slippage and erosion

Penni60 · October 29, 2007

Question for you, when you eroded what were your symptoms? What led you to know something was wrong? Was it a serious erosion or the beginning of one? Would you mind providing more details?
I had no symptoms, I had a feeling something was not right and wanted the doc to do an ENDO. He reluctantly did but supported me in the decision. He was just as surprised as I was the it had eroded. I was 50% eroded into my stomach. I can post some pics if you like.

Also, do you think there is any chance at all that your band was too small for your stomach or did you have a fill that in looking back... might have been too tight? Sorry, I really want to gather information on erosion so anytime I have an opportunity to ask, I do.

My doc said he thought it was due to a stitch irritating the stomach wall on the outside that allowed the band rub a hole in my stomach and make it's way into my stomach from the outside.

The thinking used to be that NSAIDs caused erosion, then they discovered that wasn't true. Then they thought it was coffee and caffeine, that wasn't it either. Then they thought it was smoking. Nope, not that either.

Now they think it is caused by a band that is too tight. Either the surgeon put a band on that was too small for the patient or that the patient got a fill that was too tight for too long. This is the theory that makes the most sense to me.

Erosion is just too difficult to diagnose right now. In order to say for sure what causes it you have to get it at the beginning and that is just too difficult to do at this point. There is NOT one definitive cause for erosion.

Ever see an abused dog that has a collar on that is too tight? After months of this the collar starts to erode into their neck and it has to be surgically removed and repaired. The same thinking could apply here as well.

Also, why is it that some docs have such a high erosion rate (7-10%) and other docs have such low erosion rates (my doc is 0.0016%)? That kind of a difference can't be the patient base the doc attracts, that sounds like surgeon issues to me. The numbers lead me to believe that.

My opinion on this is that some docs have a low rate because not all patients return to the same doc to have the band removed. So their rates will be low. My doc probably has a high rate because he removes lots of eroded bands from other docs patients. His personal rate is low because he watches his patients closely. He requires you come in for a visit every month or two months to get a check up and check in with him. He always returns phone calls and emails. He is a very hands on doc. I have seen some docs at the first sign one of their patients is having complications they bail on the patient and ignore their phone calls and emails. That is just unprofessional now.

Of course, then there is infection. Poor sterile technique during a fill can cause a port infection and the infection can travel up the tubing to the actual band.

My doc has one eroded patient. The patient had her band for a few years and went to a US RN for a fill. The fill was clearly too tight and the patient knew it. She could barely drink liquids but she refused a slight unfill as she was losing weight like crazy and wanted to get to goal faster. So she went for months and months with a fill where she could hardly drink Water. I suspect her "too tight" fill is likely what caused her erosion from hearing her story on the boards but clearly, nobody will ever know for sure.

An RN should NEVER EVER access a lapband port unless under the direction of a band doc, in the office, and in a controlled environment. Contrary to the information out there Inamed does not certify anyone to give fills. There is no certification process, according to Inamed, for giving fills. I asked them about this once before when there were alot of supposed certified people out there giving fills in hotel rooms. Inamed told me they did not offer any certification classes to anyone for this. Only docs are cleared to do fills. It is under the docs supervision and his discretion to allow an RN to do a fill.

But this begs the question... is it the patient or the doc? How is it that my doc has one erosion in 1600+ bands and some other docs have a 4-10% erosion stat when according to Inamed global stats are 1.3%? If their infection stats were that high in comparison to other docs we would blame the doc. I'm not so sure it is any different here with the exception of fills that are too tight and the patient won't get a slight unfill.

I really question if you might have misunderstood this. I think you might have it backwards. Erosion is currently thought to be the doc's fault in general. Slips are typically the patient's fault. Not always, but usually. People that don't chew well, take bites too big, PB a great deal, keep fills that are too tight, etc... they are the folks that tend to slip more than others. I think there are some slips that nobody knows why it happens. But many times slips happen in people that didn't follow the post op diet, they don't chew food well, they eat things they know they can't tolerate, overeat, etc.

