Lapband Slippage: Causes & Prevention
A Clinical Study
A clinical study was done in Germany to review complications following lap band surgery. Thirty-five hospitals were involved in the study, with 4138 patients that underwent gastric banding over a five-year period. Lap Band long-term complications were described in 8.6% of all patients. The most common complications included: pouch dilation or enlargement (5.0%), lap band slippage (2.6%), and Lapband migration or erosion (1.0%). (Stroh,C Manger, T “Complications after adjustable gastric banding”, Chirurg, 2006, Vol 77,pag 244-250)
Normal Lap Band X-Ray Under Fluoroscopy
Enlarged Lap Band Pouch
What is Lap Band Slippage?
One of the long-term complications of lap band surgery is called “Lapband slippage” and can be defined as “when the Lapband and the stomach pouch are both prolapsed.” This means that the lap band has shifted position and the enlarged stomach pouch has also shifted or twisted so that food does not go through the lapband into the rest of the stomach. This may result in pain, discomfort, decreased appetite and inability to eat or drink, and vomiting. Lapband Slippage does not happen immediately but may take several months to develop.
Large Lap Band Pouch
Lap Band Slippage generally develops in a progressive manner. As food intake is increased, the stomach begins to stretch and grow and the patient may stop losing weight or start to regain weight. At this point, patients may only exhibit an enlarged stomach Lap band pouch. This can be medically treated by deflating the lap band to release pressure and slow the growth of the pouch (successful in 70% of cases, or surgical treatment can be considered). However, if the enlarged lapband pouch continues to grow, the lapband progressively rotates until both the lap band and the enlarged pouch become prolapsed, resulting in Lap band slippage. This is followed by functional stenosis (narrowing) of the stomach.
Lap Band Slippage
Lapband Slippage Symptoms typically include progressively worsening reflux, vomiting and epigastric complaints, which may increase to sudden near-total dysphagia (inability to swallow or eat anything, including saliva).
Risk factors or causes of lap band slippage include surgical technique, model of the lapband used, early consumption of solid foods, early inflation or filling of the band, consumption of carbonated or sparkling beverages, and frequent vomiting.
Treatment for lap band slippage requires surgical intervention. The lapband must be repositioned or removed, based on the operative findings and condition of the stomach pouch. If appropriate, the surgeon and patient may elect to choose another type of bariatric procedure such as a Gastric Sleeve.
How Do I Prevent Lap Band Slippage?
In order to decrease the risk of developing lap band slippage, it is important to follow the recommended diet following surgery and to avoid introducing solid foods too early. In addition, the fills should not be started before 6 weeks post-operatively and these Lap band fills should be very gradual. We also recommend that fills should be done under fluoroscopy, even if you are asymptomatic (no symptoms of lap band slippage), to be able to monitor the position of the lapband, and the size of the stomach pouch and condition of the esophagus. This will allow for early diagnosis of an enlarged stomach pouch or possible lap band slippage.
Originally posted 2009-02-17 13:25:15. Republished by Blog Post Promoter
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Comment by Melva Gabura — February 19, 2009 @ 7:00 am
Hello,
Many Lap band slippages were seen with the first 3 Inamed models due to the preformed ” C ” shape of the lap band and the high pressure balloon..
Recently, the Realize band has shown an increase in slippage among patients because of been also preformed.
I still like better the Quick Close lap band ( Johnson & Johnson), the one that shows no rigidity at all and has a low pressure balloon.
Comment by Dr. Arturo Rodriguez — October 15, 2009 @ 9:27 pm
If there is a leak in the port can the leaked fluid cause damage or create some kind of pain/discomfort in the abdomen?
Comment by Tim S — November 7, 2009 @ 2:20 pm
Hello,
Some patients can have a sharp pain at the port area when there is a Lap band leak at that level.
The pain respond very well to Tylenol and should not last more than 12 Hrs.
When pain plus inflammatory response are together the patient need to be checked for Lap band erosion.
Comment by Dr. Arturo Rodriguez — November 8, 2009 @ 7:06 pm
i just had my lap band filled 2 days ago, and it is painful to both drink and eat. I can however swallow will this go away as I lose more weight or should I see my doctor?
Comment by Mary — January 16, 2010 @ 1:49 pm
Be just on liquids for couple days taking Maalox and Azantac and if is not a change in what you feel you should have half cc taken out..
Comment by Dr. Arturo Rodriguez — January 16, 2010 @ 3:24 pm
Hi there bandits. My name is Di. I have had my band for 3 yrs. My son who is now 17 has had his for almost 2 and doing well. I have had acid reflux since 6mnths after the band was inserted, so I know all about the waking up in the night almost asperating on gastric fluid, I also get episodes of sore throat and laryngitis. I find that maxalon and buscopan help alleviate these symptoms. I reched my goal weight a year ago and have since had 3cc removed over a period of 9 months, the symptoms I have described to you have been relieved by doing this, and I have only put on 5 kgs… so I think I’m maintaining pretty well, but I cannot go without my chronic medication of nexiam 40mg daily, if i stop this medication it feels as if I’m having a heart attack. I have had 2 gastroscopes when these symptoms have appeared and both times its been a case of food being stuck in the band, but no erosion or prolapse has been found. What I am worried about is the potential for slippage and erosion in the years to come, does anyone have any advice on how to prevent this?
