GeezerSue

And the answer to Part Two of your question (you haven't asked it yet) is "Yes, there is a chance you could actually gain weight between surgery and the time you have an adjustment that provides real restriction." Back to the first part...immediately post-op, the mucosal lining of your stomach was probably quite swollen. Even Water had to go through slowly. Then, over the past couple of weeks, the swelling has reduced (this is a good thing) and the stoma (the opening between the top and the bottom) is bigger. So now, more stuff goes through more easily. The stoma opening increases as the swelling decreases, and as you slowly add food that will provide some nutrition and satisfaction without moving the band, because you want the scar tissue inside to form around the band, right where the doctor placed it. That's how we get back to Part Two. So, there may come a time, after the first four weeks and before you get a restriction that is just right for you, that you "can eat as much as before" and feel "like I don't even have a band." This is absolutely normal, too. Just wanted people to be prepared. Sue

It is ALL so subjective. I went with a patient who had a port replaced. She chose to have the surgery while awake and then she drove home. Four hours or so. If you were intubated for the surgery (some are, some are not), the "I'm getting a cold and sore throat" feeling is the result of having had a piece of plastic shoved down your throat. It is likely more an irritation than a virus. Sue

Call Don Mills at Inamed. If he can't help, Walt Lindstrom can. They've been through this before. It is NOT investigational, or experimental or unproven. They just don't want to pay.

Call Don Mills at Inamed. If he can't help, Walt Lindstrom can. They've been through this before. It is NOT investigational, or experimental or unproven. They just don't want to pay. I understand Walt writes a pretty effective letter: http://www.obesitylaw.com/

Two different issues are getting confused here. I have no background or training in this area, save many years of dealing with insurance companies. But here goes: 1(a)--Will you be insurable on you new company's group insurance or when your company changes carriers. Yes. That's what group insurance is all about. 1(--Will you be insurable on your own? Depends on the policy and they'll probably exclude any treatment involving the band, routine or emergency, as well as treatment for morbid obesity. 2(a)--Will your new insurance cover adjustments to an existing band? Who knows? But I wouldn't count on it. (If the new insurance policy covers the band surgery, then it should cover adjustments for the "already-banded" who end up being covered on that policy.) 2(--Will your new insurance cover other health issues, including emergencies, involving the band? If it wasn't already "excluded," [see 1( above] I'd fight for coverage if/when the need arose, based on the "like any other implant" position mentioned above. Sue

TOTALLY depends on who and where your doctor is. In Mexico, they just want to know you are okay for the surgery at hand. In the US, they want to make sure you can't sue them for anything afterward. If there's psych testing, they just want to know that you are not likely to be suicidal when your coping mechanism--stuffing food in to deal with life--has been removed.

I did. Didn't take fans. Took husband. Impossible-to-remove-from-hair-goop. Forty thousand electrodes hooked to your body. My experience was that I learned that I had really bad sleep apnea when I was sure I didn't ahve it at all. Go through the testing. You need to know. (My cardiologist gently mentioned that if I didn't have sleep apnea, I'd be the first person with a BMI of about 45+ he'd met who didn't have it.)

