Baba Wawa

I attached one of the result pages from my manometry. I have zero muscle function in the esophagus. My doctor is referring me to a renowned thoracic surgeon for evaluation. He is astounded that the disease has progressed so fast, never seen this before. He did recommend drinking carbonated beverages to help open the LES and it has seemed to help.

http://reference.medscape.com/medline/abstract/22791463 Since I've spent a bit of time researching this condition, I have come across this interesting study. The problem with achalasia is that the lower esophageal sphincter fails to relax when food is swallowed. The study found that carbonation lowers the pressure in the distal esophagus allowing it to open and allow the food or beverage to enter the stomach. I've already been told to drink Water with meals to help push food through, so I'm going to test this theory and start my meals with a few sips of Perrier. It's 100% natural, the carbonation is very soft. I do drink it from time to time as a "mocktail" with lite cran-pom and lime juice over ice when I'm being social and the carbonation has never been a problem. My nut and doctor have both said that 0 calorie carbonation is an issue of comfort than anything else. Since my band is empty, it's really a non issue at this point. I'm really concerned about the distention of the proximal esophagus when I eat or drink anything (manometry test used only 1.5 oz saline and it distended) and the cardiac irritation that ensues. If I can mitigate this while my doctors sort out all the various issues and come up with a treatment plan, I hope I can at the very least eat more comfortably and not feel like my heart is jumping out of my chest. I have an appointment with the GI doc this afternoon.

Losing weight has helped my knee. I had multiple injuries (skateboarding, skiing, softball, volleyball and working on my feet 26 years) and ended up having most of the articular cartilage, the meniscus, both medial and lateral removed and had chondroplasty done on a 15x15mm lesion with marrow edema. I had artificial synovial Fluid injections too, which helped. Have you tried the synovial fluid injections? You have to do a series of 3 or 5 exactly one week apart. It really did help though.

When my SI joint went out in '07 I did PT for a year 3x week. I transitioned to chiropractor after my progress plateaued, still see him every couple of weeks for adjustment. My right SI dislocates. My left knee needs replaced...not surprising the rt SI is a problem. I went from being unable to walk without assistance to walking 1.5 miles...it's painful but I CAN do it

Mobility: sacroiliac dysfunction and spinal stenosis at L4-L5. I've been on disability since 2/07.

I don't dislike my band, but I sure dislike what it's done to my GI tract. I love that I'm under 200 lb and can shop in any store. I love that I can walk better, do more, but living with a motility disorder is very much a compromised quality of life. Different problems. The only + is that I feel better about how I look. It's motility, not mobility, though I have that too. Achalasia Gastroparesis IBS

Hope it goes perfectly and this is resolved

Thanks B! Will post in the morning.

I don't dislike my band, but I sure dislike what it's done to my GI tract. I love that I'm under 200 lb and can shop in any store. I love that I can walk better, do more, but living with a motility disorder is very much a compromised quality of life. Different problems. The only + is that I feel better about how I look.

Read everything you can, complications, successes and in between. In the end it is your choice. We are a community of people who found themselves linked by a common problem, obesity. As we move along in our journeys, we are all focused on our goal and may choose different paths to get there. I chose the band. I was successful, losing 65% of my excess weight, 90 + lb. I am also unsuccessful, since I have some serious complications which have caused me a lot of stress, pain and disappointment, at least a dozen diagnostic tests in the last year and I need at least one more surgery, maybe 2. I was compliant. That's no guarantee. This is a big decision, so don't be in a rush. The fact you've been losing steadily since December is significant. 5 months of success is nothing to sneeze at. It means you've made some major lifestyle changes that can be permanent if you choose to continue to eat healthy and exercise. You might be one of the few people who are successful at diet and lifestyle changes, just as I am one of the few people who have Lapband surgery are compliant and still develop major complications through no fault of their own.

