy used to do LapBand and stopped and that's all he needs to know. AARRRRRGGGHHHH!!! After my PS, I'm going to deliver him some stats comparing the two surgeries. But not 'til I'm post-op, on accounta he's the guy with the knife. AARRRRRGGGHHH!!!!

In the US, which for a while anyway had the worst banding results in the world, the doctors want patients on lengthy, bizarre pre-op diets. A couple of New Zealand doctors also wanted patients on two weeks of pre-op liquids. They were convinced that doing so would "shrink" the fat around the liver. They were running a test, which they said they'd publish, on their theory when one of the doctors wrote back to me. Two years ago. I still haven't seen a word published showing any proof at all that two weeks of liquids does anything other than make patients crazy and stressed and guilt-ridden when they don't follow it. And many US doctors want to adopt a "fill schedule." And they often titrate the patient up to restriction so slowly that s/he gives up long before any restriction is reached. Or they say "lose 10% of your body weight or I won't do the surgery." Why can't these know-it-alls stop assuming that everything American is better just because it is American and look around? There are very expereinced band surgeons all over the world, whose patients do just fine. Do our guys pay attention and follow their lead? No. Makes me so glad I went to Mexico. End of this rant, but I'm sure I have a couple more in me.

Okay, sleep apnea is one comorbidity. Your BMI right now is about 35.6. My guess--but I don't know much because I was self-pay--is that you are very close to the lowest border for approval. That is, they could say, "Well, you're not MO and if you lose ten pounds you won't even have a BMI of 35 and you only have one comorbidity, so before we pay for this we need to see documentation of one year of medically supervised diets. Don't think that this is what they WILL say. But be prepared in case it is what they DO say, because some people have received responses like that. And other insurance companies have approved people with your stats right away. Why you have the surgery is your business, not mine. It's just that I've seen several financially comfortable women who were 50-60 pounds overweight who were banded and/or who were thinking of it. In a way, I get it, to stop them from becoming MO. On the other hand, I'm only half-way to where I want to be and am learning how very difficult the "head work" is. If I had had only 80 pounds to lose and got only half way, I'd be pissed. I guess it's not fair, but from this perspective it's like, "there's SO much learning and rethinking we have to do EVEN WITH THE BAND, that if there's a chance you could do the learning and rethinking without the surgery, it would be a better thing." Does that make sense? I'll be thinking positive thoughts about your insurance, Sue

Are you morbidly obese? I'd guess that you might be close, but only if you are 5'4" or less. Most insurance companies pay for surgery for those who have a BMI of 40 or a BMI of 35 with comorbidities. I don't mean to be cruel (it seems to come naturally) but your post gives me the impression that you want to have surgery to LOOK better. If that's the case, you need to know that the AVERAGE 220 pound person who needs to weigh 140 and has ANY weight loss surgery will, after two years, weigh about 170 pounds. Maybe a less grumpy, non pre-op person will answer better? Sue

Yeah, Kelly. And I'm a "senior citizen." (Which means there are no kids around and we've often got all day to...you know...exercise.) In fact, in discussing plastic surgery, I hesitated about spending money and doing the boobs, as that is purely cosmetic. He asked, "If you have your boobs done, does the possibility that you'd parade around here naked once in a while increase at all?" I admitted that plastic surgery might increase those occasions exponentially. "Well then," he declared, "cheap at twice the price."

Flouro for me. Sue sitting here glowing in the dark

Immediately post-op, the thought of coffee just grossed me out. And I usually like a cup or two of really strong, unsweetened, black coffee. But for a couple of weeks, it didn't sound or smell appealing. Now I drink it again. But I usually have a sugar-free, vanilla powder and about two ounces of milk in it, to get in my morning Protein. That's especially important to me when I'm more restricted in the morning. I drink a silly product called Arrowhead Sparkling Water (I prefer the orange essence), which contains 0% everything, no sweetner (real or artificial), but IS carbonated. But when restricted, I have to let it sit for a while and then I stir it to let most of the carbonation out. IMHO, a day full of diet Coke is not a good idea. Too much everything bad, and nothing of value in it. You might want to learn to love water.

Three WEEKS? Good lord, woman! Get naked and start chasing that man around the house. OTOH, you MAY need to be creative depending on where your port is placed. And who said you're not supposed to exercise? No weight lifting, maybe. But you should (probably) be walking and doing other exercises that don't stress your band or port placement.

Aha...the business center in the Hampton Inn! Memories. There are GREAT juices at the supermarket next door, in varities that are not always available in smaller US grocery stores. And you can always get chicken broth and tea at Sanborn's. The hiking will help with the gas.

Sultana, Even though I don't want to be a smart ass so early in the morning, I'm going to warn about this anyway, even though I know you know. Jessie Ahroni, the noted band guru, says there are only three adjustments we need to worry about: too loose, too tight and just right. I know that a lot of people--usually Americans, we're famous for it--get hung up on the numbers. And I have observed, ususally among the newly banded, that people want "as much of a fill as" someone else has. But the number of cc's of saline we have is essentially irrelevant. What IS relevant to me is how much restriction I have. In my case, with a 9.75cm band, my ideal fill is around 1.4 to 1.6 cc's, right now, subject to change as my weight and fat and anatomy change. I think my band holds around 4.0 cc's, but all I need to focus on is the level of restriction I have. And, IMHO, whether a fill (or adjustment) is conservative or aggressive is not a function of how many cc's of saline we have, even if we have identical bands, but of how much restriction there is. In other words, your 2.0 would have me completely shut down. Given my anatomy and where my band is placed and all that, 2.0 would be so aggressive as to be malpractice! And yet, you may be underfilled. SOOOOO, it sounds to me as though your doctor was trying to give you a lot more restriction than you had as of the second adjustment. Now you may have to wait. Because I've learned that many people become more restricted a week later. (I don't get that, but it happens.)

The Mexican doctors almost always underestimate how difficult it is to get band adjustments on this side of the border. That didn't stop me, but I live close to Mexico and adjustments, while a hassle, are doable. If I want to go to a US facility, and if they don't mind taking me, the cost can run from about $300 to about $1300, per adjustment, in Southern California. And, right now, I'm looking at two adjustments within the next month or two. I want to get unfilled for plastic surgery and then I'll need to get refilled after the surgery. You might want to find out where the Johnson & Johnson SAGB trials are taking place near you. And then find out if those doctors will do adjustments for people banded with the SAGB before it was approved here. But it still could be costly. On the west coast there are experienced US LapBand doctors banding for, I think, as little as $12,500. Have you checked out the east coast? Sue

Depends on your research skills. Right now, except for the FDA trials going on with the Swedish band, the only "legal" band in the US is the Inamed LapBand. For most of us, finding doctors who know about our bands is a challenge. Finding a doctor who knows about the Swedish band will be a BIG challenge. Then, convincing that doctor to service your band which you had implanted elsewhere, instead of with him, is a problem. They are surgeons. They make a living doing surgery. The follow-up is a necessary evil to many of them and many do not want to follow-up on somebody else's project. Right now, I would not go for a Swedish band implanted out of the country, unless I had airline travel priviledges and/or big bags of money for the travel. Just my opinion. Sue

Been out all day. Donali, as usual, was right on.