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I think it really depends on the surgeon. I went with one of the top bariatric surgeons in Australia, hes the one who first started using a minimally invasive method to do the surgery in Australia and trained other surgeons to do it that way. My surgeon and dietitian said its highly recommended to stay on the fluids for three weeks unless you cant tolerate the shakes. The only shake flavour ive been able to tolerate since surgery is the coffee one, the other flavours made be very nauseous, and even then having more than one of the coffee shakes per day made me nauseous. Ive mostly been living on fluids the three weeks, except for the cottage cheese every couple days. According to studies, its safe from a surgical perspective to start on puree at 5 days post op, but you dont have to if you dont want to, you can simply stay on the fluids for the three weeks. My surgery came with a complete package of the surgeon, registered nurse, dietition/nurtitionist, counselling and the fresh start program so i trust my highly experienced team who im in regular contact with. I didnt spend two years researching surgeons to just go with someone who doesnt know what theyre doing, i went with my surgeon for a reason, that hes one of the best in Australia. Im also a registered nurse so i really knew what to look out for when finding the perfect surgeon for me. Ive known some people who do 2 weeks fluids, 2 weeks puree, 2 weeks soft and then normal diet. Some ive known do only a couple days of fluids then by day 3 or 4 theyre on puree and then 2 weeks post op on a soft diet. So it really depends on the surgeon your with and who actually keeps up to date with the current research. Personally i wouldnt have gone with a surgeon who said puree at 3 days post op then soft at 2 weeks!

My self-pay price quote from Southwest Bariatrics in Austin, Texas is $15,000 plus there could be miscellaneous fees depending on what insurance have. That includes all follow-ups/fills for one year. They give no discount for self-pay clients. My insurance does not cover the surgery but I can utilize my Employee Assistance Program for the pysch eval, and I can have my regular doctor perform the physical and blood work (because I need a physical for this year anyway). My exercise eval is $60 and I think my nutrition consult is $150. I called another place (I think a "lapband chain store" type) and they also quoted me $15,000 but first they asked in what town would I have the surgery. I asked if it would be cheaper to have it done in Houston and there was a loooooong pause and she very slowly said nooooooooo. :thumbdown: ...sure.

The paper i got from my doctors only had bariatric and another brand like it. And also i can eat 0sugar popsicles and 0sugar Jello, and chicken broth (tasted it hated it) and tomato soup:/ I dont like any of these. (other than the popsicles and jello but i cant live off of that) and i paid 105 for my bariatric meals so i have no choice sadly:/

Im not really sure if shes experienced with bariatric surgery. It took me alot of calling around and searching to find someone that seemed to know what they were talking about when it came to WLS and when I called her to make an appointment with her after I had already scheduled the appointment she said, "Oh wait wednesday.....im guna be at the other office wednesday.... well I have another dietician that works for me and she will be at that office will that be ok?" and me being stupid said sure. So The dietician I saw who was really nice maybe just dosnt have the experience that I had hoped for. As for losing too fast, definately not. Tomorrow is my 4 week post op mark and I might be at around a 15lb loss.

I've never really been a huge drinker, and before surgery it was not uncommon for me to go many months without a drink. I had my surgery Nov., 2015 and am living an entirely different lifestyle in a new country where drinking alcohol is the one common denominator at every social event. Because I suffer from social anxiety, this appeals to me because it calms me down and makes me more outgoing and friendly. That is, if I wasn't drinking I would stay home. My question is how does this effect weight loss and maintaining weight?

Thank you for responding! Yes, I was looking into dr Ariel Ortiz at occ. happy you had a positive experience. he has great reviews. a friend had it done with dr cueva at renewal bariatrics. Had a very good experience. When I called them the person I spoke to was much clearer than the person I spoke to at occ. also dr cueva is $2500 less. I would pay if necessary more money, but if I don’t need to why should I the only reviews I found about him were all positive but they were on renewal bariatrics Facebook page. I’m having a hard time making a decision.

