DrWatkins

Great job on your weight loss!

Good point. Dr. Blackstone is a gastric band surgeon. She would also know some great plastic surgeons in the area. Sorry for any confusion.

Dr. Robin Blackstone in Scottsdale is a great band surgeon. She's the closest one I know.

Typically you can get any band pretty tight. I would recommend a Fluid check to make sure it has in it what they think is in it and also a fluoro to check the restriction it creates. hope that helps brad

Insurance companies don't specialize in your health. They specialize in denying things. They collect money every month in insurance premiums. Their business is figuring out ways to keep as much of the money as possible. They do this by denying things for stupid reasons and ratcheting down payments to doctors and hospitals. Don't torture yourself thinking insurance companies make sense. There are thousands of ways (other than evil insurance companies) that people have band surgery. Never give up hope.

Let me know what part of the country you're in and I'll give you some names.

What city are you near? I have lots of great band surgeon friends.

If the saline is injected into the surrounding tissues the body simply absorbs it and uses it. The majority of our blood is saline and interestingly it has the same salt content as the ocean. If you go into the emergency room dehydrated they will pump thousands of milliliters of saline into you (I.V. fluid). If a fill misses the port you get 0.5 to 4 milliliters (whatever the volume of the fill).

Over 1,000 as primary surgeon and many, many more assisting and teaching other surgeons.

Thank you guys for the awesome feedback! Seems we surgeons have some work to do to reach perfection. Your feedback is really appreciated. Keep it coming!!! brad

Sometimes it is a bit tight for a few days after a fill, but if this persists, I would have some saline taken out. The band should be perfect all of the time and perfect is when you get full on small meals, aren't hungry and easily lose 1-2 pounds per week.

If the 6.75 stays in there more than a week I would doubt you have a leak. The 10cc bands (Vanguard) can be hard to withdraw the exact same amount you put in. If you are maintaining good restriction then the band is likely holding saline. If the restriction repeatedly goes away after fills then it is likely you have a leak especially if they withdraw zero saline on a repeated basis despite replacing the saline each time. Fluoro is always a good idea if the clinical picture is confusing. When we replace a port we always go through the same incision and it can be done under local anesthesia (with some sedation to make it more pleasant). hope that helps brad

Colleen, You're welcome. I love band patients and am continually inspired by the amazing things they accomplish. The more information people have the more successful they are. That motivates me to spend time here.

I'm sure there are excellent plastic surgeons outside the United States that are less expensive. If it were my wife or family, I would have them get plastic surgery by any number of the awesome plastic surgeons I have worked with in the U.S.

We accept any banded patient for fills regardless of who did the surgery. We have a clinic in Oak Brook, IL if you want to call them. Dr. Duane Tull is the surgeon in Oak Brook and he has had the surgery himself. Neat guy. Their info is on our website, Synchrony Health :: Home. hope that helps brad

Out of fear that we're going to get kicked off the boards for using up all the bandwith, I'll be brief! If a surgeon's office number appears at the end of a TV ad this suggests that they are using the ad and paying for the placement. For years, in the Inamed/Allergan committee meetings, a common complaint was that many patients were leaving the country to buy surgery only (no aftercare) and then returning to their local community to care for the complications. This gives the band a bad name in the local community and the problem isn't the band so much as it is with complications from out-of-the-country surgery and no aftercare. Surgeons complained that they promoted the notion that you could buy the surgery without the aftercare. We thought they ignored those comments. Urgent unfills are a problem. I've driven a few hours before to unfill a band in the back of my car. I've made house calls, boat calls (patient at a marina), truck calls (in Wal-Mart parking lot), met people in the mountains and many other interesting trips to unfill bands. Like most of my band surgeon buddies I keep a tackle box in my car with all the stuff in it and use it often. The other day I flew to Columbus to unfill a band (have my pilot's license). They had awesome leather recliners in the pilot's lounge of the small airport that worked perfectly for band adjustments. As more and more surgeons offer the procedure, access to fills will improve over time. Currently, it's a problem. It would be fun to have a lapbandtalk.com meeting. Should we march around the White House or what?

