Several Issues - Need Advice

[Silkcityflorida 5]

Hi. I'm new to this forum and not really sure I am in the right place. Please redirect if appropriate.

I am really discouraged and trying to get back on track.

Can anyone offer advice regarding sizes of lap bands and what to do if the doctor "can't get any more saline in" and make the restriction small enough to do any good?

Any experience with Medicare covering fills?

I had my lap band installed on 5/5/2010 while I was still working and covered by company insurance. Lost 25 pounds leading up to the surgery. Was scheduled for my first fill on 6/6/2010. After the surgery, the nurse commented they had installed an "extra large" - not sure why that choice was made.

Was following the post surgery protocol when I had a heart attack on 5/29/2010. Was in the hospital for most of the next 2 months (Fluid around the heart/lungs, that sort of thing). During that time I lost another 25 pounds.

Finally got my first fill 12/2010. Didn't really feel much restriction. Got an adjustment a few months later. Still didn't feel any restriction. Got another fill a few months later and the doctor said, "I think I have filled this as full as possible - can't get any more in". Still only experienced very rare restriction.

Without the restriction, I have failed miserably at controlling things myself and gained back 40 pounds.

I now have finally decided to reconnect with the surgeon and get started again. But, I found out that he has not done any lap bands since late 2011, his coordinator/nurses have both left the practice (one in late 2010 and one in late 2011) and he only does occasional fills, and the office person is not sure fills are covered by Medicare (I am now retired) - said I would have to research that myself.

I have asked his office to tell me exactly what their records show regarding how much saline has been inserted and exactly which size lap band was installed and what capacity it has. They promised to get back to me next Monday.

Meanwhile, I have begun a search for a new, "out-of-towner" surgeon who can give me post-surgery support for a lap band installed by someone else. The ones with the most experience are quite a ways away, and either don't take Medicare or are not sure Medicare will cover adjustments (fills/removals of saline). Some have said Medicare will absolutely not cover maintenance, while other posts on this site seem to say Medicare covers the surgery. I would assume then that by extension it also covers post-surgery support.

At the seminar and pre-surgery discussions, I remember comments about their support structure, about how frequently I would be monitored, and if I was not losing at a sufficient rate, they would know I was cheating. Now, they are saying it has always been the patient's responsibility to contact the doctor if discussions or support were needed.

It never dawned on me that the potential lack of demand within my surgeon's practice would cause him to abandon lap band installations, and I never dreamed that after I had the band installed I would end up so "on my own".

[laurigee 545]

Have you ever had the band checked to see if it is placed correctly, doesn't have a leak, or is disconnected?

[DELETE THIS ACCOUNT! 12,703]

I agree with Laurigee, if I were in your shoes, I'd have the band checked for proper placement and function. I've never heard of someone having a band filled to max capacity and still not in the Green Zone, so that makes me nervous either something isn't quite right with the band or the doctor isn't doing something right.

As far as Medicare, yes it does cover fills, but you are responsible for paying 20% of the cost. (I am disabled on Medicare)

As for band size, usually the surgeons choose the band sized based on your anatomy.

I will be honest, being as he no longer does Lap Band and so much has changed with his practice, I wouldn't feel comfortable continuing treatment with him. I really don't think you'll have a problem finding another surgeon to take you as a patient. The only times surgeons have major issue is when the patient was banded in Mexico, then a lot of surgeons won't touch them. But being as that's not the case with you, it shouldn't be a problem.

Best wishes to you!

[2muchfun 8,928]

Definitely check into a fill with flouroscopy to check out your restriction?

And, it sounds like your surgeon may not have been very experienced with fills? A very tight stomach can push back on a fill making it seem like there's no more room?

tmf

[CHEZNOEL 4,061]

Sound advice above. Good luck.

[Silkcityflorida 5]

Thank you all so much for the great advice!

For the first and second fill, he did it under a scope in the hospital, and showed me the screen. It looked correct at that time.

However, I agree I am turned off by the original surgeon given his change in practice, and it is time for a second opinion with another one.

The one I would prefer to go to because he has a good reputation is flat out against treating patients for whom he did not do the installation, regardless of where it was done.

I will continue searching, and hopefully can find one within 100 miles that has significant experience.

It is good to find out about Medicare!