My surgery is approved and I am scheduled for November 22nd! I couldn't be happier! I thought I would share the news and my steps that it took to get here. While I only signed up on Bariatric Pal recently, I have read along to many of your stories since May. It's nice to hear the steps to the process and I know it helped me so here goes my process so far . My journey started on May 25th, my file was submitted to insurance on October 31st, I was approved by Cigna on November 4th, and my surgery is now scheduled for November 22nd. May 25th=Attended seminar, heard from the surgeon, and learned about the different types of bariatric surgery. June=Had my first appointment with the surgeon where we discussed my background, family history, and what type of surgery I was interested in. August 3rd=Psychologist visit where we discussed what type of support I have for the surgery, my background, and my feelings towards the surgery. August 3rd, September 2nd, & October 7th=Monthly dietitian visits. We would go over my food log for the month, any questions that I might have had, and discuss my progress. July, August, September, October=Monthly appointments with my primary doctor where we discussed what I am doing to lose weight. November 11th=Pre-surgery testing including an upper GI test, chest x-rays, EKG, and blood work. November 11th=Pre-surgery dietitian visit where we discussed what I will be eating post-surgery.

Hi Stacyann, My surgery was on June 30, 2014 and while I was not outwardly nervous the day I had surgery, my blood pressure said something totally different! I have never had high blood pressure at all, but the day of my surgery when they checked, it was 204! Little beepers went off! I realized I was internally scared, but had only found bariatric pal two days before my surgery. After about 5 minutes of deep breathing and telling myself that so many people I knew had surgery with the Dr. I had also chosen, my blood pressure came down to 130/74 and I got a hold of myself! I had a drain and it did not bother me, but the last day it began to be a little sore. I had stopped taking pain meds and it was not painful - just sore. Because I was checking out that day they took it out. I took a deep breath, clenched my tummy muscles and it was a breeze when they took it out. No pain. The drain hole healed up very quickly, too! 7 days after surgery it was healed and is the size of a pencil eraser. My surgeon used an anesthetic pack for my stomach. It was a pouch that I wore around my neck and two little bitty (and I mean super tiny) tubes delivered anesthetic directly to my stomach during my hospital stay. So I really felt very little, if any pain after surgery. Once I came home, other than needing a nap in the afternoons and trying to make sure I walked, I really have had no pain. When I did have pain I found it was from becoming lactose intolerant - a very common issue after surgery. Lactose free milk is just plain gentler on your stomach and once I switched, it has been great. I am due for my 2 week post op appointment in 5 days and other than drinking shakes for meals, I don't feel like I have had surgery. No pain, no discomfort. I know everyone's different, but I want you to know the my truth. I also had many friends and family praying for me and that feeling surrounded me as I took comfort in knowing I was cared for. Keep asking questions and know that we are all in this together. (No high school musical song pun intended!) Lissa

It depends on the plan. If you are paying for insurance out of pocket, look at plans that offer bariatric coverage as part of the plan. Not all do. Speak with a broker or check healthcare.gov.

Call your bariatric team and ask -- each has their own rules. I wasn't allowed raw veggies for six months.

Hi guys...so today was my first day of pre-op. I haven't felt hungry but I think my shakes are making me sick. I had three shakes (Bariatric Advantage vanilla) and everything came back up tonight. Has this happened to anyone else? Should I try a different shake? Any advice or suggestions?

Thanks. I'm only taking the Bariatric fusion Vitamins. No need for any other supplements according to my surgeon and my labs (from August thru March when last done) are all within normal range. The price is right for me

Are the bariatric fusion chewables a good choice of vitamins for the sleeve patients?

