DrWatkins

Hmmmm..... Are you recent post-op? Lots of causes for nausea. Are you taking any aspirin, Aleve, ibuprofen? (can irritate stomach) Do you still have your gallbladder? (common in weight loss) Any chance of pregnancy? Have you tried an antacid like Zantac? (calms stomach acid irritation)

liquid diet will certainly clean out the ole tubes for sure. Kaopectate is good for this as it gels the stool instead of paralyzing your colon like other agents that then lead to constipation. Another thing to keep in mind is antibiotic induced diarrhea (pseudomembranous colitis) which some people get after the intravenous antibiotics given prior to surgery. This typically causes really watery stool and doesn't get better until treated. So, if anyone gets persistent watery stool it would be good to ask your doctor if they think you may have pseudomembranous colitis.

The stomach is designed to store food for a bit while digestion takes place. The esophagus is not a storage organ, it's a transport organ like an elevator with two buttons - down and up. It always tries down first and when that doesn't work it switches to up. Typically, "stuck" is when poorly chewed food or too big a bite gets stuck to the point of backing up into the esophagus. Also, if you eat perfectly but eat too much, it will back up into the esophagus and want to come back up. hope that helps

It is true that some insurance companies do not cover the cost of the band itself (approx $3,000). Isn't that outrageous? It is true that some insurance companies do not cover band fills but they will pay for band surgery. Isn't that outrageous?

The main purpose of losing weight before surgery is to shrink the liver. When you are overweight, the liver is overweight and we lift the liver to put the band in. If the liver is large it makes the surgery more difficult, harder to see high up on the stomach where we're working. The first weight you lose comes right out of the liver. It is easier for the body to mobilize liver fat than the kind that makes our clothes tight. You wouldn't believe the difference it makes in the ease of surgery when patients lose even 10 pounds before surgery. The biggest livers are in men, diabetics and BMI>50. I tell patients to lose 10 pounds for each of these. So for example, a female, non-diabetic, BMI<50 is an easier case as far as the liver is concerned. There have been instances of surgeons not being able to put the band in due to the size of the liver. Leaving a "fatty liver" for many years can actually cause cirrhosis - the same liver disease that alcoholics get. Fatty liver can cause elevations in liver enzymes on blood tests. Losing weight is amazingly great for your health for many reasons. It also is great for your liver.

I think if you're easily losing weight and don't feel like you're on a diet, it is okay not to get a fill. We've had patients that reached their goal without a single fill. The band journey is very individual. If you reach the point of being hungry and hard to lose or maintain weight and you feel like you're on a diet and you feel like the band's not working then get a fill.

The volume in bands to reach perfection is really quite different from one individual to another. I tell patients to not worry about what other people have in their bands. We have patients that lose all their weight with no fills and we have some patients that get filled a bit beyond the max amount of saline to reach perfection. I think that regardless of how much saline is in there, if you can eat a lot and are hungry and it is hard to lose weight you probably need more saline in your band to help you out. A lot of patients reach perfection on the fill but then get discouraged later because the perfect restriction gradually goes away. This is caused by the fact that the stomach tissue inside the band is losing weight with you and you need another fill to reach the same degree of restriction. hope that helps

If not full on solid foods you may need another fill. It would also be helpful to do a Fluid check i.e. pull all the fluid back into a syringe and see how much is really in there. VG stands for "Vanguard". This band was called the "11cm" band outside the United States. The smaller sizes (9.75cm, 10cm) were FDA approved in the U.S. in 2001. They had issues with the 11cm band so they re-designed it and got it FDA approved several years later. The company didn't want people to call it the 11cm band because they of the earlier problems so they gave it a name instead of a size. hope that helps

If it helps, we have a band practice north of Cincinnati and my partner, Dr. Mobley is banded himself as well as his wife and half his family. The entire office is banded and we do fills (by a banded nurse) in Columbus, OH.

I don't know if this helps but you can attend our band support group in West Chester, OH north of Cincinnati. From south Dayton the drive is less than 30 minutes. You could call the office for details 513-939-BAND (2263).

Thank you for posting this. People considering leaving the country for "cheap surgery" need to know a couple of things: When you leave the country for "cheap surgery" you are not buying the aftercare. Most U.S. surgeons do not sell the surgery without the aftercare and that is one reason why it cost more. Many people who leave the country end up paying more money in total and struggle to find aftercare. Also many people just have the surgery and no aftercare and end up spending money for nothing other than frustration. The least expensive route, I would argue, is to find a great U.S. practice near your home. You have the greatest chance for success under this scenario and the least amount of frustration. hope that helps

If the redness and discomfort resolve completely with antibiotics that's a good sign. If redness and port pain return within a few weeks of stopping antibiotics this would be suspicious for a port infection. Time will tell. hope that helps

Good point. Certainly every patient's symptoms are different. Many people feel that erosions make you really sick due to intestinal contents leaking out into the abdominal cavity. It is true that most erosions do not present this way. They typically present with weight regain. I have heard of "asymptomatic" erosions where patients continue to lose weight despite seeing an eroded band on endoscopy. Over time, however, the erosion tends to continue to the point of loss of restriction. The good news is that erosions are so rare nowadays we don't have much experience with it.

I saw that he is in Coos Bay, Oregon but I do not know him. The best way to research a surgeon is to call the hospital or surgery center where they work and ask the operating room nurses what they think of a particular surgeon. You will get great information from the people that work with surgeons (and are not in their practice). That's always good advice for any operation. hope that helps Merry Christmas!

Try Dr. Robin Blackstone (band surgeon). She is excellent and she will know excellent plastic surgeons in the area. I was just at a meeting with Dr. Blackstone last week regarding the new REALIZE band. Here's her info from American Society for Metabolic and Bariatric Surgery website. Robin L. Blackstone MD FACS (Center of Excellence) Regular Member Surgeries Performed: LB LGBP Scottsdale AZ USA 480-391-3885

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.

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

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

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?

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