CowgirlJane

Insurance is a puzzle. I knew that my insurance covers WLS and I met all the criteria, but we had a few extra hoops to jump through to get approval for a revision. That extra hoop was easy once I was diagnosed with a slip. Basically, if you had a "failure" of the previous surgery like a slippage it didn't matter your BMI or co-morbidities. Even so, they wanted my NUt and psych assessment to approve the band removal... I think they got wires crossed because that makes no sense. The insurance person said, oh we needed it anyway for the sleeve procedure approval. Anyway, my doc was alarmed by my slip too because even though all Fluid is out he said the band was too tight and it had slipped alot. It is strange because I feel basically no restriction. He too warned me that I could suddenly be totally blocked and require emergency surgery. Tomorrow, I have my EKG which is the last step before the removal - I somehow missed that I needed to do that. Only after the EKG is done will they schedule the removal. Ask your doctor how often the "repositioning" actually works or if it is likely to slip again.

Oh no, don't give up! You are worth more then this - you deserve to get this after all the committment you have already demonstrated. Do a day or two on just protein shakes, go back in and ask to be reweighed and I bet you wil get under that .5 pound. It seems very strange that this happened since our weight fluctuates a bit day to day even if we are on a perfect diet, or even after WLS!!! Demand a recount! Wear lighter shoes! Half a pound - this is really ridiculous.

So, I found out I was approved for band removal, which is done on an outpatient basis. My insurance company called me and reassured me that if I needed to go to the hospital, and stay overnight(s) that would be no problem. They haven't yet approved me for the sleeve, but she told me there were no obstacles - basically indirectly saying I will be approved. I told her that it was a little strange to me to do that in a surgical center (surgery in the am, recover there for the day, go home and then come back the next day for IV fluids and a check - I live 30 minutes away). Anyway, I asked her about that and she said that it is becoming very common for the Band and Sleeve and many other surgeries now. She repeated what my doctor had said - that there are good reasons to NOT be in a hospital with all those sick people...lol. Anyway,I just thought it was interesting as it sounds like recovering at home, in a recovery house, or in a hotel is becoming more common. I have a friend who is a nurse who has volunteered to stay with me for the first day or two if I want... I hate hospitals, so i am very open to this idea and figure that if I am really bad I will ask to be admitted rather then go home as my insurance will cover that.

Good luck and I am sure you will be just fine! BTW, I change my mind about 10 times a day, good thing it will be awhile before I can get the surgery.

I sorta think blenders are a pain to clean properly... but I like their ice crushing ability. What do you think is the most convenient, easy to clean, handiest way of mixing Protein? I never really liked using a shaker since not all mix that well (although it has been years since I tried this).

It seems to me you have lost ALOT! You are doing great! It does sound like you may be dehydrated - that makes me feel terrible (I havve not been sleeved, but have had dehydration and it is awful). If it were me, I would be confiding in the surgeon on this... and perhaps even ASK for the IV fluids to get you jump started. I hope you feel better soon.

I have not yet had the sleeve surgery (pain after being banded wasn't bad) but the doctor told me that most people experience about a 3 out of 10 on the pain scale. It sounds like there is a lot of variety in that. I wonder if having a hernia repaired makes it more painful??

I feel like a split personality on this - some days i am so excited to get sleeved, other days i am sure that i just.can't.do. another WLS. You all have raised great points though. When I was restricted, I didn't really feel satiated. I still wanted to eat, and felt something like hunger. People try to tell you it is 100% in your head. I agree that the "mind parti" is a big issue, but I also felt hungry, in the stomach. Right now I am focused on getting the band removed, I think that the earlist I would get sleeved would be like November due to work committments and trouble getting time off.

I am pre-op. The nutritionalist wasn't sure if I needed to do the liver shrinking diet in advance of having the band out, but suggested i do a diet that is 30-40 G of Carb. I don't really know how to eat that way, but I eat considerably more then a person who is already sleeved. Sorry I should have said more!

Can someone point me to example menus or other suggestions how to stay under 40 G of carbs per day? thanks!

Insurance company called and they have approved the band removal. Finally. Actually, when she first called she said I was approved for the sleeve. I think they have their wires crossed, because she then backtracked on that. I asked her if there were any obstacles to the sleeve approval and she didn't think so. We'll see. I had the same problem with the band - not so healthy foods we the ones less likely to "hurt". Even now, with no restriction and a slipped band, I can eat unlimited quantity of junk, but I have to watch dense Proteins and raw veggies to ensure no problems. I am sure glad that you are finding that the sleeve gives you more time to "think" rather then just react to the hunger. I need that too.