Thanks for all the feedback:redface: As for the being unemployed, while it was my choice to quit-not the smartest choice in the world financially (the job I was at was taking too much of a toll on both my mental and physical health) staying unemployed is not my choice. By the time I quit I was also only getting 12 hours a week. I have been trying to get another job, I have some prospects, but in my area there aren't many places hiring, and a lot of them I am not qualified for. I've started looking in cities up to 2 hours away. I'm willing to relocate for the right job. Food wise, I do try and keep my portions seperate, I prefer boiled chicken over fried-really good with some california chili's, some chicken bullion and a jalapeno-yummm. Anytime I get extra money, I try and get some healthier stuff for me to eat. I've been trying to eat my protein first, and making sure I chew really well. It's killer holding off on the sweets, but I've had my will power strength renewed. And I've started writing everything down again. I was at the start of my journey, but my surgeon had said I didn't need to. He was wrong. It helps to keep me accountable ad I know that I need that. The home life, i really can't do much to change it at this point. My mom would kick her husband out if she could, but financially she can't right now. We have 7 of us in our house. My mom, her husband, 3 of my sisters, me and my grandmother. My grandmother has Alzheimer's, and my mom takes care of her. The only income my mom gets is to pay for my grandmother's care-medical supplies, various other things- She can't care for herself at all. And the 7 of us live in a double wide mobile home. And for some reason we don't qualify for assistance. We've tried but we're apparently in a weird zone where we make too much to qualify for medicare, but we don't make enough to cover other programs. I try to get out of the house whenever I can, due to a bad relationship with my mother's husband. He isn't a very nice person, and he's responisble for a lot of my low self esteem. So, I try to remove myself from the situation whenever possible. Today I went and busted my butt at the gym, and then came home and took my dog for a mile and a half walk. And I have an appt on wed for my third fill hopefully.So I'me going to hope I get a little more restriction from it, and keep going and busting my butt at the gym.( My mom is nice enough to pay for it-she doesn't have much, but she does what she can) And I still have my personal trainer that was a xmas present. Thank God. Beecause he does bust my butt.

There are two basic schools of thought on this topic within the bariatric world. Those docs whose practices have been based upon the RNY, which has some specific structural weaknesses that preclude the use of NSAIDs and other stomach irritating drugs, tend to transfer that experience to their recommendations to their sleeve patients. Those docs whose practices have been more biased toward the sleeve based procedures (primarily the duodenal switch and the VSG), which don't have the same structural defects as the RNY, generally have no problem with the use of NSAIDs; indeed, NSAID use is one of the major selling points for the sleeve and DS over the RNY. My doc, who has about twenty years of sleeve experience behind him, recommends NSAIDs for pain relief as soon as the normal post surgical prescription narcotic pain relievers are no longer appropriate. Even for normal, non-WLS people, NSAIDs are potentially problematic drugs, and consistent use of them (even the OTC versions) should be done under MD supervision as there can be potential organ damage resulting from long term use, Some docs recommending NSAIDs for their VSG patients often recommend that they be accompanied by a PPI, but that need is somewhat controversial. For the "typical" occasional use, there is little difference between a "normal" person and a VSG post-op. As usual, do take your surgeon's advice seriously, but consider that their current position on the topic will probably be changing over time, so should you find yourself in future need of NSAIDs, particularly on a chronic basis, check with your surgeon again for an updated recommendation.

Just for anyone who might be interested in how this works at Silver Cross in Joliet - interesting perhaps because it is classified as a "Center of Excellence" - from what I can gather, that is a designation from Medicare (??) and is quite significant. There are only six of those types of "Centers..." in the state of Illinois. The informational meeting lasted almost two hours and carefully explained the various types of bariatric procedures and then the process that needs to be completed before the operation (in my case, it will be banding). The surgeon led the session so ALL questions were answered and many people had many questions - there were around 50 people there. Medicare covers it - which is great because in my case I have Medicare disability - so all that I will have to wait to find out is if my supplemental insurance will pick up the other 20%. I am guessing that they will based on the information I got tonight. The one observation I have to make is about all the discussion concerning the quantity of food that is typically consumed afterwards - some people seemed shocked by the small amount. But --- any of the naturally thin people I know eat those minuscule amounts on a daily basis, so why would we be any different?

I was denied a really revision due to lack of 6 Month diet so I just had it removed. I couldn't take another day like that. Now I'm working toward getting sleeved. However our insurance changed in Jan and no one can give me a straight answer as to whether bariatric is covered.