Careful what you ask for... National Institutes of Health National Heart, Lung, and Blood Institute Facts About sleep Apnea WHAT IS SLEEP APNEA? Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood. First described in 1965, sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. It owes its name to a Greek word, apnea, meaning "want of breath." There are two types of sleep apnea: central and obstructive. Central sleep apnea, which is less common, occurs when the brain fails to send the appropriate signals to the breathing muscles to initiate respirations. Obstructive sleep apnea is far more common and occurs when air cannot flow into or out of the person's nose or mouth although efforts to breathe continue. In a given night, the number of involuntary breathing pauses or "apneic events" may be as high as 20 to 30 or more per hour. These breathing pauses are almost always accompanied by snoring between apnea episodes, although not everyone who snores has this condition. Sleep apnea can also be characterized by choking sensations. The frequent interruptions of deep, restorative sleep often lead to early morning headaches and excessive daytime sleepiness. Early recognition and treatment of sleep apnea is important because it may be associated with irregular heartbeat, high blood pressure, heart attack, and stroke. WHO GETS SLEEP APNEA? Sleep apnea occurs in all age groups and both sexes but is more common in men (it may be underdiagnosed in women) and possibly young African Americans. It has been estimated that as many as 18 million Americans have sleep apnea. Four percent of middle-aged men and 2 percent of middle-aged women have sleep apnea along with excessive daytime sleepiness. People most likely to have or develop sleep apnea include those who snore loudly and also are overweight, or have high blood pressure, or have some physical abnormality in the nose, throat, or other parts of the upper airway. Sleep apnea seems to run in some families, suggesting a possible genetic basis. WHAT CAUSES SLEEP APNEA? Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. In some people, apnea occurs when the throat muscles and tongue relax during sleep and partially block the opening of the airway. When the muscles of the soft palate at the base of the tongue and the uvula (the small fleshy tissue hanging from the center of the back of the throat) relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether. Sleep apnea also can occur in obese people when an excess amount of tissue in the airway causes it to be narrowed. With a narrowed airway, the person continues his or her efforts to breathe, but air cannot easily flow into or out of the nose or mouth. Unknown to the person, this results in heavy snoring, periods of no breathing, and frequent arousals (causing abrupt changes from deep sleep to light sleep). Ingestion of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea. HOW IS NORMAL BREATHING RESTORED DURING SLEEP? During the apneic event, the person is unable to breathe in oxygen and to exhale carbon dioxide, resulting in low levels of oxygen and increased levels of carbon dioxide in the blood. The reduction in oxygen and increase in carbon dioxide alert the brain to resume breathing and cause an arousal. With each arousal, a signal is sent from the brain to the upper airway muscles to open the airway; breathing is resumed, often with a loud snort or gasp. Frequent arousals, although necessary for breathing to restart, prevent the patient from getting enough restorative, deep sleep. WHAT ARE THE EFFECTS OF SLEEP APNEA? Because of the serious disturbances in their normal sleep patterns, people with sleep apnea often feel very sleepy during the day and their concentration and daytime performance suffer. The consequences of sleep apnea range from annoying to life-threatening. They include depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep while at work, on the phone, or driving. It has been estimated that up to 50 percent of sleep apnea patients have high blood pressure. Although it is not known with certainty if there is a cause and effect relationship, it appears that sleep apnea contributes to high blood pressure. Risk for heart attack and stroke may also increase in those with sleep apnea. In addition, sleep apnea is sometimes implicated in sudden infant death syndrome. WHEN SHOULD SLEEP APNEA BE SUSPECTED? For many sleep apnea patients, their spouses are the first ones to suspect that something is wrong, usually from their heavy snoring and apparent struggle to breathe. Coworkers or friends of the sleep apnea victim may notice that the individual falls asleep during the day at inappropriate times (such as while driving a car, working, or talking). The patient often does not know he or she has a problem and may not believe it when told. It is important that the person see a doctor for evaluation of the sleep problem. HOW IS SLEEP APNEA DIAGNOSED? In addition to the primary care physician, pulmonologists, neurologists, or other physicians with specialty training in sleep disorders may be involved in making a definitive diagnosis and initiating treatment. Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep. Several tests are available for evaluating a person for sleep apnea. Polysomnography is a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels. These tests are used both to diagnose sleep apnea and to determine its severity. The Multiple Sleep Latency Test (MSLT) measures the speed of falling asleep. In this test, patients are given several opportunities to fall asleep during the course of a day when they would normally be awake. For each opportunity, time to fall asleep is measured. People without sleep problems usually take an average of 10 to 20 minutes to fall asleep. Individuals who fall asleep in less than 5 minutes are likely to require some treatment for sleep disorders. The MSLT may be useful to measure the degree of excessive daytime sleepiness and to rule out other types of sleep disorders. Diagnostic tests usually are performed in a sleep center, but new technology may allow some sleep studies to be conducted in the patient's home. HOW IS SLEEP APNEA TREATED? The specific therapy for sleep apnea is tailored to the individual patient based on medical history, physical examination, and the results of polysomnography. Medications are generally not effective in the treatment of sleep apnea. Oxygen administration may safely benefit certain patients but does not eliminate sleep apnea or prevent daytime sleepiness. Thus, the role of oxygen in the treatment of sleep apnea is controversial, and it is difficult to predict which patients will respond well. It is important that the effectiveness of the selected treatment be verified; this is usually accomplished by polysomnography. Behavioral Therapy Behavioral changes are an important part of the treatment program, and in mild cases behavioral therapy may be all that is needed. The individual should avoid the use of alcohol, tobacco, and sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods. Overweight persons can benefit from losing weight. Even a 10 percent weight loss can reduce the number of apneic events for most patients. In some patients with mild sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, using pillows and other devices that help them sleep in a side position is often helpful. Physical or Mechanical Therapy Nasal continuous positive airway pressure (CPAP) is the most common effective treatment for sleep apnea. In this procedure, the patient wears a mask over the nose during sleep, and pressure from an air blower forces air through the nasal passages. The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. The pressure is constant and continuous. Nasal CPAP prevents airway closure while in use, but apnea episodes return when CPAP is stopped or used improperly. Variations of the CPAP device attempt to minimize side effects that sometimes occur, such as nasal irritation and drying, facial skin irritation, abdominal bloating, mask leaks, sore eyes, and headaches. Some versions of CPAP vary the pressure to coincide with the person's breathing pattern, and others start with low pressure, slowly increasing it to allow the person to fall asleep before the full prescribed pressure is applied. Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild sleep apnea or who snore but do not have apnea. Possible side effects include damage to teeth, soft tissues, and the jaw joint. A dentist or orthodontist is often the one to fit the patient with such a device. Surgery Some patients with sleep apnea may need surgery. Although several surgical procedures are used to increase the size of the airway, none of them is completely successful or without risks. More than one procedure may need to be tried before the patient realizes any benefits. Some of the more common procedures include removal of adenoids and tonsils (especially in children), nasal polyps or other growths, or other tissue in the airway and correction of structural deformities. Younger patients seem to benefit from these surgical procedures more than older patients. Uvulopalatopharyngoplasty (UPPP) is a procedure used to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate). The success of this technique may range from 30 to 50 percent. The long-term side effects and benefits are not known, and it is difficult to predict which patients will do well with this procedure. Laser-assisted uvulopalatoplasty (LAUP) is done to eliminate snoring but has not been shown to be effective in treating sleep apnea. This procedure involves using a laser device to eliminate tissue in the back of the throat. Like UPPP, LAUP may decrease or eliminate snoring but not sleep apnea itself. Elimination of snoring, the primary symptom of sleep apnea, without influencing the condition may carry the risk of delaying the diagnosis and possible treatment of sleep apnea in patients who elect LAUP. To identify possible underlying sleep apnea, sleep studies are usually required before LAUP is performed. Tracheostomy is used in persons with severe, life- threatening sleep apnea. In this procedure, a small hole is made in the windpipe and a tube is inserted into the opening. This tube stays closed during waking hours, and the person breathes and speaks normally. It is opened for sleep so that air flows directly into the lungs, bypassing any upper airway obstruction. Although this procedure is highly effective, it is an extreme measure that is poorly tolerated by patients and rarely used. Other procedures. Patients in whom sleep apnea is due to deformities of the lower jaw may benefit from surgical reconstruction. Finally, surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese. NATIONAL CENTER ON SLEEP DISORDERS RESEARCH (NCSDR) The mission of the NCSDR is to support research, training, and education about sleep disorders. The center is located within the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. The NHLBI supports a variety of research and training programs focusing on cardiopulmonary disorders in sleep, designed to fill critical gaps in the understanding of the causes, diagnosis, treatment, and prevention of sleep-disordered breathing. FOR MORE INFORMATION Information about sleep disorders research can be obtained from the NCSDR. In addition, the NHLBI Information Center can provide you with sleep education materials as well as other publications relating to heart, lung, and blood diseases. National Center on Sleep Disorders Research Two Rockledge Centre Suite 7024 6701 Rockledge Drive MSC 7920 Bethesda, MD 20892-7920 (301) 435-0199 (301) 480-3451 (fax) NHLBI Information Center P.O. Box 30105 Bethesda, MD 20824-0105 (301) 592-8573 (301) 592-8563 (fax) U.S. Department of Health and Human Services Public Health Service National Institutes of Health National Heart, Lung, and Blood Institute NIH Publication No. 95-3798 September 1995 .