So, I have known for weeks that my band has slipped and needs to come out. I have GREAT (read expensive) insurance that covers WLS and yet, the approval for the band removal is taking forever. They wanted the psych eval and nutrition assessment for the band removal, which seemed so strange. Luckily, I had those since I had started down the path of a revision to RNY previously... but I still don't have approval to get de-banded! I am super happy with the doctor and support I have found. There is a lot of excitement because they have many successful patients and they have a comprehensive support program. They do a pretty high volume of sleeves and conversions from the band to sleeve, are a center of excellence, all the things you want. I also find the surgeon himself to be well recommended and a real pleasure to interact with. Even with all that, I find that my nagging doubts about the sleeve procedure just won't go away. I feel like I am doing the same thing that I did 10+ years ago when I was banded... which was get pretty excited, see a lot of evidence that it works well in the short term and really going blind in terms of what the future holds. I think I could even get comfortable with taking that risk, since my weight has become such a HUGE obstacle for me - Healthwise and enjoyment of life wise - except for the feeling that I am going to need to stay on a low carb/low cal diet for the rest of my life even with the sleeve... which keeps leading me back to the circle of "why don't I just do that" without surgery. Of course, I have not been successful at keeping weight off long term by dieting. I really worry that I will be one of the "regainers" because although I so much want to make lifestyle changes, I want to not be an overeater, but I have not yet broken free of that so far. I am not a clasic binge eater, but I pretty consistently overeat and it definately has an emotional component. Eating has become sort of an emotional ballast for me - keeps life even and on course I guess. I have been to counseling, I have done alot of different things to try to resolve that - so it is hard for me to understand, really understand, how it will be different this time. It seems like I will do really well, say with weight watchers or something, for a long time and then "boom" something breaks the pattern or disrupts me and I simply cannot get it back. When I was active in the "bandster" support online groups, there was a real focus on basically writing every failure off to the "it's just a tool, you need to make lifestyle changes". I understand, couldn't agree more, except for some of us staying permanently on a diet has not worked well so far. I want it to work, I am very motivated to make it work but I have these visions of being 5+ years out, suffering from terrible reflux (this appears to be a big issue for long term and I don't fully understand why) and being told to follow Atkins or something to keep the weight off. That is a scenerio that makes me feel discouraged. I have thought about the RNY, even considered the more dangerous DS - but I feel very very uncomfortable with both of those procedures as they are even more drastic/invasive then being sleeved. Anyway, that is my vent of the day. This process of making the committment to the procedure, especially if you have been down the road of a procedure (band) that did not deliver what was promised, is a complicated one - at least for me.

This is one of the many diets I have done. I don't know if I buy it....

While I agree that this isn't cause for panic/over reaction, I do think we should "listen" to the bad news too, not just the good stories, to make a more informed decision. I too was banded and I did NOT get to goal and I did NOT maintain what I lost. There is of course more to the story, but while we are all individuals it is still wise to look at the results that a wider population experienced and learn from it. I think that my results reflect what a whole heck of a lot of people experienced, but of course in 2001 when i was banded, and there was little long term studies, i too thought that the odds of problems were small and odds of permanent sucess were great. I also had a few friends who did really great with the band, at least at first, and so those personal stories encouraged me to listen to the good news and kind of poo-poo the possible bad news. I am trying hard to go in with my eyes wide open. For me, the regain wasn't what alarmed me. I was more alarmed by some of the longer term complications like serious reflux that shows up 6+ years after surgery. It gave me pause; to wonder how well we really understand the long term consequences of this surgery/. Anway, I appreciate people finding and posting this info even as incomplete and imperfect as it is.

People typically lose the vast majority of what they are going to lose in the first 6-12 months. take advantage as it may get alot harder...

Sounds like you have had it really bad! I have had nasuea since my endoscopy, but no puking. I am tired of that low grade feeling like I am carsick though....

