JaxBandster

This is a letter I wrote to the practice administrator for Dr. Cywes and Dr. Pinnar outlining the many reasons I decided to go with another surgeon even though it will cost me more money and time. I wasn't going to post it publicly, but since they seem inclined to ignore my repeated requests for my medical records, I feel justified in doing so. For what it's worth I do like Dr. Pinnar, but the accumulation of all the issues below finally motivated me to make the change. Dear ******, I am contacting you as the practice administrator to request that all claims submitted to my insurance provider be withdrawn and to outline the reasons for my decision to go with another practice for my surgery. I will apologize in advance as this may be rather lengthy but this has been a difficult decision and one that I have weighed for the past month. On February 7, 2008 I had lap band surgery which was performed by Dr. Cywes. I had considerable success until approximately two years ago when I began to be able to eat more and began to put on more weight. I then went to Dr. Baptista for maintenance fills primarily due to my past experiences of having to wait hours to get in for a fill with Dr. Cywes. It was faster and easier for me to get them done by Dr. Baptista. Last November, Dr. Baptista order an upper GI to check my band and discovered that my band had eroded. This was confirmed by an upper endoscopy in December. It was at this time that I decided I wanted the gastric sleeve but I was not comfortable with Dr. Baptista’s level of experience in this area so I made a call to Dr. Cywes as I felt more comfortable with him with a more complicated surgery. When I called and explained my situation to the person who answered the phone, she placed me on hold and then came back and informed me that Dr. Cywes felt I should have Dr. Baptista perform the surgery. In other words, he was not interested in seeing me since I went to his former partner. At this point, I decided to go to Dr. Webb’s practice to explore this option. When Dr. Webb’s office requested my records from your practice, I subsequently received a call from the office inquiring as to my reasons for pursuing another surgeon. I explained my experience to her and she assured me that Dr. Cywes did not mean that he was not interested in seeing me and that there were options out there that Dr. Cywes would like to speak with me about. She suggested that I come in with no obligation other than to hear what options were available to me and I agreed. After meeting with Dr. Cywes, I agreed to have him do the surgery to remove the band and subsequent repeat surgery. This was on 2/1/2012. It took a month to submit the initial pre-determination request and the subsequent appeal letter as a result of the initial denial by my insurance provider. We received the approval to proceed on 3/1/2012. Due to an issue at Shand’s with Dr. Cywes, I had to schedule the surgery for 3/29/2012 with Dr. Pinnar at Memorial. Everything went smoothly. I liked Dr. Pinnar immediately and felt comfortable with him. On April 6th, I had my post-op follow up appointment with Dr. Cywes in order to remove the abdominal drain that Dr. Pinnar had placed during my surgery. On April 27th (3 weeks later) I had another post-op appointment. In those three weeks I had put on weight due to my lack of restriction and not following the low-carb plan. As is typical for Dr. Cywes, he saw that I had gained weight and he gave me his usual talk about our relationship with food for 15 minutes and when he was done he said that he would need to tighten my band. I then had to inform him that I didn’t have a band. It appears that he hadn’t even looked at my chart prior to coming in. He just assumed that I had been not following the program. When I got back to my office, I wrote ***** and asked that my gastric sleeve surgery be performed by Dr. Pinnar. I am not comfortable having such an invasive and complicated surgery performed by a surgeon who doesn’t bother to read my chart in his office. On May 15th, after repeated attempts to contact ***** to inquire as to the status of filing a claim for surgery with my insurance company, I finally wrote a lengthy email expressing my frustration with the practice, lack of communication and lack of action in filing my claim. I copied you on this email and it is attached. At this point I finally received a response from ***** saying that she was having computer issues and had not been receiving emails. I responded to her expressing that I understood about computer issues and asked when she would file my claim. She wrote me back on May 17th and said she would be filing it that day. The next day (May 18th) **** wrote to me explaining that she had faxed clinical information to my insurance company. She stated that my current BMI was 35.8 and that if I had a BMI under 40 I would require a serious co-morbid condition to get approved for the sleeve. I wrote back to her explaining that since this surgery was a result of an eroded band that I didn’t believe my insurance would require me to have a co-morbidity. I didn’t hear back from ***** until May 25th stating that she had finally filed my claim. On June 1st, I had a follow-up appointment with Dr. Pinnar. Once again, I had gained more weight, but I wasn’t concerned about it as I knew the reasons why. While I was waiting for Dr. Pinnar, the nutritionist came in looking very concerned and asking me what was up? She also asked me if I felt I had sufficient restriction. I explained to her that I didn’t have a band. She then asked if I was a conventional weight loss patient. This was not the first time she had seen me but once again, it was a case of not reviewing a patient’s information before coming into speak with them. I also had a chance to speak with **** and express some of my frustrations and concerns about the filing of my claim. She assured me that she understood and that she would make sure my claim was filed properly (i.e. for a repeat surgery as opposed to a first time surgery). After **** left, I proceeded to wait approximately 45 minutes to see Dr. Pinnar. He knew I was there as I spoke to him when I first came in. I could hear him out in the hallway talking on the phone and waited patiently for him to finish his conversation. I justified that it must be an emergency since he knew I was there and was keeping me waiting. When he finally came in, he apologized and explained that he was on the phone with his attorney. I was aware of the issues he was having with the physician who bought his practice in Virginia and we discussed that matter for a few minutes. Thankfully, he was aware that I had had my band removed due to erosion. Still, I am a very busy woman. I manage the cash for ********** in their Treasury department. My boss depends on me a great deal. I understand that Dr. Pinnar has some serious issues going on, but he needs to address them on his time, not mine. On June 7th, I wrote to ***** to advise her that my insurance company had submitted a reply to their correspondence department stating that in order to approve the surgery for the sleeve I would have to complete a six month weight loss program with my PCP, which is standard for someone having their first bariatric surgery. Since this is a repeat surgery resulting from erosion, I feel that this requirement should be waived. In my email, I reminded her of this and asked her what the next steps would be for my appeal. I wrote again on June 12th and again on June 14th asking what the next steps in the process would be. To date, I have not had a response from her. ****, I hope you can understand my frustration with this process. I am frankly tired of being ignored and having to constantly remind my health care provider of my medical status and hand feed insurance policy language to support my claims. I have registered with another practice and have an initial consult this Friday with them. I would appreciate my records being sent to them as promptly as possible once they submit the request for them. Even though this is going to cost me a considerable sum of money and probably a little more time since I am basically starting over again, I feel I will be more comfortable with a practice who respects my time and communicates with me. I am a very patient person, but my patience has been pushed to the limit.