Another reason I suspect you might have the slips/erosion backwards is that it isn't the sutures that really hold the band into place, it's the scar tissue that forms around the band. The stomach is sewn up and over the band but the scar tissue that forms during the post op diet is what really secures the band into place. Theoretically, you should be able to remove the sutures after the scar tissue has formed and the band should stay in place.

Just to clarify something, I think it is wrong to say it is the patients fault for something and it is the doctors fault for something. Fault should not be placed for a complication unless it is blatantly obvious. No one knows for sure what causes slips, erosions, etc. It is just too grey an area. There is speculation as to what MIGHT have caused the problem but to say it is the patients fault for this but not this is unprofessional and immoral in my opinion.

Mariposa Bella · October 29, 2007

Sorry to post here, but I just noticed Penni posted.. Are you there my dear Penni. Do you remember me?? We had lunch in Orlando. How are you doing? Drop me a line sometime.

Penni60 · October 29, 2007

Hey there YeS IT IS ME!!! I have been preoccupied with work and going back to school for my BSN lately.

How are you these days? How are your kids?

Mariposa Bella · October 29, 2007

They are doing great. I have been real busy too, but needed to come back here to get motivated and back on track. Well, I had been at my goal weight for over a year. But the fat monster found me again, I've gained about 15 lbs, but I'm getting back on my horse again. I haven't been filled in over a year and will get a fill in a week. I can't wait. Wow, I am amazed at how much the site grew. I hardly know anyone on here anymore. Well, I am so glad that you are doing great. Your grandson is beautiful. Take care, and talk to you soon.

WASaBubbleButt · October 30, 2007

>>An RN should NEVER EVER access a lapband port unless under the direction of a band doc, in the office, and in a controlled environment. Contrary to the information out there Inamed does not certify anyone to give fills. There is no certification process, according to Inamed, for giving fills. I asked them about this once before when there were alot of supposed certified people out there giving fills in hotel rooms. Inamed told me they did not offer any certification classes to anyone for this. Only docs are cleared to do fills. It is under the docs supervision and his discretion to allow an RN to do a fill.<<

We will have to disagree on this point. Inamed most certainly does certify RNs to do fills. *I* personally have been invited to a certification class from Inamed. I will be going the next time the class is available. They have certification classes every few months. I was scheduled for the last one but was unable to make it at the last minute. I will be attending the next one.

I believe what you are referring to is that they won't certify just any RN. I have to be referred by a physician, and I am. A GI surgeon in my area is referring me. Matter of fact, he'd like to attend as well as he may consider doing fills. He is not a bariatric surgeon but a GI surgeon. He'd be great for fills, especially those not banded in the US or if someone's doc moves or retires. Their patients have a hard time finding a fill doc.

I have no desire to do fills, but I would like the education.

RNs access ports for a living for goodness sakes. Portacaths? Docs don't do it, RNs do. RNs are absolutely qualified to do fills with additional training, they typically have more experience accessing various types of ports than your average doc. When you go to an ER and the ER doc doesn't know how to do an unfill the best choice if your surgeon is not available is to ask for a chemo nurse because they have the expertise in accessing ports. It's what they do for a living.

Nobody should be accessing any port for any reason unless in a controlled environment such as an office setting.

I got my information and invitation from Bart Bandy (yep, that's his real name) to the certification class. He used to be the owner of Inamed. After he sold Inamed to Allergan he is now the Sr. VP for Allergan.

It is the sales manager for Allergan that was giving out bad info on who may attend the certification class. I believe Bart Bandy corrected him on this info quite some time ago, such as about six months ago.

There is an Inamed certified fill nurse in Arizona. She and her paramedic daughter are both Inamed certified, neither work for a doc (the RN is a RN Midwife and works out of her own office, no MD available in her office) and she went to the certification class.

The information you received is quite frankly, incorrect.

WASaBubbleButt · October 30, 2007

Don Mills! That is the name of the Sales Mgr. person at Allergan that was giving out wrong info. I couldn't think of his name earlier.