Are you feeling any better at all? That's got to be a drag. Sorry you're miserable ((()))

If you're not on solids and experiencing pain and difficulty swallowing you need to discuss this with your doctor. Personally, I would go back to liquids for a day or two and try again. Typically whenever I go in to the band doctor, I'm asked a series of questions: 1) do you find yourself looking for food during the day? 2) how much food are you eating at each meal? Is it dense Protein with veggies? 3) are you satisfied for at least 4 hours? 4) are you having any difficulty when eating, pain or other problems. 5) are you drinking 64 oz + per day, not drinking with meals or for 30 min after? 6) are you exercising? 7) are you consuming any alcohol? 8) what medications are you taking, including OTC, supplements and Rx? I don't know why 8 turned into an emoticon, lol! This helps them to determine if you need a fill or perhaps in the case of #4, if you are having a problem that a fill will only make worse. Some people go a year or more without a fill and do very well. Please post next week after your dr appt and let us know how it went

I have palpitations often. Prior to my band being emptied, I was having them constantly. I have an almost 3 year old band that has not slipped. My GI and cardiac symptoms are due to esophageal damage from the band. The lower esophageal sphincter and distal esophagus spasm, the food or Water I'm swallowing distend the esophagus, putting pressure on my heart, causing arrhythmia. This is confirmed by months of tests and worsening of symptoms despite having an empty 11cc band that never slipped. It's now being discussed in the bariatric community whether there should be esophageal manometry required prior to AGB or VSG since they both create high pressure on the LES, which can damage the nerves and cause achalasia which may or may not resolve after band removal. Achalasia occurs in 1:100,000 in the general population. My doctor says he's seeing it in 1:100, not a huge risk, but if you have it, it's a difficult condition to manage and is miserable. I also have mild gastroparesis and IBS which has worsened since my band was emptied.

Vaso-Vagal Reflex is what you're speaking of. Your symptoms could be so many things that are easily remedied. Dehydration: lowered hydration = less blood volume = low blood pressure which can make you feel lightheaded, dizzy, etc. Calories: are you eating enough and is it nutritionally balanced? Be sure to follow up with your doctor if your symptoms continue.

Please read this with an open mind. It might just save your band and damage later on. I've been trying to figure this out, since my Dx was confirmed last week. I kept my band loose, 3.5 cc in 11 cc Realize C band. I ate per my doctor's and nutritionist's directions. I didn't drink with meals, though drinking with meals might be better. I cut my food into 1/4 inch pieces, chewed 15-25 times. In fact, I was doing all this for 3 months prior to surgery. I ate 1/2 to 1 cup food, taking 20-30 min to finish. I stopped eating with the "soft stop" signs. I've come across some information that might explain what happened to me and why. So what's the problem? The problem is that our pouch can only hold 1-2 oz of food. A half cup is 4 oz. If you're a little bit too tight, food will be retained in the pouch, putting back pressure on the gastroesophageal junction. Eating a cup of food a year or more out, isn't unusual and this would be 4-8 times the capacity of the pouch. As we're told not to drink at all with our meals, the food stays in the pouch, longer, which can be a problem. Any random tightening, a fickle band, can have disastrous consequences to the esophageal function. An ounce is appx 29 cc, my manometry test involved just 45 cc of saline (about 1.5 oz). It doesnt take much to cause problems. The esophagus is not intended to hold food at all. Continued episodes of this causes nerve damage and will present initially as heartburn or GERD symptoms. This is misleading and potentially damaging. How many times have you seen a post where someone states their heartburn had returned and their doctor puts them back on a PPI? What is needed is an Esophogram to determine if they've become too tight (if its been some time since their last fill) or a small unfill if they've had a recent fill. If there is any chest or epigastric pain, further tests would be in order to rule out esophageal problems. Manometry can pick up small changes indicating damage that cannot be seen with EGD or UGI, avoiding further damage by unfilling the band or removing it all together. This sort of explains why the "rules" around eating and drinking with a band might result in fewer complications and that quicker pouch emptying might be a good thing. I've been drinking with meals again for a few months, but have noticed no difference in satiety. Let me emphasize something here. This post is intended to educate and share knowledge in order to spare someone else the problems so many of us have had. Most of the time achalasia secondary to AGB is reversible with emptying or removing the band, but it is a contraindication to VSG, eliminating that surgery as an option for revision. Getting a band might prevent a person from being able to revise to their surgery of choice, eliminating all but malabsorptive options (RNY and DS). http://www.ajronline.org/doi/full/10.2214/AJR.04.0655 http://link.springer.com/article/10.1381%2F09608920677522200 5?LI=true http://www.ncbi.nlm.nih.gov/pubmed/22411570 http://www.searchmedica.com/xml-resource.html?c=pc&ss=defLin k&p=Funnelback&rid=http%3A%2F%2Fubm-search01.squiz.co.uk%2Fs earch%2Fcache.cgi%3Fcollection%3Dpubmed%26doc%3D61%252F21683 804.xml%26off%3D0%26len%3D-1%26url%3Dhttp%253A%252F%252Fubm- search01.squiz.co.uk%252Fpublic%252Fpubmed%252F21683804.xml& t=pubmed

Congrats! You look great!