Hi Bunkie, I wish I knew how to describe the pulling and twinges I had. They were in the esophogial area right below my sternum. I described them to my surgeon and he pretty much dismissed the symptoms explaining that erosion usually doesn't have any symptoms. (shrug) My surgery was on March 29th and with the exception of being able to eat most anything I want I am doing really well! I actually still have a minimal amount of restriction from where the band used to be. I still have to eat slowly and chew well or I get uncomfortable. In fact, I got stuck really hard on steak a couple of weeks ago. I was miserable! So don't expect to go right back to being able to eat "normally" after you get your band out. Unfortunately I can and do eat much more than I was able to before but that will come to an end once I revised to the sleeve. :-) With the drain, I was fortunate that I like to wear long flowing skirts and I simply pinned the drain to the inside of my waist band and it hung down from there. It was annoying as hell and I was glad to get it out but it didn't hurt or anything. I don't know what I would have done if all I had were tight skirts or pants. Maybe worn a long sweater or jacket?

This is the weirdest thing and I hope someone can help me figure it out. I had my band removed 3 weeks ago due to erosion. I am back on regular food and last night we had steak. It was very tender and I still tried to chew well but I think I may have taken too large of a bite because I got stuck! I mean majorly stuck! Sliming, burping, some pain, the whole nine yards. This lasted for a couple of hours! I finally got past it but today I am taking it easy and having Soups and Protein drinks etc. I noticed when they did the fluroscope at my post op that the area where my band was is still very narrow. In fact, when I watched the Fluid go through the esophagus and into the stomach, it looked and acted like there was still a band there. I attributed it to post-op swelling and the fact that I had 40% erosion of my into my stomach but figured it would ease up eventually and I would be able to eat like I could pre-band. I'm just wondering if this type of restriction will continue or ease up after time. I'm planning on revising to the sleeve once I have healed from the 1st surgery but at the moment, I still feel like I have a lap band! LOL Definitely going to take it easy on the meat going forward!

Hi Jill, There is a lot of speculation about this subject. There are some theories that say it is from filling the band too quickly and too tightly. There are some that say some people are just predisposed to erosion. There are others that say it's due to patient non-compliance. To sum it up, no one really knows for sure.