Chanelle, my heart is going out to you. On doing a cursory search of the academic medical journals on pregnancy after bariatric surgery (because as of yet, I have not found one which encompasses 'surgery whilst pregnant' and I concede the procedures documented do not encompass VSG), I found the following. Go straight to the abstracts/conclusions to get the gist of the research and findings. Sorry to everyone else for the information splat taking up your screens. This is clearly not merely an issue of the fetus being exposed to radiation through an x-ray or the impact of the anesthesia on the fetus during the VSG procedure (which is not to be overlooked and if you'd like me to send you a complete article privately, I can - 'cause it's very long to post here and you'd need to read all of it to get the baseline). It is also about the severe nutritional, Vitamin and mineral deficiencies present in the first weeks after the operation which appear to have a significant impact on the progress of the fetuses growth and development in utero. A point that would need significant evaluation, monitoring and intensive hands-on care. If you would like to ask any questions on the below, please do not hesitate to contact me. Much love x Analgesia, Anaesthesia and Pregnancy A Practical Guide 3rd Edition By Steve Yentis Chelsea and Westminster Hospital, London By Surbhi Malhotra St Mary’s Hospital, London Publisher: Cambridge University Press Print Publication Year:2012 Online Publication Date:December 2012 Online ISBN:9781139012966 Paperback ISBN:9781107601598 Book DOI: http://dx.doi.org/10.1017/CBO9781139012966 Subjects: Anesthesia, Intensive Care, Pain Management ,Obstetrics and Gynecology, Reproductive Medicine Chapter 3 Anaesthesia before conception or confirmation of pregnancy Many women will require anaesthesia when they are pregnant and many will be unaware that they are pregnant at the time of the anaesthetic, especially in the first 2–3 months of their pregnancy. The thalidomide catastrophe initiated the licensing arrangements for new drugs and their use in pregnancy; the current cautious stance of the pharmaceutical industry is reflected in the British National Formulary’s statement that no drug is safe beyond all doubt in early pregnancy. The anaesthetist should have a clear knowledge of the time scale of the developing fetus in order to balance the risks and benefits of any drug given to the mother. A teratogen is a substance that causes structural or functional abnormality in a fetus exposed to that substance. Problems/special considerations The possible effect of a drug can be considered against the stage of the developing fetus: Pre-embryonic phase (0–14 days post-conception): The fertilised egg is transported down the Fallopian tube and implantation occurs at around 7 days post-conception. The conceptus is a ball of undifferentiated dividing cells during this time and the effect of Downloaded from Cambridge books Online by IP 129.215.17.188 on Wed Jan 29 01:41:58 GMT 2014. http://dx.doi.org/10.1017/CBO9781139012966.004 Cambridge Books Online © Cambridge University Press, 2014 drugs on it appears to be an all-or-none phenomenon. Cell division may be slowed with no lasting effects or the conceptus will die, depending on the severity of the cell damage. Embryonic phase (3–8 weeks post-conception): Differentiation of cells into the organs and tissues occurs during this phase and drugs administered to the mother may cause considerable harm. The type of abnormality that is produced depends on the exact stage of organ and tissue development when the drug is given. Fetal phase (9 weeks to birth): At this stage, most organs are fully formed, although the cerebral cortex, cerebellum and urogenital tract are still developing. Drugs administered during this time may affect the growth of the fetus or the functional development within specific organs. Management options The anaesthetist should always consider the possibility of pregnancy in any woman of child- bearing age who presents for surgery, whether elective or emergency, and should specifically enquire in such cases. If there is doubt, a pregnancy test should be offered. If pregnancy is suspected, the use of nitrous oxide is now generally considered acceptable, despite its effects on methionine synthase and DNA metabolism, as there is little evidence that it is harmful clinically. Similarly, although the volatile agents have been implicated in impairing embryonic development, clinical evidence is lacking. Some drugs cross the placenta and exert their effect on the fetus, e.g. warfarin, which may cause bleeding in the fetus. Key points The possibility of pregnancy should be considered in any woman of childbearing age. No drug is safe beyond all doubt in pregnancy. Further reading Allaert SE, Carlier SP, Weyne LP, et al. First trimester anesthesia exposure and fetal outcome. A review. Acta Anaesthesiol Belg 2007; 58: 119–23. 6 Section 1: Preconception and conception Pregnancy shortly after bariatric surgery. Transliterated Title: Svangerskap like etter fedmeoperasjon. Authors: Skogøy K; kristin.skogoy@nordlandssykehuset.no Laurini R Aasheim ET Source: Tidsskrift For Den Norske Lægeforening: Tidsskrift For Praktisk Medicin, Ny Række [Tidsskr Nor Laegeforen] 2009 Mar 12; Vol. 129 (6), pp. 534-6. Publication Type: Case Reports; English Abstract; Journal Article Language: Norwegian Journal Info: Publisher: Norske Laegeforening Country of Publication: Norway NLM ID: 0413423 Publication Model: Print Cited Medium: Internet ISSN: 0807-7096 (Electronic)Linking ISSN: 00292001 NLM ISO Abbreviation: Tidsskr. Nor. Laegeforen. Subsets: MEDLINE Imprint Name(s): Publication: Oslo : Norske Laegeforening Original Publication: Chistiania : Alb. Cammermeyer, 1880- MeSH Terms: Bariatric Surgery/*adverse effects Pregnancy Complications/*etiology Adult ; Bariatric Surgery/methods ; Duodenum/surgery ; Female ; Fetal Development ; HELLP Syndrome/etiology ; Humans ; Infant, Newborn ; Infant, Small for Gestational Age ; Obesity, Morbid/metabolism ; Obesity, Morbid/surgery ; Pregnancy ; Pregnancy Complications/metabolism ; Pregnancy Outcome ; Risk Factors; Time Factors ; Ultrasonography, Prenatal ; Weight Loss Abstract: Bariatric surgery is increasingly used to treat morbidly obese patients. Fertility in women may be enhanced after these procedures, owing to substantial weight loss and possibly a decreased absorption of oral contraceptives. We report a pregnancy that occurred two months after biliopancreatic diversion with duodenal switch in a 32-year-old woman. She subsequently developed haemolysis, elevated liver enzymes and low platelets count (HELLP) syndrome and had a weight loss of 43 kg (from the bariatric procedure) until the infant was delivered preterm by caesarean section (due to low activity). The infant was small in relation to the gestational age, with a weight of less than 50 % of the expected (780 g at 29.6 weeks). Histological examination demonstrated a small placenta with insufficient spiral artery trophoblast infiltration, possibly caused either by severe preeclampsia or by maternal nutritional deficiencies. Severe metabolic aberrations may complicate pregnancies after malabsorptive bariatric surgery. Patient preparations before weight-loss operations should include information on fertility and birth control in the postoperative period. Protocols for monitoring of patients that become pregnant after bariatric surgery are needed. Comments: Comment in: Tidsskr Nor Laegeforen. 