When our daughter was 15, her German teacher called me to complain that "she looked at me as though she hated me!" At the conference (to which Frau Whoozits brough her union rep, because she KNEW she had stepped over the line on a number of other issues), I laughed and said, "She's 15. Her job description is to be difficult. She doesn't drink or smoke or do drugs or have carnal knowledge of the football team. If she says anything she shouldn't say, or does anything she shouldn't do, let me know right away and I'll handle it. But I'm pretty sure a professional with credentials such as yours can deal with the irate glare of a 15-year-old." Then I took the kid aside and said, "That woman is a nut case. I don't really care whether you hate her or even what you do. But I don't ever want to deal with her again. Be sweet, be a jerk, I don't care. But if you ever do anything that makes her want another parent conference, I'll make your life a living hell." We had no more problems. Don't let this phase of parenting get you down. What kept me from getting nuts was the realization that I had already done all the foundation work, and any "control" I thought I could gather was merely an illusion. I had been the coach. I had called all the plays. At fifteen, I was demoted to cheerleader. Two years later, I tried to butt-in regarding prom arrangements. Finally, she took me aside and said, "Look. I appreciate that you have friends whose kids I know. You need to appreciate that I don't want someone I KNOW is planning on getting drunk barfing all over me and my prom dress. So could you back off, please, and let me continue to plan an evening with MY sober friends, instead of kids I don't hang with because they've got issues?" Ooooo.