I copied and pasted, below, some of my early posts from the first few months after band surgery. I was so enthusiastic and on board with my new lifestyle. I was fully committed to learning everything I needed to know in order to succeed. I did not want to hear anything from anyone who was saying their band didn't work out. There were people who posted that they followed band rules and lost their band due to slips, erosion or esophageal dilation. I countered that very few complications are band caused. I suggested that perhaps they over ate, ate too fast...you get the picture. I was wrong to do that. It's true that early in our band journey we NEED to hear positive reinforcement that we made the "right" decision. That's why you won't see me post negative information on a post from someone who is doing well, newly banded or had decided to band and isn't asking for help deciding. If I posted in a way that seemed insensitive or overtly negative anywhere but on the complications forum, I apologize. I try to avoid that, but I'm human. I believed, as many of you do, that if I did all the right things, I'd keep my band for the rest of my life. I cannot convey the disappointment and even grief I'm feeling over the impending loss of my band. I'm also feeling a lot of anxiety about post removal. That might be bleeding thru in my posts. I'm in constant discomfort, unable to eat much of anything and generally not feeling very well at the moment. My point in this post is to encourage everyone who has WLS to listen, sympathize and file away posts about band complications. As I've stated in more than one post, the information might help you save your band one day. I don't want to scare anyone. I just want to share my experience within a community that might benefit from it one day. Don't be afraid to read my message. It can't hurt you. This was 2 months post op: Tonight I am going to a play with friends...I subscribe and we go out about every two months Nov-July. Yesterday I figured I should try on some of my smaller (size 24) clothes to see what I should wear. NONE OF THEM FIT! THEY ARE ALL TOO BIG! I am between a 20-22 so all the 24-26 and 3x are going to the donation pile or to my ebay collection. I went to the Talbot's outlet and bought two pairs of 22 WP shorts, very nice for $27 including tax. I now have one pair of jeans, a pair of capris and two shorts that I can wear. We always go to Maui in October and was trying on my dresses that I take with me and got into some of my Blue Ginger dresses I haven't been able to wear for a long time...some of the others are way too big.... Any way enough rambling on! Happy day for me! My first fill: I got my first fill today and it went very well...no pain and so far so good with water. I lost 5 lb in almost 5 weeks and due to travel plans in September and October opted to go ahead and get it now. My surgeon's office does them under flouro and it took about 10 min to do...port was flat on the abdominal wall and very easy to access. It did feel weird as she was numbing me up, but other than that couldn't feel it. I am hoping to up my loss to about 1.75 lb per week or 7-8 lbs per month with this fill... whew...glad to have that under my belt! A post on accountability: This morning it occurred to me that I have not lost any weight since the 30th of August. My first impulse was to post something on the forum regarding a stall, frustrated, etc, but then I got to thinking about it HONESTLY. I have not logged my food since the middle of July! I looked back and I remember thinking that this is so easy, I don't have to log every bite! WRONG! I lost consistently (even without a fill) 1-1.5 lbs per week while logging. Since I stopped logging I have lost a total of 6 lbs in 6 weeks, but nothing for the last two weeks. I don't think I am eating as much as I am burning, but how do I know??? This could be the 20% stall, but without documentation of my intake, I cannot really tell. My highest weight was 290 about 2 years ago. 20% of 290 is 58 and I am down 51 lbs from that weight so it is close enough to be called that, but most likely it is what I am eating, rather than how much. I have been eating more carbs... There have been numerous social events, so I have been drinking a bit of wine... And I have had some dessert... here and there... So now I recommit to journalling my food intake so I can assess why I am stalled and what to do to change it WITH SOME CERTAINTY.... I have lost an inch or so since the stall started, so it isn't really a stall, but a great opportunity to refocus my efforts towards meeting my goal of 1.5 lbs per week on average. I do have restriction and I need to do a better job of utilizing it to my advantage. Me, defending the band: Many folks who are anti-band will use a study that was published in 2003 and followed lap-band patients from 1997-2002...that would be like car and driver only reviewing cars made from 1920-1970 and holding them to today's standards of road-worthiness... The bands in use today are much more "user-friendly" and the surgeons who "install" them know a lot more about the causes of complications like those cited in the early study and MOST complications are caused by overstuffing the pouch and eating around the band (grazing, sliders etc) as well as over zealous docs who overfill bands. Go to the WLS failure forum, complications forum or regrets forum and read about the issues the people who have chosen many different surgeries experience, then you can be satisfied with your decision, whatever it may be. I also question why certain individuals feel the need to hang out here and tout their surgery. If they were as knowledgeable as they claim, they would be publishing a book on their surgery, pointing out the benefits vs the risks, and it would speak for itself. Here is an example of a study on VSG and it's failure rate...I found this doing a quick search and now it is out there and will be quoted by the VSG haters to support their position.... The exact failure rate of sleeve gastrectomy is unknown. Using the Spanish National Registry for bariatric surgery, Sanchez-Santos et al[7] reviewed 540 patients who had undergone SG either as a primary or staged procedure over a six-year period. The authors reported excellent overall outcomes; however, 15 percent of the subjects were considered failures based on weight recidivism in the first three years, with 3.3 percent of patients submitting to a second bariatric procedure. Younger age, lower body mass index (BMI), and thinner bougie size were attributed to improved sustainable outcomes. Similarly, Himpens, in an article by Deitel et al,[8] presented his early five-year results after sleeve gastrectomy at the First International Consensus Summit for Sleeve Gastrectomy in 2007. In 46 such patients, he reported a disappointing 37 and 23 percent inadequate weight loss and second procedure rates, respectively. More recent unpublished presentations by Himpens indicate failure rates as high as 30 percent in five years.[9] Studying the Austrian experience with SG as a stand-alone operation, Felberbauer et al[10] reported a seven-percent failure rate at three years based on a cutoff of 25 percent excess weight loss (EWL). Applying the traditional 50-percent EWL criteria, the failure rate increased to 25 percent.[10] Me supporting a struggling poster: Good for you Tanya....that is why the forums are here, to share and hopefully keep us from getting too complacent and not utilizing our chosen tool. The side note that I have been meaning to post since the day after I wrote this is that though I haven't lost pounds, I have lost a full size, so it isn't about just the weight. Perhaps it is time for a fill or a talk with your nutritionist to help you to get back on track... Congratulations on your recommittal and I will look for you to post your success!!