The band balloon is a permeable membrane and it will lose a tiny portion of the saline over time. The smaller the band and the tighter it is, the more saline you lose over time. A bigger band with a small amount of saline will lose very little saline over time (assuming no leak). If the saline leaks out the body will absorb it very quickly. Sometimes when we do a fill we're not actually in the port and the fill goes into the tissues. This creates confusion when we do a Fluid check on the next fill. If you live anywhere near Cincinnati, I'm happy to do your fills. hope that helps brad

If your band held 2.0cc for 2 months it seems unlikely that you had a leak then. The question is if you have a leak now. The best way to determine if you have a leak or not is to have them do a "Fluid test" at each fill, i.e. draw back all of the fluid and see how much is there. Most leaks will drain all of the fluid out within 3 days. Occasionally we'll see a slow leak that takes a week, but if your band has the majority of the fluid in after a week then there's no leak (hey, that rhymes). Also, sometimes we think we add fluid to the port but it doesn't get into the port, etc. Sometimes we think there's a leak but over time we determine that there isn't one. I've seen everything. I would advise that if the band isn't tight enough (full on small meals, not hungry, easily lose 1-2 pounds per week) then have them add some more saline and do a fluid check. If the fluid is repeatedly at zero, have them replace the port. Replacing the port cures 99% of fluid leaks. I've seen a few patients that had needle injuries to the tubing but that's rare. And leaks are not a problem in the sense that we use sterile saline which is the same stuff in intravenous fluid they give you in the emergency room if you're dehydrated. It doesn't hurt to have a few milliliters of saline leak out. Your body just absorbs it. And it goes without saying that fills should always be done with a Huber non-coring needle. Regular needles can cause leaks in the system. (So can Huber needles, but much less of a chance). hope that helps brad

This is a great discussion to have because it is very informative to everyone on these boards. It's necessary information. I'll speak to the Inamed advertising - we paid half the ad costs and I think one patient came to our clinic as a result of their ads. The ads referred patients to a call center that was a turnoff to patients. The ads (and the campaign) were so ineffective they pulled it. Allergan now does ads on their own to raise general awareness. Certainly American patients having surgery by American doctors easily transfer their care without much fuss. American doctors do accept a lot of risk when they accept the care of a patient who had surgery out of the country. I agree that $1100 is way too much. To me that basically says that they don't really want to do it, but if you pay the outrageous fee then okay sure. What is happening now is that more insurance companies are paying for the band and soon it will be commoditized like gallbladder and hernia surgery and the aftercare will be fairly ubiquitous. Gastric banding is at an awkward state in the evolution of a new technology where you have early adopters having trouble getting care in their neighborhood. This will change over time. Medicare rates are truly at all time lows. Most of their reimbursement is below what it costs to provide the service (at a high level of quality and customer experience). Most physicians accepting Medicare are paying their light bills by other means. The main thing to recognize is that the informed patient will undertand that when you leave the country for low cost surgery, you are only buying the operation. Success = operation + post-op support. I'm always impressed by people that leave the U.S. every time they need a fill and get their aftercare out of the country. Most people don't (can't) do this. The other thing that makes my eye twitch is that I've known many examples of people who purchased the operation only -very cheaply- and over the next year spent more money in total getting their aftercare than if they had just stayed in our practice and received their care by an amazing team right in their neighborhood. (Cheap surgery can be expensive). We've also seen patients that come back from "cheap surgery" with a disaster and end up paying two and three times what we charge simply fixing complications. That scenario gives me heartburn. It just shouldn't happen. I've heard of several patients that came back with just a port and no band inserted. I've heard of several patients where a non-traditional band was inserted - some of these look like they were made in someone's garage. I've heard of nurses stealing the narcotic pain medications and injecting patients with saline and patients being in pain with the "pain medication" not working. We've had to remove several bad band infections in patients that went outside the U.S. Many places outside the U.S. will re-use disposable instruments by soaking them in anti-septic solution (i.e. not sterile) because it's cheaper than sterilizing reusable surgical instruments. If you don't use sterile instruments your infection rate is going to be higher. To prevent infections, U.S. operating rooms are required (and regularly inspected) to have laminar flow whereby the ventilation system is in the ceiling in the center of the room and the air flows down and out away from the operating table. This air flow prevents contaminated air from other parts of the room circulating around the open wounds. In other words, you don't want air flowing from shoes and floor up onto the surgical wounds. Also, U.S. operating rooms are required to have positive pressure. You can test this yourself by putting a Kleenex on the floor beneath the door of the operating room. The Kleenex should be blown away from the door. If the Kleenex doesn't move or even worse, gets sucked under the door into the room, that operating room doesn't have positive pressure and the infection rate will be much higher (the air is flowing from contaminated areas into the operating room). You want this to flow the other way. Air should flow from sterile areas into contaminated areas - not the other way around. If an operating room doesn't have laminar flow and positive pressure, you shouldn't have a surgical implant placed. The infection rate will be too high. You can tell if an operating room has laminar flow if the ceiling around the operating room lights has a square area with metal grids with fine holes in them and the return air ducts are in the corner of the room. You can also do the Kleenex test to see if the room has positive pressure. If the operating room doesn't have laminar flow or positive pressure, RUN! Anyway, I like you too, WASaBubbleButt. You make me think. brad