Nah, I wasn't involved. Robin was just in my neighborhood.

Yes. I did several months of reflux and then decided to get an unfill. I felt IMMEDIATE relief. Dr. Kuri (if I recall) suggested wating around three weeks, but I waited over two months. I gained weight. I didn't/don't care. I was no longer creating a situation in which esophageal irritation/cancer cold get a foothold. I've been refilled (a smaller amount than my first fill) for about three weeks. I've lost five pounds (I had gained about twenty in two months). I need to reread Donali's post of Polar Bear Mike's post of Dr. Kuri's advice about eating earlier in the day. I think anyone with even minor sensitivity issues needs to do that. And I need to remember that I have restriciton now, and stop eating "just one more bite" as I was able to do during my unfilled months. Other than those things, I'm a fervent supporter of "theraputic unfills." Good luck on your decision.

First, get a good lie ready, just in case, and stick to it! "Gall bladder surgery" seems to be well accepted. So does "hernia repair." I'd go with the hernia story, because you can do that more than once and even if you've already had gall bladder surgery. And it's very believable, as the obese have a higher incidence of hernias. (Just read up on them first.) Then, be prepared to be flexible. Some people (ask Jimmy C.) have VERY sensitive stomachs for a couple of weeks post-op, and end up in the hospital and even on an IV while the stomach heals. Other people (mostly mid-banders, I think) have lunch the day of surgery. But, if you have a problem swallowing your own saliva, you are going to be spending a lot of time spitting. (If/when this happens, it just means that your brain thinks the band is blockage and it's sending gallons of slimy saliva down to clear the blockage.) But spitting looks pretty gross. And it could goop up the foils in a weave, ya know. If you REALLY don't want people to be suspicious, be prepared to be able to hide while your body gets used to the band. Sue *who was out shopping a couple of days post c-section; needed several-hour-long-naps every day for a year post-hysterectomy, just two years later; and was having root canal less than two days post-band, twenty-seven years later*