I think that reading message boards is the personal aneddote method of "research" - it is an important component but may not accurately reflect "averages". Also, the techhniques are evolving, and the studies cover longer term... there is a chance that the current procedures are different then they were 5 years ago. Another point is that it is pretty well known that if you are lower BMI, you have very good chance of losing 100% of excess, if you are heavier, not so much. That study seems to reflect that, the average BMIs were 46-60 for the three data sets. My surgeon says his patients that are in the 30s range of BMI tend to lose 100% of their excess, but people who are higher lose more like 70-80%. His data I believe is only 3 years so I am guessing his long term stats will show something less then that. When I was banded 10 years ago, the EWL% for gastric band was reported at around 60-65% - I don't know what the current studies show. What I think happened with the band is that maybe 20-30% of people did lose 100%; alot of others lost maybe 40-60% of excess and a pretty significant number really didn't do very well. What those stats didn't reflect back when I was banded were the long term (5-10+ years) issues and how many people would need to have the band removed. Of course the sleeve is totally different, but I think the harsh reality is that much like band and even the RNY, there will be many people who regain.. over the long haul. You know what, my sleep apnea doctor who was the one that kicked my butt to explore this surgery had a good answer to that "argument". His point was that being trim and healthy for 10 years, even if I DID regain would be 10 years with less weight on my joints, 10 years of better quality life, 10 years of better health. When I look at where I am at now, and the path I am on... well... I see his point even if the we don't really know the long term yet. I personally am still grappling with the studies that show reflux gets much worse at 6+ years out. scares me as I have hated it with the band A few other factors: -people that don't get satisfactory results tend to fade away from message boards because it kinda hurts feeling like the only failure -people who convert to a DS or RNY likely move away from this message board -people who have alot of health problems... well, they sometimes die or otherwise become unavailable to post. I am not saying necessarily sick from the WLS, I mean just in general.

Very interesting link! The 43% failure rate was I believe partly calculated based on the number of people they could not follow up with. What I also found very very alarming was how GERD and ACID REFLUX really increased at 6+ years out. That seemed associated with a couple of things, one of them being over eating... I would like to think that i have the self control to follow the rules forever, but it is a concern.

Well, you are definately a great example for me to see just how successful I could be too because my current BMI is 49. I think you are younger (I am 47) and I know individual results may vary , but it is still so encouraging to see how obviously successful you have been! I am trying to start reducing NOW so that when the band comes out and I am waiting the sleeve I can hopefully lose a little... and at least NOT gain. At 5'5", my normal weight should be something like 135-145 range, but I would be estatic, positively estatic if I could maintain a weight of around 160... I mean, that would just send me over the moon with joy. I was wondering if I fell in the catagory of the "high BMI". It is amazing that people reach the weight they are gonna hit in that 12-18 months even when there is so much more to lose. My surgeon uses the 38, which I think falls in the range of normal for the best results so i am happy with that. Thanks again! I have spent some quality time at Pub Med reading through studies, but it is so wonderful to have such an nice summary punctuated with your own personal experience!!!

1. Reduce overall body pain - all this extra weight hurts! 2. Slowdown the onset of my arthritis. I already know i need two new knees. The knee surgeon implored, begged me to get some weight off so I don't wind up disabled. This actually makes me cry a little.. I mean I can't control my hunger and eating even though I am at risk of becoming disabled??? 3. Being able to fullfill even more of my horse dreams. I love riding, I love my riding friends - it is a thrill and a joy and a central theme in my life (now that my kids are adults). I want to do more! I want to ride steep mountains, do long endurance rides, run barrels (speed!), ride in a drillteam (spandex!) but mostly I want to be a really good rider and I am currently limited severely by all this excess weight. 4. I want to have more energy and endurance and not be sweaty exhausted from physical exertion. 5. I want additional career opportunities - I am pretty sure that my obesity has ruled me out from certain promotions 6. I want to not feel embarrassed in social situations. I want to look in the range of normal 7. I travel frequently for business and even though I don't need an extender, I feel like a sardine in a can. I remember the days of not being pressed up against the seat arms, I want those days again! 8. I want to feel more attractive and noticed in a good way by the opposite sex (especially DH, but hey, I am flexible!) 9. I want to live long and stay active enough to enjoy those future grandkids! 10. I want to make a long trek through exotic lands, and dang it, i just don't have the energy to do it. 11. It would be great if my feet didn't hurt as much (oh, did I mention pain already??) 12. I just want to be a normal person who doesn't constantly think about food, eating, not eating, weight, if clothes fit, if that chair will be comfortable etc. Is that too much to ask?