Don Mills is the sales manager, Bart Bandy is the Sr. VP.

minerals13 · October 31, 2007

I'm with you Linda! I didn't know what PB was either and I had the same reaction....gross! Are you banded?

lindata · October 31, 2007

Hi Minerals. I'm getting banded this Fri!

Linda

minerals13 · October 31, 2007

How exciting for you! Look forward to hearing about your experience and I hope it's everything you dream of.

Penni60 · November 2, 2007

I should have prefaced my post to say that my information is from about a year ago. So Inamed/Allergan could have changed their policy since then. If so then I stand corrected. I still don't agree with the policy simply because of my past experience with the company.

We will have to disagree on this point. Inamed most certainly does certify RNs to do fills. *I* personally have been invited to a certification class from Inamed. I will be going the next time the class is available. They have certification classes every few months. I was scheduled for the last one but was unable to make it at the last minute. I will be attending the next one.

I believe what you are referring to is that they won't certify just any RN. I have to be referred by a physician, and I am. A GI surgeon in my area is referring me. Matter of fact, he'd like to attend as well as he may consider doing fills. He is not a bariatric surgeon but a GI surgeon. He'd be great for fills, especially those not banded in the US or if someone's doc moves or retires. Their patients have a hard time finding a fill doc.

I have no desire to do fills, but I would like the education.

RNs access ports for a living for goodness sakes. Portacaths? Docs don't do it, RNs do. RNs are absolutely qualified to do fills with additional training, they typically have more experience accessing various types of ports than your average doc. When you go to an ER and the ER doc doesn't know how to do an unfill the best choice if your surgeon is not available is to ask for a chemo nurse because they have the expertise in accessing ports. It's what they do for a living.

Yes, I used to be one other those RNs that accessed Portacaths for a living. I also accessed Subclavian lines as well along with central lines, picc, etc. Just because I had the knowledge to access the line does not mean that I have the knowledge to give a fill or to handle an overfill. I just think it should be in a controlled environment in case something goes unexpectedly. Just my opinion.

Nobody should be accessing any port for any reason unless in a controlled environment such as an office setting.

I got my information and invitation from Bart Bandy (yep, that's his real name) to the certification class. He used to be the owner of Inamed. After he sold Inamed to Allergan he is now the Sr. VP for Allergan.

It is the sales manager for Allergan that was giving out bad info on who may attend the certification class. I believe Bart Bandy corrected him on this info quite some time ago, such as about six months ago.

There is an Inamed certified fill nurse in Arizona. She and her paramedic daughter are both Inamed certified, neither work for a doc (the RN is a RN Midwife and works out of her own office, no MD available in her office) and she went to the certification class.

I just hope they have really good professional consultation insurance. I am sure they are quite good at what they do and are very careful but it just concerns me that this is going on. Again just my opinion.

The information you received is quite frankly, incorrect.

WASaBubbleButt · November 3, 2007

I should have prefaced my post to say that my information is from about a year ago. So Inamed/Allergan could have changed their policy since then. If so then I stand corrected. I still don't agree with the policy simply because of my past experience with the company.

No, they haven't changed their policy. Don was just giving out wrong information.

I suspect that he gets calls on a daily basis requesting info on getting certified to do fills. Too many people that want to do their own fills or a gazillion others that want to start a "fill" career. So he just doesn't tell about the class. To be honest, I can't blame him yet when there is a legit person they will be given wrong info.

I don't agree with a lot of policies of Inamed. While I think they have a good product I believe the company is run with the morality of a stray alley cat. I just don't like them, far too much dishonesty for my tastes. That's why I'm thrilled there is now another FDA approved band, J&J. Perhaps Inamed will be forced to clean up their act a bit.

wendy1263 · November 3, 2007

I talked to my doctor today during my first fill and asked about slippage. He said they pull a piece of your stomach up over the band to hold it into place and stitch it in. He said they've done tons of surgeries and have never (so far :rolleyes) had any slippages or erosions.