2009 Mar 12;129(6):536-7. (PMID: 19291887) Entry Date(s): Date Created: 20090317 Date Completed: 20090319 Latest Revision: 20110330 Update Code: 20131125 DOI: 10.4045/tidsskr.09.34019 PMID: 19291886 Database: MEDLINE with Full Text The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study Mette Mandrup Kjær, MD; Jeannet Lauenborg, MD, PhD; Birger Michael Breum, MD; Lisbeth Nilas, DMSc OBJECTIVE: The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery. STUDY DESIGN: Nationwide register-based matched cohort study of singleton deliveries after bariatric surgery during 2004-2010. Data were extracted from The Danish National Patient Registry and The Med- ical Birth Register. Each woman with bariatric surgery (exposed) was in- dividually matched with 4 women without bariatric surgery (unexposed) on body mass index, age, parity, and date of delivery. Continuous vari- ables were analyzed with the paired t test and binary outcomes were analyzed by logistic regression. RESULTS: We identied 339 women with a singleton delivery after bari- atric surgery (84.4% gastric bypass). They were matched to 1277 un- exposed women. Infants in the exposed group had shorter mean gesta- tional age (274 vs 278 days; P .001), lower mean birthweight (3312 vs 3585 g; P .001), lower risk of being large for gestational age (ad- justed odds ratio, 0.31; 95% condence interval, 0.15– 0.65), and higher risk of being small for gestational age (SGA) (adjusted odds ratio, 2.29; 95% condence interval, 1.32–3.96) compared with infants in the unexposed group. No statistically signicant difference was found between the groups regarding the risk of gestational diabetes mellitus, preeclampsia, labor induction, cesarean section, postpartum hemor- rhage, Apgar score less than 7, admission to neonatal intensive care unit or perinatal death. CONCLUSION: Infants born after maternal bariatric surgery have lower birthweight, lower gestational age, 3.3-times lower risk of large for ges- tational age, and 2.3-times higher risk of SGA than infants born by a matched group of women without bariatric surgery. The impact on SGA was even higher in the subgroup with gastric bypass. Key words: adverse pregnancy outcome, bariatric surgery, gastric bypass, pregnancy Pregnancy after bariatric surgery: a current view of maternal, obstetrical and perinatal challenges Ronis Magdaleno Jr • Belmiro Gonc¸ alves Pereira • Elinton Adami Chaim • Egberto Ribeiro Turato Received: 6 May 2011 / Accepted: 14 December 2011 / Published online: 29 December 2011 Ó Springer-Verlag 2011 Abstract With the increase in the number of bariatric surgeries being performed in women of childbearing age, physicians must have concerns regarding the safety of pregnancy after bariatric surgery. The aim of this review is to summarize the literature reporting on maternal, obstet- rical and perinatal implications of pregnancy following BS. Methods English, Spanish and Portuguese-language arti- cles were identied in a PUBMED search from 2005 to February 2011 using the keywords for pregnancy and bariatric surgery or gastric bypass or gastric banding. Results The studies show improved fertility and a reduced risk of gestational diabetes, pregnancy-induced hypertension and pre-eclampsia, macrosomia in pregnant women after bariatric surgery. The incidence of intrauter- ine growth restriction and small for gestational age are increased. No conclusions can be drawn concerning the risk for cesarean delivery and the best surgery- to-conception interval. Deciencies in Iron, Vitamin A, vitamin B12, vitamin K, folate and Calcium can result in maternal and fetal complications. Conclusions Pregnancy outcome of women who deliv- ered after BS, as compared to obese populations, is better and safer and comparable to the general population. Close supervision before, during and after pregnancy following bariatric surgery and nutrient supplementation adapted to the patient’s individual requirements can prevent nutrition- related complications and improve maternal and fetal health. Keywords Bariatric surgery Pregnancy Pregnancy complications Morbid obesity Weight loss Vitamin A Deficiency in Pregnancy: Perspectives after Bariatric Surgery Cristiane Barbosa Chagas1, 2, Cláudia Saunders3, 4, 5, Silvia Pereira1, 6, 2, Jacqueline Silva7, 2,Carlos Saboya8, 9, 6, 2 and Andréa Ramalho3, 10, 11 (1)Clinical Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (2)Center for Research on Micronutrients, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (3)FIOCRUZ, Rio de Janeiro, Brazil (4)Nutrition and Dietetics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (5)Research Group in Maternal and Child Health (GPSMI), Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (6)Clínica Cirúrgica Carlos Saboya, Rio de Janeiro, Brazil (7)Human Nutrition, Center for Research on Micronutrients, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (8)Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (9)Brazilian Society for Bariatric and Metabolic Surgery, São Paulo, Brazil (10)Social Applied Nutrition Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (11)Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373. Edifício dos Institutos Bloco J, 2° andar, sala 26, Ilha do Fundão, 21941-590 Rio de Janeiro, Brazil Andréa Ramalho Email: aramalho.rj@gmail.com Published online: 12 December 2012 Abstract This study aims to describe the clinical consequences of vitamin A deficiency (VAD) in pregnant women after bariatric surgery. Included are studies on VAD during pregnancy and after bariatric surgery conducted in humans from 1993 to 2011. There are few investigations on the relationship between pregnancy and bariatric surgery and on the damage to the binomial mother–child resulting from VAD in this relationship. The high percentage of VAD in the postoperative period is a cause for concern, especially considering the function of this vitamin in certain biological moments and in moments of intense nutritional demand. This vitamin serum evaluation is recommended during the prenatal period. Keywords Pregnancy Vitamin A Vitamin A deficiency Obesity Bariatric surgery Retinol Beta carotene Night blindness