The *theory* (still unproven to the best of my knowledge) is that a pre-op diet can somehow shrink the fat around the liver...and this would be/might be important because the surgeon has to maneuver around the liver to get to the stomach and place the band. (In my case,the liver "leaned" the other way, so if I had followed the diet, it would have been a big waste of effort.) Two surgeons in New Zealand were doing a study on the theory. That was a couple of years ago. I don't recall having heard results of the study. Then, many doctors who heard the theory thought they'd try that, too. So far, so tolerable. BUT THEN, there is also a crowd that says, "Well, if they won't follow the diet pre-op, then they probably won't follow it post-op, and so if they won't follow the diet I won't do the surgery." And those jerks are the ones who have NO idea what this obesity thing is all about. I'd avoid them. My surgeon's pre-op diet was "nothing after midnight" the night before surgery, and his post-op diet was about a week of clear, then progressively more un-clear liquids, followed by purees, then mushies...all of which should be finished in about three or four weeks. And then about two successful weeks on solids before the first adjustment.

I take a chewable calcium I get at Traders Joe's.

Sue

Ya know. I don't know. And I think it's hit and miss. So I bought a pill cutter and use it for any pill that's time released. Dr. Rumbaut told me to hold a capsule in my mouth until it was really, really soft, and then--just before the Gelatin dissoves--to swallow it with water.

I had heard--from patients--about patients being treated this way and was somewhat skeptical. Then I was treated this way, so I asked another surgeon. It seems that this concept was proposed at an ASBS conference, until the doctor proposing it was shouted down by his (banded) colleagues. I sent this message to the doctor who tried this with me. Please note that, at no time, did I accuse him of engaging any inappropriate behavior, INCLUDING this practice. He wrote back and was livid. Feel free to jump to your own conclusions: The "Psychological Lap-Band Adjustment," a Patient's Perspective There are those doctors within the community of surgeons specializing in the adjustable gastric band, who are promoting the adoption of the "Psychological Fill" or "Psychological Adjustment." Although their motives are pure, they could not be more misguided. Inadvertently, they are doing a disservice to their patients, to the manufacturer of the band and to themselves. The theory appears to include the following false assumptions: 1) there is not a physical cause component of obesity; 2) what patients most need is to retrain their brains to believe that they are full when they are not; 3) obese people are below average in intelligence; 4) obese people respond positively to negative intimidation tactics; 5) the Lap-Band patient is unable to determine when restriction wanes; 6) obese people do not speak to each other or compare experiences with each other; 7) it is ethical for surgeons to mislead or withhold information from patients; 8) training as a surgeon prepares one to practice psychology; and, 9) surgeons are competent actors. The technique being suggested includes the surgeon's telling the patient that s/he is "the only patient" who is not cooperating, or "the worst patient," or "the least compliant patient" encountered by the surgeon. The surgeon then removes saline from the band, and subsequently replaces essentially the same amount of saline, but threateningly advises the patient that s/he will barely be able to tolerate food. In some cases the surgeon insists on a follow-up appointment to remove saline a month later, insisting that the fill is so tight that the patient will have to return to have the band loosened so that he or she does not cause damage to the esophagus. There is a placebo precedent in medicine, but if it is appropriate at all, it is appropriate in rare occasions. In the proposed situation, however, the patient is required to be dim-witted enough to believe that the surgeon would intentionally over-fill the band and announce that s/he is overfilling it. The patient is supposed to be psychologically needy enough to do anything to gain the surgeon's approval. The patient is expected to believe what the surgeon says is sufficient restriction rather than his/her her own sense of satiety, when one of the prime benefits of the adjustable band is the restoration of the sensation of satiety. The patient is expected to refrain from communicating with other patients, 'lest numerous patients discover that they all have been declared "the least compliant patient." The patient is expected to present for the band adjustments devoid of any training or experience in the field of psychology. The patient is further expected to present for band adjustments devoid of any training or experience in critiquing dramatic performances. Some surgeons might easily be seduced into thinking that this kind of false paternalism is helpful to patients. So many patients arrive in deep states of need due to their histories or habits of not attending to their own needs sufficiently. However, it is incumbent upon caregivers to have EXCELLENT boundaries and the "Psychological Adjustment" is a clear violation of said limits. One of the biggest advantages of AGBs is the degree to which they empower patients. Patients have control over the rate of weight loss. The band supports change on every level and each patient changes at the rate and in the order that best fits each one's individual needs. The feedback loop is positive and the patient gains confidence, learning to trust oneself over time. A lifetime of psychological undermining regarding food and eating patterns can be healed, and more. By deceiving patients, the "Psychological Adjustment" DIS-empowers patients, making them dependent upon the surgeon's wisdom. The patient is left NOT trusting him/herself and is, in fact, incented to NOT trust him/herself. Faced with the"Psychological Adjustment," the more easily intimidated patient merely drops out and BELIEVES that s/he has become a Lap-Band failure, damaging both the patient and the manufacturer of the product. The other patients--either alone or in discussion with each other--conclude that the surgeon who practices the "Psychological Adjustment" has limited understanding of--and even less respect for--the obese patient. Inevitably, the surgeon will have damaged his own reputation most of all. Three damaged parties in a situation which should have included the concept, "First, do no harm." A shame. So, in case anyone received this kind of treatment, there is precedent. And feel free to complain. Sue