Hi Jenn, I'm not real certain if they are going to make me go through the pre-surgery requirements or not. I have another follow up appointment next Friday and am hoping they will go ahead and start the pre-determination filing after that. I will have to let you know as I go along. Yes, I was born and raised in Jacksonville (with a 20 year stent down on the Gulf coast) and had my surgery up here. Dr. Cywes put in my band, his partner Dr. Pinnar removed it. How did your barium swallow go?

Doing great three days after having my band removed due to erosion. (My band was 40% eroded) The abdominal drain is still in and will be until Friday but the color of the Fluid is changing from pink to yellow as it should. There is a little irritation around the area where it is placed in my stomach but the surgeon assured me today that is normal. The only complaint I have right now is that the more the swelling goes down the hungrier I get and I am still on Clear liquids until Friday and I can only go to mushy foods (baby food consistency) until then. I'm not starving, oddly enough, but the head hunger is incredible. I have lost ten lbs from the day I came home from the hospital (IV fluids) and am currently at the same weight I was at when I was admitted and six lbs down from when I began the pre-op diet. So far so good

Hi Jenn. Dr. Pinnar did my surgery. I have BCBS-AL through a private employer. It definitely depends on the plans that your employer chooses to offer through the insurance company. Fortunately, I know for certain that my plan covers the sleeve.

Sorry about the above post, I copied and pasted a reply to a friend of mine who just got the sleeve. I meant to copy a revised version of the post. Blame it on the pain meds!

Hi you! I'm home!!!! Sorry I couldn't write before but it's hard to send messages on Facebook via the phone when you are on pain meds. It probably wouldn't have made a whole lot of sense. I am really glad to hear that you are doing better. My understanding is that the first three days are the worst and then things begin to slowly get better. Has the nausea gone away? Are you hungry? Will you be going back to work next week? My procedure seems to have gone pretty smoothly. I wasn't nervous at all. Didn't have any nausea. Dr. Pinnar said that everything looked the way he anticipated it would look. The drain was a bit of a surprise. I wasn't expecting that. He said it was a last minute decision on his part. Now I have to figure out how to deal with that while at work. I went yesterday morning for my leak tests. They said everything looked fine but it took until 7:00 for Dr. Pinnar to let me know it was okay for me to drink. Then I had to drink a certain amount within a couple of hours before he would let me go home. I drank what I was supposed to, was discharged around 11:00, them we had to run around getting perscriptions filled. I was really tired by the time I got home. My only real complaint is the dry mouth I get while I'm sleeping. I don't have a lot of pain, just soreness. Oh, I gained 10 lbs in the hospital!!!!!! It's beginning to go down slowly but they really kept me hydrated! LOL

Had my lap band removed on Thursday, March 29th. My procedure seems to have gone pretty smoothly. I wasn't nervous at all. Didn't have any nausea. My surgeon said that everything looked the way he anticipated it would look. He placed a drain in my stomach which was a bit of a surprise. I wasn't expecting that. He said it was a last minute decision on his part. Now I have to figure out how to deal with that while at work. They took me down on Friday morning for my leak tests. They said everything looked fine but it took until 7:00 for my surgeon to let me know it was okay for me to drink. Then I had to drink a certain amount within a couple of hours before he would let me go home. I drank what I was supposed to, was discharged around 11:00, then we had to run around getting perscriptions filled. I was really tired by the time I got home. My only real complaint is the dry mouth I get while I'm sleeping. I don't have a lot of pain, just soreness. Oh, I gained 10 lbs in the hospital!!!!!! It's beginning to go down slowly but they really kept me hydrated! LOL So basically, the band removal seems to have been a lot easier than having it placed. Now I need to work towards getting my sleeve. My surgeon has said that if I had another band placed that I would more than likely erode again and I certain don't want to have to do this again. Onward and upward!

Time for an update. I went last week for my pre-op appointment with my surgeon and the first thing I was told was that Shands had cancelled the operating block for my surgeon and that I would have to wait weeks and maybe months for another date unless I wanted to speak with my surgeon's partner and have the surgery at another hospital (which happens to be a local Bariatric Center of Excellence). I figured what the hell and opted to speak with him to see if I liked him. Well, I didn't like him. I LOVED him! I have spoken with four surgeons in the past six months and he is the first one to ever take the time to go into explilcit detail about how my band eroded and then exactly what he will need to do when he removes it. When I asked him which revision surgery he would recommend, he said he wouldn't recommend anything until he got inside to see what kind of damage the band has done. The one thing he was completely adament against was me having any procedure that involved getting another band. He said that in all likeihood, I would erode again. I just love this guy. He is very thorough, a perfectionist (he spent 30 minutes fixing the information in my chart) and he and I are very much on the same page. So I am still scheduled for this Thursday the 29th at Memorial Hospital and I'm ready to get this thing done. I'm sure I will write about my experience once I get home and in bed so others can have something to guage their upcoming surgeries with. I know that reading about everyone else's experiences sure helps me. See you after surgery!