BIG NEWS IN THE BAND WORLD On October 30, 2012, a Reuters article revealed that Allergan is considering selling the Lap-Band® to another medical device company due to declining sales of the band. Not surprisingly, this news has caused some excitement in the bariatric surgery community. When I first read the article, my immediate thought was that I don't have enough information to make it the subject of an article of my own. I'm still missing a lot of information, but have plenty of opinions about it (which can come as no surprise to you), so I've decided to give you my opinions with you in this article from today’s special edition of the Bandwagon® on the Road e-newsletter. ALLERGAN PEDDLES THE BAND I have a hard time drawing any conclusions (pro or con) about the band itself based on the Reuters report. The decline in Lap-Band® sales could be the result of management or other business problems rather than due to a problem with the band itself. It's highly unlikely that Allergan will ever reveal the whole story to anyone but their team of attorneys and board of directors. So, what could this hot news story mean? As you read on, please remember: these are only personal opinions from an ex-bandster who’s fairly well-informed but not a medical professional and in no way associated with Allergan or any other medical device or other company in the world of bariatric surgery. For what it’s worth, here’s my take on the story. The US economy is in tough shape, the popularity of bariatric surgery in general is leveling off, and insurance coverage for bariatric surgery is still a challenge. Allergan is not alone in this - Johnson & Johnson must face the same challenge in marketing the Realize™ Band. The story of what's really behind all this is clouded by the reactions of the media and of band-bashers who sing the "I told you so" song because they assume (without any credible basis at this point) that Allergan's decision is related to the safety and/or efficacy of the band. SO, WHAT’S THE REAL STORY? All the other bariatric surgery procedures now performed in the USA can have serious complications and failure rates, but it's easier to point the finger of blame at a single manufacturer of a medical device than it is to blame the thousands of surgeons who are doing bariatric procedures that don't happen to use a medical device. The FDA isn't looking over the shoulders of all those surgeons the way it scrutinizes Allergan or Johnson & Johnson. When Dr. John Doe stops doing bariatric surgery and goes back to yanking out gall bladders, no one leads a parade down Main Street waving banners about the dangers of the procedures Dr. Doe was doing. Except in rare cases (such as the sad story of my original surgeon), nobody's even discussing Dr. Doe's surgical expertise or behavior. It's an example of what I call the David & Goliath Syndrome. A big company like Allergan is an easy target thanks to its size and visibility. The general public may step on Dr. Doe's fingers but otherwise will kick him to the curb in eagerness to throw rocks at Allergan. One of the hurdles facing any manufacturer of an adjustable gastric band is that it is (in my opinion) the bariatric procedure that requires the most patient education, aftercare, and support. In the 5 years since I was banded, I have encountered plenty of evidence of bariatric clinics doing a great job of that, but I've also encountered clinics that are failing at it, to the detriment of their patients. Not because they're doing something wrong, per se, but because they're directed by a surgeon (or team of surgeons) who was trained to think of surgery of any nature as an in-and-out deal. They're used to seeing the patient 3 times: a pre-op visit; in the operating room (with an unconscious patient); one post-op visit; and never again unless the patient experiences a complication that requires more surgery. That's fine when the surgery involves removing a gall bladder or a mole or a wisdom tooth, but it's a set-up for failure with band patients. The bariatric surgeon who vetted Bandwagon told me several years ago that the band manufacturers make few demands on the surgeons or clinics that buy their products because they don't want to marginalize the customers who don't follow the manufacturer's advice but have acceptable patient outcomes. Avoiding marginalization of customers is a smart business decision but a poor medical decision, and I think it's a mistake for us to view surgeons only as super-wealthy, super-powered medical demi-gods anointed by a Supreme Being and the ASMBS. They're also customers, and just like you and me when we're shopping for a new car, they're looking for a product that has reliable quality and performance at a price they can live with. They are business people who want to make money (to pay their staff, their malpractice insurance premiums, their colossal student loans, and their kids' college funds). Sure they want to practice the art (and science) of medicine, but they can't do that very well if they can't pay their bills. Finally, keep in mind that someone, somewhere is going to end up with the Lap-Band in some form. It is highly unlikely that Lap-Band® research & development, its technology and FDA approval, to say nothing of the existing customer base, will drop to the bottom of the bariatric pond and never be seen again. Both Allergan and the new owner will legally and ethically have to stand behind their product, with the details of that worked out to the last detail by teams of expensive attorneys and insurance companies. Even surgeons who stop doing band surgery to concentrate on other procedures will still have the basic skill and knowledge to provide fills and other aftercare to their band patients. Although I lost my beloved band in April 2012, I do not regret having Lap-Band® surgery and if I were starting my WLS journey today, I would ask my surgeon's opinion about the Allergan decision and also ask how (or if) it will affect his/her practice. The answers to those questions would be towards the top of a long list of questions I'd be asking before deciding to have surgery. And if I still had my band, I'd be asking my surgeon the same questions so that I could go forward with some degree of comfort (if not 100% satisfaction) that I'd have someone to turn to should I need band help in the future. I most certainly would not be rushing off to make an appointment with the Speedy Weight Loss Surgery Revision Center, or at least not until I'd done plenty of homework on the procedures offered by the quacks at Speedy. Trading in a car just because it's 2 years old has never made sense to me, and if it isn’t broke, why fix it? Although my journey from Lap-Band® to vertical sleeve gastrectomy ended up taking 6 months, I'm still nagged about it by a little doubting voice, especially when my sleeve is giving me trouble. Should I have chosen the sleeve, or not? Should I have risked the return to morbid obesity, or gamble on more surgery? There are no easy answers to questions like that. If there were a cure for obesity, I'd be first in line for it, but until that cure is invented, I'm making the best of what I've got.