I am in the pre phase, but trying to improve habits, and heck maybe even lose some weight! I have been tracking my food and notice that I do pretty good during the day - high Protein, wholesome foods, lots of fruits and veggies. After dinner, I seem to go to heck. I try not having junk in the house, but I seem to be constantly wanting to eat. If we don't have dessert, I will have a bowl of Cereal. It is just a very strong desire to eat starting about 2 hours after dinner. About 5 years ago I lost 85 pounds on WEight Watchers and I had to break myself of the habit of eating in the middle of the night. Seriously, I would wake up in the middle of the night really hungry and not be able to get back to sleep. I had to really force myself to just STOP and that habit has not returned. (I believe now that i was waking due to undiagnosed sleep apnea). So, i would love to hear some tricks and tips from people who have successfully beaten the "eating after dinner" challenge.

This is a huge decision, so you are smart to be thinking it over carefully. I was banded 10 years ago when the choice was really the band or the gastric bypass. I have never felt comfortable with the gastric bypass - not then and not now. I realize that is largely an emotional reaction, but I think we all need to feel comfortable with the basic idea of the particular surgery. I chose the band, largely because it is reversible. What I didn't realize is that it will MOST LIKELY need to be removed at some point. Mine does, it has slipped. I have documentation from Bioenteric LapBand that states it should not be considered a permanent implanted device. What I also didn't realize at the time is that while it is removable, many (most?) people have fairly significant scarring, swelling and adhesions. In other words, it does damage while it is in there. Be careful when you consider this "reversible" aspect as a benefit - it isn't as beneficial as I had thought. I personally didn't mind the fills, my problems with the band were a little different. I lost weight my first year, but honestly it took alot of dieting and exercise to get from 272 down to about 202 over a year. I did better losing weight on weight watchers. I was very happy to get down to the low 200s, but it was clear to me that my odds of becoming normal weight were close to nada. Things went really bad when I had such excessive reflux/heart burn that I needed to have it unfilled - I regained everything and plus some. As was pointed out very eloquently by others, the issues around having a "pouch" are very real and need to be clearly understood. So, I hear that the new bands are better. The old ones were smaller, so even unfilled they caused some of the problems. The sleeve is not entirely risk/issue free either. Personally, the reflux is a big concern because I never had it before banding and it became a major quality of life issue. I hate it. When I had fill in my band I had to sleep with the head of my bed elevated, I couldn't eat within many hours of bedtime etc and I still had problems.

I feel very positive about the doctor and his level of experience and local reputation. I also feel very good about his... frankness .. in discussing the risks. That is why I still worry about the reflux because he is honest in saying that it can be a real problem for some people. A significant minority of people. He will do it in one surgery for self pay patients who can't afford two surgeries. For anybody that can swing it financially, he really wants a healing period between the band removal and sleeve surgery of at least a month. I think reduced swelling is the main reason. I am looking for the lowest risk approach, so I am definately doing it in two steps. Since my band has slipped, I should think insurance approval should be easy, but get this, my insurance wants an updated psych eval just to remove the slipped band!!! What?? I had the eval last Nov when i was looking into the gastric bypass and figured I would need a new one for the sleeve surgery, but to get a slipped band removed??? strange. Anyway, I haven't jumped through all the hoops yet. Your points about how the leak is treated are good questions that I will ask when I talk to him next. I had an upper endoscopy a week ago and it seems to have angered my band. Irritated stomach and increase in reflux/acid. I can't wait till it is gone.

Tiffkins, thank you for that very informative post. What really struck me is the "pouch" comment. That clicked since having a pouch sucks. Having a normal, but smaller stomach seems a much better solution. Do you happen to know what they use as the cut off when the say "high BMI" patients having different outcomes. I have read this elsewhere but have been unclear on what the cut off is to be considered "high BMI" for purposes of these studies.

My doctor was very frank about the increased leak rate for revisions. It made me scared, but I sorta thought... well, they''ll just re-operate and it will be fine. I have since been reading more up on it, including the horror stories from the forums and I realize that for some people, the recovery from a leak is a terrible ordeal. That is really scary and being a revision patient, a very real risk. My surgeon has done a number of revisions and I understand no one has died yet, but this is a serious issue for him - so I am coming to terms with handing my fate over to his skills and hopefully some decent luck! What is not satisfying is the acid reflux issue. I never had it until banding and it is just terrible. I have lived with it now for awhile and it really scares me that it will likely persist, may even be worse with the sleeve. The doctor offers me no reassurances on this subject at all. I am wondering how you are all doing with it?