When your restriction only lasts for a few days after each fill, it MAY mean that your saline is slowly leaking out of the port. I would recommend they do a Fluid check with each fill and make sure the saline they put in is still in there. If the fluid checks consistenly return zero fluid, you should have your port replaced which would solve the problem. Hope that helps brad

Certainly, choice of procedure is a very individual one and I respect that when patients are well-informed about the true differences. Certainly band complications are no doubt much less severe than the "gut altering" procedures. For example, I would much rather have a port issue fixed with local anesthesia than peritonitis due to a leaking staple line which can be disastrous. The topic of "surgery outside the U.S." is a delicate one. At the risk of controversy I would like to provide some insight perhaps on the way U.S. surgeons view this: Please know that as far as technical ability in the operating room goes, there are many excellent band surgeons outside the U.S. That is not the problem. You also have to know that plastic is more expensive in the U.S. Many surgeons outside the U.S. purchase the band for a third of the cost American surgeons have to pay. (About $1,000 vs $3,200). Part of this difference is that manufacturing companies are far less likely to be sued outside the U.S. Liability insurance for bariatric surgeons in the U.S. is beyond outrageous. This insurance in other countries is cheap and most surgeons don't even buy it. If something really bad happened during or after surgery it would be very difficult to sue a surgeon in another country and it would be very difficult to find a lawyer to take a case like that. The majority of band patients that travel out of the U.S. to have surgery never return to the foreign practice for their follow-up care or support group. Most patients in the U.S. return to their surgical practice for adjustments and support group and this requires hiring adequate staff. American doctors that take a patient into their care after having surgery out of the U.S. are taking on a major liability that most doctors feel is simply not worth the risk. So, if I could buy the band at a third of the cost and didn't have to buy expensive liability insurance and most of my patients never returned for their fills and adjustments and support gruop, I could offer the surgery for a very low price. My desire, however, is to help patients lose as much weight as we possibly can together as a team. I always tell new patients that this is not surgery; it's a weight loss program. For patients not covered by insurance who are paying out of pocket we've always lumped the aftercare into the price because if you make patients pay for fills after the operation they don't come in as often because you have financially disincentivized their aftercare. We in essence require patients to purchase the aftercare with the operation as they are both equally important to the ultimate outcome - success! Hope that helps brad

Yes, you're in the Swelling Gone, Awaiting First Fill phase of the healing period. You can do it! Massive weight loss, coming up!

I can't tell you the number of times I've walked a new patient back to the waiting room and one of my patients runs up to me and plants some lipstick on my cheek. That never gets old!

There are certainly some surgeons that agree with you. For me personally, I don't like the thought of having most of my stomach in the waste bucket forever. I like leaving the GI anatomy the way we were born - the band being on the outside and completely adjustable and reversible. If the sleeve is too small - you have to just deal with it. If the sleeve is too big - you have to just deal with it. There is talk of banding sleeves that stretch out over time and my thought is why not just band in the first place and have something easily adjustable for the rest of your life. We have hundreds and hundreds of band patients doing perfectly and I do think they don't post on message boards as much for some reason so one can get a false sense that all band patients have problems. Some surgeons love the sleeve. Not for me. Understand these are my opinions. When surgeons have bariatric surgery they overwhelmingly choose the band and there are many reasons for this. I tend to steer away from operations that surgeons would never choose for themselves.