Hi everyone, I was a low BMI bandster. I had good weight loss success with my band, but it has been a journey. Fills, unfills, episodes of being so tight I had to have an immediate unfill, etc. About 6 months ago I started having symptoms associated with a slip and the upper GI tests I've had done definitely show a slip. My choices are: remove lap band (which is not what I want to do), reposition lap band, or revise to a sleeve or bypass. I work for one of the largest health care providers in the St. Louis area and my insurance will cover a revision, but only with a provider in their network. Guess how many bariatric providers there are in the network? 2! One is the surgeon who did my lap band and he only does lap band. The other surgeon is currently not doing revisions and won't be for potentially another year. I could go to another surgeon and do self-pay, but that seems crazy to go through that again. I was self pay for my lap band surgery because my BMI was not high enough and I just recently paid all those bills off. I am also leery of the sleeve surgery because it is so permanent. Lap bands can always come out. I feel like the decision is being made for me. I prayed for assistance making this decision and all arrows are pointing me this way. Has anyone had success after a lap band slip, then reposition? I am worried about it happening again in another three years.

i am day two out of surgery. did bariatric advantage as well.... your surgeons diet was the same as mine..... there are so many different pre op diets out there.. i had to tell myself "its just food" and the truth is, the diet gets easier after day 2 or 3. hang in there!

