DrHekier

From our experience with one insurance company that is denying the band they are saying that it is 'experimental' because they believe the gastric bypass is better than the Band. You can consider an appeal and you and/or your surgeon should provide articles comparing the LapBand to the bypass. Good luck!

We just banded a patient from Fayetteville, and are unaware of any support groups there. Certainly let us know if you can get a group together!

For solid food, gastric emptying is often seen by about 90 minutes, but may last a few hours. Certainly wouldn't expect anything to remain until Monday! Have a great Monday and a great Lap Banding experience!

Many of our patients don't feel much restriction until the 2nd or sometimes even 3rd fill. In fact I think there was a thread here on this website with a poll asking how many fills it took for people to feel restriction. Also, it appears that those patients with the Vanguard or VG size Lap Band (which you have) may take just a bit longer to get to their sweet spot of restriction because with the larger size band there is more variability during your fills. Make sure you go to your surgeon's support groups. That way you can ask questions with people who are farther along than you, and also at the same stage as you. Our patients seem to get the some of best education from other patient's in the support groups. Of course, this site is a support group in and of itself, and you will find many people willing to help! Good luck!

Have you had a recent fill? To me it sounds as if some of your symptoms might be related to restriction from the band. If you had a recent fill, maybe you need a small amount of fluid removed from the band.

The only issue that I can think of is if you go on to have a stereotactic biopsy. For a stereotactic biopsy, you need to lay on your stomach for about 30 minutes or so. (Go to google images and search 'stereotactic breast biopsy') You may be a bit sore, especially at the port site. Since you have a palpable mass, there is a good chance you would be a candidate for an ultrasound guided biopsy, for which you lay on your back. Now of course, the mammogram and/or ultrasound may show you do not need a biopsy at all. Keep us informed, and good luck!

Here's the link to the clinical policy bulletin by Aetna, revised March 31, 2006: http://www.aetna.com/cpb/data/CPBA0157.html

Both the 9.75 and 10 cm bands hold 4cc. The Vanguard (AKA VG or 11cm Band) holds 12 or so cc's so you have one of the other ones.

My understanding is that in 2002 the IRS ruled that obesity is classified as a disease in its own right, and medical expenses for treatment are tax deductible. So get that money back from Uncle Sam!

About 2 weeks ago I attended a Lap Band symposium and the change for Aetna was mentioned. Apparently it just took place a few weeks ago. My understanding is that Lap Band and Gastric Bypass are now on equal footing as far as Aetna is concerned. In the past Aetna had extra criteria required for patients who wanted to choose the Lap Band as opposed to the gastric bypass, and those extra criteria are no longer required. Since this is a new development, your physician's office may not be aware of it. Good luck!

I have heard through the grapevine that in the next few weeks there may be a lawsuit filed against BC/BS of TX to challenge the legality of the 12 month supervised diet requirement. Perhaps they got wind of that and are becoming more lenient. Disclaimer: This is only hearsay on my part, and I am not alleging any wrongdoing by any party.

Medicaid eligibility is decided on a state by state basis. Call your state's Medicaid office and ask them if CPT code 43770 is covered. Good luck!

It appears Michigan Medicaid may cover the Lap Band. The CPT code for the Lap Band is 43770, and it appears to be covered. See the following link: http://www.michigan.gov/documents/MSA_05-70_143729_7.pdf Good luck!

See if your Lap Band surgeon has made arrangements for an evaluation by a nutritionist or dietician. As part of our program, all of our patients are evaluated by a registered dietitian. Call your surgeon's office, they should be able to help. Good luck!

Here's a picture of a tragic case of slippage. Not for the faint of heart.

Both my wife and I (both of us are surgeons) tell our Lap Band patients that we don't even care about their weight until the first adjustment. Most of our patients lose some weight because we ask them to be on a liquid diet post-operatively and then mushy food before transitioning back into a solid diet. But our belief is that we shouldn't expect weight loss until an adjustment or two is made, which won't be until more than a month after surgery. Regarding the brain transplant comment, I assume it was a joke and meant in jest. Besides, most insurance companies won't pre-authorize brain transplants without a 6 month history of medically guided attempts at gaining higher intelligence, and you must have documented a 5 year history of brain atrophy. A medical letter of necessity is also helpful, and of course you have to check to see if there is an outright exclusion on your policy.

Gastroparesis can also be seen in diabetics. Do you have diabetes?

Do you have a history of GERD (reflux)? If so, your doctor may want to get the Upper GI to evaluate if you have a large hiatal hernia that may change his/her approach to surgery.

There was an earlier thread that you might find helpful. http://www.lapbandtalk.com/showthread.php?t=12271 Good luck!

I have heard of an instance of it happening in the U.S. As to what the proper step would be, it depends on the specific situation I suppose. 1)For example, does the patient have a higher than average BMI making Lap Band placement more difficult. (Our average patient has a BMI of around 46, with the high 81.) 2) Does the patient have prior surgery with intra-abdominal adhesions, making surgery more difficult? 3) Does the patient have prior gastric surgery, such as a fundoplication, or gastric bypass, which might make the surgery more difficult.

That is possible, but very difficult to tell with static images. The upper GI is taken as a "movie" and the sequence would be helpful to see. 1) Supposing this is a misplaced band, WHICH IS ONLY A SUPPOSITION, I don't think it's a Mexico vs. US issue at all. 2) We currently perform upper GI swallows postoperatively before the patient goes home. However, we may change this practice. We have never had an instance where that upper GI test changed our management of the patient. Additionally, a few months ago a paper was published in the "Journal of the American College of Surgeons" from a group that performed over 1000 Lap Bands. They stopped doing upper GI swallows after their first 100 patients because the swallow didn't change any course of management. 3) Again, I don't think this is a Mexico vs. US, or Swedish vs. Inamed issue.

It's difficult to tell from your images what exactly is going on. Keep in mind that since many physicians in the US (including myself) have little or no experience with the Swedish Band that you had placed in Mexico. At first glance, looking at your pictures, I thought that the "Band" looked a bit off to the side, as if the stomach itself was not banded, but at the same time, it certainly does appear to show restriction to the barium flow. Do you have pictures from your endoscopy?

What I always found interesting with Aetna's requirement is that the FDA does NOT approve the Lap Band being put in patients with 1) Patients with cirrhosis or 2)Inflammatory bowel disease (see http://www.fda.gov/cdrh/pdf/P000008b.pdf); and surgeons may not choose to electively place the Lap Band in patients with conditions 3, 4 and 5. I will leave each to draw their own conclusions with regards to Aetna and their policy on Lap Bands

Medicare, while a federal program, is handled by different regional carriers throughout the country who can set their own rules. My understanding is that beginning this year, Medicare will cover bariatric surgery for patients under 65, but not for those over 65 years old.

With regards to Wadley vs. St Michael's, we have seen that insurance companies that cover St Michael's and not Wadley will provide out of network coverage for the Lap Band at Wadley. Dr. Keilin and I are on active staff at St Michael's as well as Wadley, but St Michael's does not offer the Lap Band. We have had a significant number of patients who have insurance that generally covers St Michaels only; they have the Lap Band covered at Wadley without any difficulties since the insurance company understands that the Lap Band is not an available procedure at St Michael's