Dr Keshishian is a well respected bariatric surgeon who is well practiced in all types of WLS. In his own words : Adjustable Gastric Banding The adjustable gastric banding was approved and became widely used in the United States starting in 2002-2004. The early resulting data was acceptable in regards to the excess weight loss and the complications rate associated with it. As more and more scientific data was published, it became clear adjustable gastric banding was not as benign or effective as initially thought. The associated weight loss was significantly less for the majority of patients. This information was even present in the literature provided to the patient by the manufacturer. Additional patients started developing Delay complications associated with the band, which includes esophageal dysmotility, a worsening of reflux, and continuous nausea and vomiting, in addition to inadequate weight loss. In my opinion, the adjustable gastric banding procedures are inferior to the alternatives available. The specifics of different surgical outcomes are outlined on the poster available on our website. Adjustable gastric banding should be considered as a last resort, if at all, as a surgical procedure for treatment of morbid obesity and its associated comorbidities. Other complications that continue to plague adjustable gastric banding include slipped band, erosion, esophageal dilatation, and the required need for frequent adjustments. The LAP-BAND AP® System http://www.dssurgery.com/procedures/adjustable-gastric-banding.php?subnav=2 http://www.dssurgery.com/images/weight-loss-surgery-poster-large.jpg

I think you're assuming a lot. Many band clinics paint a very rosy picture of WLS and banding in particular. There are plenty of posts on forums of people going back to work in 1-3 days, as well. Hyperbole it's not. It's a reflection of our society's need for instant gratification. I also think your reference to rants is a bit sexist. Just my $.02 ...and it took a whole 30 seconds to find a recent post referring to this. http://www.lapbandtalk.com/topic/168484-how-long-should-i-take-off-work/

I think you made the right decision Marci. I too have a 3 hour round trip to the doctor that did my band...I also have heard of just a couple of people getting a new band and being successful and they both had the old 4cc bands initially. I know of several dozen who have not and end up with removal or revision and pretty bad damage. Keep us posted on your progress! Congrats