DrHekier

Most of our patients need somewhere around three fills to get to their 'sweet spot.' I know one patient who lost 99 pounds on one fill, and others that didn't start losing until several fills. Each person is unique and it might take some time to get to your sweet spot.

You might need to get some fluid taken out, an 'unfill' is what some people call it.

I think this is one of the most important threads in a long time on LBT. Lap Band surgeons constantly struggle with trying to convince people that if you aren't losing weight, that doesn't automatically mean you need a fill. Too full is bad!

(Speaking as a Lap Band doc, not a patient, so I realize I may be WAY off base.....) My idea of the sweet spot is when you barely know your Lap Band is there. I worry that if the band is 'tight' that it may limit what you eat and you gravitate towards things that are easier to eat such as very dry crunchy foods (tortilla chips, cheetos, pretzels) or liquids such as chili, shakes, Soups, etc, which we have seen occasionally in our patients. My favorite story about the sweet spot is a patient of ours who is a 66 year old man who has lost about 90 pounds in his first 9 months. Every time I see him in clinic he tells me he thinks his Band is broken because he never feels tightness, nor any restriction! I think that is the perfect sweet spot, when the Band helps control your hunger, but doesn't prevent what you can eat. I tell my patients to focus more on hunger control than on tightness/restriction. My two cents.

I seem to recall the slippage rate being quoted as 1%. Our practice has a slippage rate of a bit under 1 percent so that seems right to me.

I'll ask my office manager if we have had any patients use a specific attorney, but I know Walter Lindstrom is highly regarded.

There may be different 'flavors' of Fed BCBS, with some PPOs providing preauthorization. We have been told by our Fed BCBS representative that they do not provide pre-authorizations or pre-determinations. They say if you meet criteria they will pay for it so they are asking us to take it on faith. We are waiting to get reimbursed on our first Federal Blue Cross Blue Shield patient done in 2007. If we see there are no problems with reimbursement than we will do them more frequently. I read here on this board of another patient with Federal Blue Cross Blue Shield who paid the surgeon and hospital and then filed on the insurance to get the reimbursement.

I think you may be a touch too tight. I always remind my patients that if you are too tight it can lead to inadequate weight loss. Excessive tightness causes restriction to 'good foods.' Some patients who are too tight compensate by having high calorie foods. Tortilla chips is VERY common; chili, shakes, Soups are other common items. I would probably consider taking some Fluid out. If you could feel better satisfaction and early satiety with 'good food' it would prbably help you. Good luck.

I would suggest you consider calling the insurance company as well. Sometimes they seem more receptive if a 'customer' (i.e. patient) calls in addition to the doctors office.

Not quite sure what you mean about tipping them off. An insurance policy is a contract between you and the insurance company. If a procedure is a covered benefit then they have to provide it if you meet their requirements. Give them a call. Everyone's policy is potentially different. So your policy with that payor may be different than someone elses, which is why you need to call yourself. Good luck!

Boy this is almost inconceiveable. How could Fluid get into the Band, but not get out of it? How could there be some sort one-way valve that allow fluid into the port/band, but not out? I must not be understanding something here. I think of it in terms of a bicycle tire. How can you have a leak that allows air in, but not out of the inner tube? I assumed it was a matter of fluid in the tissue around the port, i.e. a seroma. So I think what you are describing is fluid around the port in the subcutaneous pocket where the port is located. Thoroughly confused....

When the fluid is drained is it within the port or from the tissue pocket around the port, ie. the port site? I would suspect the latter. It sounds like you may have developed a post operative seroma, i.e. a fluid collection. Do you have medical conditions that increase risk of infection that can be controlled, such as diabetes? In some situations the port may need to be moved to another site.

.It's a contract; once you sign up for an insurance you have to play by their rules. But sometimes you need to get an attorney to make sure they are playing by their rules as well.

A recent TEC assessment recognizes the benefits of the Lap Band when compared with gastric bypass. TEC (Technology Assessment Center) was founded by BCBS to evaluate new technologies in medicine. This is a non binding assessment that does not require any individual BCBS carrier provides coverage for a particular procedure, however one would think that it would make such coverge more likely. http://www.bcbs.com/betterknowledge/tec/press/tec-in-press.html This link may change as the announcement moves from 'in-press' status to 'published' status.

Be careful. In some cases after 3 denials you have no recourse at all and the case is closed. Might be time to get an attorney. Try Walter Lindstrom at www.obesitylaw.com

We hope for the best Sherry. If you wouldn't mind, please update us as to what you and Dr C find. We can all learn from your experience. Thanks to Dr C for helping out!

There are some services that expedite passports that I saw when I did a google search. At the very least, call the surgeon in Mexico. Maybe he or she can offer advice. Hopefully the surgeon in Mexico that put in the Band would offer to help somehow. For example, you might try to get a copy of the results of all your tests, including any images, and fax them to the surgeon in Mexico.

Sounds like possibly an intermittent slip. No contrast went through the UGI when the Band was empty, so that seems like possibly a slip. I am assuming you had a VG Band, if it was the Inamed/Allergan Band, since they had 8cc in. That is the largest Inamed Band and it is unlikely that you would have obstruction nearly a year later without a slip. How hard is it for you to go back to Mexico to see your original surgeon? I would recommend to get a complete workup by your Lap Band surgeon. All the best. Please keep us posted.

I agree that you should start with an unfill. Since you had a Band in Mexico, is your local fill doctor a surgeon?

There is no consensus regarding cholecystectomy and obesity surgery. Some surgeons are concerned that taking out the gallbladder at the time of lap band placement can increase the risk of infection. 1) Removal of the gallbladder (cholecystectomy) is termed in surgery a 'clean-contimated' case. This term is reserved for surgery in which you cut across an organ that has bacteria within it and possibly intorduce bacteria into the abdominal cavity. The gallbladder has bile, which empties into the intestine, and therfore can have bacteria within it. 1a) There has been at least one report in the literature of surgeons performing cholecystectomy at the same time as lap band placement and no increase infections were noted. 2) Many reports show a low number of patients go on to require gallbladder removal after lap band surgery. A few years ago I recall a presentation at the annual meeting of the American Society of Bariatric Surgeons on whether cholecystectomy should be performed at the same time as weight loss surgery, and there was no consensus. Bottom line, discuss it with your surgeon and learn your options from them. Good luck!

I can recommend Dr. Bob Basu in Houston. He is a faculty member with the Baylor College of Medicine. http://www.bcm.edu/plasticsurgery/physicians/basu.cfm If you choose to see him, tell him I said hello!

An upper GI can be ordered to make sure you aren't flipped, although a first step would be to take some fluid out of you band.

The 'supervised diets' sometimes mean that your weight loss program must have been supervised by an MD. If that were the case, you may need to visit your physician monthly and have them document each month that yes, you are on a supervised diet, have seen a nutritionist, etc..

I'll ask some of our Louisiana patients to take a look at the forum here. Most are from the Shreveport area. Congratulations on your new band!

I think GEHA only covers the procedure if done at a facility which is certified as a Center of Excellence