Any opinions on face-to-face support groups. It does not appear there is any group close to me. I have been through lots of weight control training, and know what I should do, but was counting on the restriction to help.

How about just using forums like this for support?

[1995janice 0]

sorry i posted on the wrong spot

[1995janice 0]

ty

[2muchfun 8,928]

Follow up-I found a local nutritionist-who started me on probiotics-aloe vera juice-and digestive enzymes.I ate mashed pinto Beans last night -bout 1/4 cup.and my belly felt good and i kept them down.!

I m feeling puny today but will be faithful to the routine .I got some yoghurt with Bifidus Regularis-You know the one..... and am taking small spoonfuls because it wants to curdle in my tummy.

Janice, you should start your own thread if you want feedback? This is an old thread and very few people will see it. What you've done is called hi-jacking. Sounds awful but I think we're all guilty of doing this occasionally. Many people will un-follow a thread after a few weeks so that they are not bombarded by notifications.

Hi-Jacking means that you've taken the original topic in your own direction. I know you didn't mean to do this so I'm just offering you some advice. You'll get more feedback and help if you start a new thread with your own topic.

tmf

[hokiemama 13]

@Silkcityflorida- just checking on you to see if you found a surgeon and to see how things are going?

[Silkcityflorida 5]

Thank you for your concern.

Actually, I reversed course a bit due to circumstances:

I checked with several surgeons, with disappointing results. The nearest one (45 miles away) will not take patients whose bands were installed by anyone else. The next nearest has a small support group but has done almost no installations. The third is about 100 miles away, not exactly close enough to address emergent issues, and support group would have required an overnight stay.

Then, I happened to run into my installing surgeon at a boating supply store and we chatted. I told him every time I called his office and told them I was Medicare, they told me I would have to check with Medicare myself to see if adjustments were covered.

He explained that he had stopped installing Lap Bands because he did not do enough to justify the malpractice insurance. He also explained his staff tried to deflect requests, especially from Medicare patients, because he only gets about $30 per adjustment.

BUT, he told me he feels an obligation to his Lap Band patients, and told me to call the office and tell them I had spoken with him personally and to schedule an adjustment.

I did, but did not reveal that fact immediately, and right away they tried to turn me off. When I told them I had spoken directly to the surgeon, they immediately changed their tone.

We set up an appointment in a couple of days. The doctor now does all adjustments under fluoroscope at the hospital so he can be sure of the accuracy of the adjustment. I had my adjustment (just .3cc more) and it has done the trick!

I am losing weight!!

The surgeon told me that if I got the runaround from his office staff to call after 6pm instead, when I would be sure to get to him personally!

This surgeon has done an extensive bowel resection for my wife, and we absolutely believe in him, so I was hard pressed to believe he had abandoned his patients. And, I was right!

When I asked him who he would refer me to if I needed the band removed, or a surgical adjustment, he told me his first choice would be the guy who would absolutely not touch anyone whose Lap Band had been installed by anyone else. Apparently, having a direct referral from another surgeon would be "different". And his second choice would have been the one who was 100 miles away.

Somehow I knew this would work out!

[laurigee 545]

I'm so happy for you!!! Persistence pays off! Good Luck!

[DELETE THIS ACCOUNT! 12,703]

Have you ever thought that they no longer do the lapband because it doesn't work.

It works for a very few.

Consider a revision and don't blame yourself.

...and another thread you're trolling. Seriously, you're this pathetic that you have nothing else to do but go from thread to thread talking out your @ss?

You fail.

[Silkcityflorida 5]

I have no reason to not believe this surgeon. I respect him and know a number of other people who know him more directly than I and they all respect him. Neither they nor I do think he would lie.

<It works for a very few> I'm sorry, but what survey did you do that confirms that? Or is your knowledge anecdotal?

If it does not work, have you considered that might be because people did not used it as the tool it was intended to be? When it is set properly it reminds you to follow the rules of the diet you should be constraining yourself to and makes you feel full more easily. But it can be defeated if you choose to do that.

I have observed that in many cases, only people who have had bad experiences bother to complain through negative posts on forums. Those that have good experiences don't feel the need to post anything. Have you had a bad experience yourself? Perhaps that is why you are so negative?

The band is now working for me, and I expect to achieve full success! And I won't let negativity from anyone dissuade me!