Hi Denise, My understanding is that erosions are rare and that no one really knows why one person erodes and another one doesn't. Some say it is because the band was filled too quickly and/or too tightly. Some say that it is due to some sort of non-compliance by the patient. No one really seems to know for sure. My own personal theory is that some people (like myself) may not like to have foreign objects in their bodies. I have had several piercings over the years besides my ears. All of them either tried to migrate (erode) out of my body or would never heal. Is my body one of those who doesn't accept foreign objects well? (Like someone who receives a transplant rejecting?) I don't really know. It's just a hypothesis. Nevertheless, it does give me some hesitation when considering another lapband. I figure the best course of action is to see what the surgeon sees when he removes my current band and decide from there.

Denise, I believe I had the large Allergan band. In answer to your other question, yes, the banded plication combines two procedures. The plication of the stomach which is basically folding it in on itself to form a sleeve and then stitching the seam without actually cutting the stomach. You get the benefit of the sleeve without removing 80% of the stomach. Then they place a lap band on top of that. The theory is that due to the reduced capacity of the stomach, you have immediate restriction. They do not have to fill the band as frequently nor as quickly as a result. I have read some patients that have had no fills and are quite satisfied with the restriction that the plication and unfilled band offers. Since they do not have to fill the band as quickly and as frequently to achieve restriction, this reduces the instances of slippage and erosion. My only concern is what happens if my body just doesn't like the band and it erodes again? If this were my first surgery, I would probably due to the banded plication in a heartbeat. But this is probably my last surgery so it needs to be the right one!

I want to thank everyone who has had this surgery for their posts! I am having my band removed due to erosion and am currently in the research phase of trying to decide between the sleeve and banded plication. I like the sound of banded plication but am so afraid of having a repeat erosion and then being unable to revise to the sleeve. My understanding is that slippage and erosion are greatly reduced with banded plication as they do not have to fill the band as frequently and as tightly as they do with the band by itself. It makes sense to me and the thought of not cutting my stomach is very appealing. I just want to make sure that whatever I do is successful because this will probably be my last opportunity to do this.

I got my band on February 7th 2008 and was extremely successful with it. I started at 277 and my lowest weight was 183. Man I looked great!!! Slowly but surely, I began to be able to eat more so I would go in for fills but they didn't really seem to have much effect. Last October my doctor recommended an upper GI to make sure everything looked okay and sure enough they discovered that my band had eroded into my stomach. I then had an upper endoscopy to confirm it and the pictures are lovely. Not! The recommendation was to have it removed and revise to another type of procedure. Fortunately, our company was doing our annual benefits re-enrollment at the time, so I upgraded my insurance and also did a flex spending card for the co-pays. After the beginning of the year we submitted the documentation to the insurance company for the predetermination and after an initial denial they approved the appeal. Also, according to their policy, they will also cover repeat surgery if the removal was due to erosion or slippage so I am also having to make up my mind about which procedure to revise to. I was initially completely sold on the sleeve but there is also a new procedure called banded plication which I am taking a close look at. Anyway, I finally have my date for the removal of my band. It will be gone on March 29th. Then I will have to wait at least six weeks before revising to whatever surgery I decide to revise to. I have gained back a bunch of my weight (currently at 240) so I am eager to get back on plan. My problem is that I eat because I can. Without that tool inside of me, I don't feel like a need to comply with anything so I don't. I have learned to depend on it. Once I have it, I am am exemplary patient! I will check back in after my surgery and let everyone know how it went. I am specifically posting my experience here since my removal is due specifically to erosion and I want others who may eventually have the same situation to have something to refer to. As far as pre-op goes, a week before my surgery I will have my consult with my surgeon and he will give me diet instructions at that time in order to shrink my liver. I will also be doing the surgery at Shands Hospital in Jacksonville and will be staying overnight as he wants to be able to observe me for any leaks due to the perforation and repair of my stomach. The surgery will be on Thursday, I will go home on Friday and I will probably wait until Tuesday to go back to work just because I don't want to push it. I was up and around fairly quickly after getting my band placed so this should be pretty comparable as long as there are no complications. If anyone has any questions, feel free to ask and I will try to answer them to the best of my ability. I want to be able to help others who may be going through the same situation. Karen