Thank you so much everyone!! I'm really lucky in that I work for the Dept of Defense (as a civilian) and we have fantastic resources on base -- including two trainers, two physical therapists and a bariatric nutritionist. We have three gyms, and plenty of safe running room. Im being monitored by all of these folks on demand. And I get to work out with some very healthy folks from all of the services (we r a joint base). All free. That said, none of them has lost 120 lbs lately, and I value the advice YOU folks gave me above all. I will take it to heart. Thank you again for your kindness and willingness to help another fitness newbie stretch hiz wings!!!!

Statistics are going to give you numbers based on wide "testing" collected from various RNY patients. We do have these stall periods in common be it 2 weeks or a month. Still, I would keep them to the extent of what they are: statistics. Honestly, try to focus on yourself and making this tool your biggest success. Follow your Bariatric team's advice and learn discipline and good choices by logging your food and exercise. It will keep you grounded and accountable. Good luck!

Definitely file an appeal and also let your surgeon's office know what's going on. They obtained pre-authorization I'm sure, so they probably have documentation that can help. It makes no sense to approve a surgery and then deny the hospital stay associated with it (two days is not an unreasonable stay for bariatric surgery). Also check with the hospital business office and let them know. There may be something wrong with how they submitted the claim. They want to get paid, so it's in their interest to help you sort this out. Sorry this is happening, it's stress you don't need. But there's a good chance that decision can be reversed. Good luck!

Hi there! I'm a 27 year old in Minneapolis, MN getting ready for vertical sleeve surgery come sometime in early 2016. My friend inspired me to pursue Bariatric Surgery after seeing her amazing results and I'm glad I did. Since going to the doctors, I've lost 13lbs (in about 3 weeks) adjusting diet and using portion control etc. I'm fairly early in the process. Met with my nutritionist, met with the psychologist, and I'm two months into my 6 months of required diet supervision. I've also started to attend the support group "Images" in Fridely, MN at Unity Hospital. I'm going head on and full speed into this. I was incredibly inspired and invigorated that I just started plastering myself all over social media and the Internet. So, if you're interested in following my journey at all you can: Go to www.bariatricbro.com Follow me on Twitter at TheBariatricBro Like My Facebook Page Follow me on Instagram at BariatricBro_VSG Looking forward to engaging with you in here and hopefully on some of those platforms as well. Shoutout to my fellow twentysomethings, guys, and Minnesotans! FISTBUMP!