Well, and to me--a terminal skeptic and former neighbor of a couple of M.D.'s who were morons--it makes me wonder a little about how much time they have for post-op support (which doesn't pay as well as the surgery.) And, while I'm picking on doctors, I might mention the concept of the "Psychological Fill," as promoted by one LapBand doctor. (His colleagues ratted him out to me.) I'll start a new thread. Sue

Oops, just went to their web site, and that IS what is says. Amazing. I'd have believed "over 600 lap bariatric surgeries." But the two of them, in 16 months, have done over 600 LapBands? Amazing. (Oh, I already said that, huh?) But I know that just a few months ago, one of the Mexican surgeons told me that he and another surgeon together had done close to 900 bands, over a period of about five years.

Are you sure? I only ask because I've been reading several boards for a couple of years, and I am not familiar with his name. And...that's how many bands some of the Mexican surgeons--who have been doing this for three or four times as long as it's been legal here--have done. I thought I'd heard the name of most of the high-volume surgeons. Oh, well, learn something new every day. (Where is he located?) Sue

There are apparently several layers of concern regarding drugs. Antibiotics are NOTORIOUS for chewing up the stomach. Some of them cause reflux in as many as 40% of patients...and those are the folks with a normal stomach. (I'm pretty sure my reflux actually began with a round of antibiotics and went downhill from there. I had to give up treating that condition.) Then, the NSAIDS apparently have an entirly different thing going. It's not about the size of the pill or how long it sits in the stomach. It's about how the pain-relieving mechanism in the drug cuts down on the protective lining of the stomach. I have had no problems that I know of with ibuprofen...but it could have been exacerbating what the antibiotic did. So, to your situation. Antibiotics do nothing for the flu. No one should take antibiotics for the flu. The flu is a virus and may respond to antiviral medications but will not respond to antibiotics, which only work on bacteria. And, acetaminophen is available in adult, extra-strength liquid. I know Tylenol makes a version cuz I've got some.

I want a constitutional amendment to make Donali in charge of everything.

Most of the time, I travel about three or four hours (each way) to the "close" fills. Once I flew about five hours, each way. Plus an hour on the ground to and from the airport, each way. But I'm retired.

And how many LapBand patients has he had? Certainly, not many! And has he no clue (this may be rhetorical) that his version of support is not likely to help you lose weight? Sorry about your having this doctor. Sue