Comment by Dianne — January 17, 2010 @ 4:08 pm
Congratulations Di!!!
I would take 1/2 cc out to prevent complications since you are in your weight now and eating slowly, chewing well and increasing your physical activity will do the rest..
Lap band is working!!!
Comment by Dr. Arturo Rodriguez — January 17, 2010 @ 5:30 pm
My band slipped shortly after surgery. 8 weeks–my first fill. 12 weeks my second fill. I did not experience any of the symptoms of having my eating limited and I began to worry. After my upper gi test, with barium contrast material, found out my band in below my stomach. Stayed true to the diet for the first 6 weeks. What could have caused my band to slip.
Comment by Boise-gal — February 2, 2010 @ 10:04 pm
Hello,
You should have been frequently vomiting in order the band to be slipped in such a short time after surgery.
If is not your case need your band be checked by another doctor.
Also need to know what kind of band you have.
Comment by Dr. Arturo Rodriguez — February 3, 2010 @ 7:56 am
Hi
I have a question I was trying to call my Dr. about but he is away on vacation. Of course self diagnosis on the internet is not good – BUT I was searching and I came across your website which I found very informative. I had the band placed in july of 2008 and I a have so far lost 165 lbs down from 440lbs. I have never had any problems such as vomiting in all this time. I only had minor fills during the first couple of visits to get the band comfortable.
2 days ago I had root canal and the dentist gave me vicodin for the pain. I took it before bed, I had also eaten (possibly a little too fast and too much). In the morning I woke up with pain in the port area. I thought it would go away – I only drank liqueds yesterday, but I had pain throughout the day (not major-like someone punched me in the port area)
Should i stay on liqueds? Any ideas?
Thanks,
Joe
Comment by Joe Robbin — February 3, 2010 @ 12:57 pm
Hello Joe,
You should stay on liquids 3 days plus Maalox e/4 hrs and Zantac e/12 hrs…Pain should go away and in the case is persistent or the port area gets infected you will need to be check for stomach erosion.
Comment by Dr. Arturo Rodriguez — February 4, 2010 @ 4:29 pm
Hello,
I just found out that I have a concentric pouch, due to bieng too tight. I have had the band for almost two years. The Doctor suggested I go on liquids for two weeks, and hopefully the band will re-position itself, and the pouch will get to the size it should be.
So my question is are there any long term complications to leaving the band in place if the band doesnt re-position itself. The Doctor stated that I can leave the band in without getting it re-filled, or that I can have it removed.
He will check me agaoin in two weeks with a barium swallow. And I am somewhat nervouse about the situation I am in.
So please if you can answer my question, about any long term complications with leaving the band in place once you’ve had a concentric pouch.
Thanks in advance,
Nica
Comment by Nica — February 18, 2010 @ 8:35 pm
Hello Nica,
How big is the pouch? I am not concern about a patient having a concentric pouch because only means that is dilated.
By removing fluid should be improvement in the size of the pouch but I would make it to wait 1 month, check and if is OK I start with very litle fills …The Lap Band can stay there without causing any problem…
Comment by Dr. Arturo Rodriguez — February 18, 2010 @ 9:53 pm
Hello Doctor,
Thanks for your response. My Doctor didn’t tell me how big a pouch I have. He showed me that it was enlarged, and the band wasn’t angled. And that is was called a concentric band/pouch. But when he took all the fluid out,the pouch became smaller, and the band changed position where it looked like it had a little bit of an angle. But he said there was a 50/50 chance that it would fully correct itself within a month. So he said I would have the option of taking the band out, or leaving the band without fluid, if it did not correct itself.
This happened three days ago, and I have been on complete fliuds since then. The night coughing, and gerd have completeley stopped. Do you recommend your patients go on a liquid diet for two weeks for this kind of problem? I ask because, I have been doing some searching on the net, and I havent found anything that states it is necessary to do full liquids.
I have lost 60lbs, and need to lose another 10lbs.
Again thanks for taking time to answer my questions!
Nica
Comment by Nica — February 19, 2010 @ 8:33 am
Hi Veronica,
I usually let the patients eat what they want after removing the fluid out.
The pouch will not grow because will be not restriction to allow to be forced.
I do not remove the Lapband because of been concentric or not having the right angle or either re-position the lapband because of this.
I will recommend you to increase your activity and not having the lapband been to tight in the future and these will prevent you from complications.
Comment by Dr. Arturo Rodriguez — February 19, 2010 @ 6:33 pm
Thank you! I have been on liquids for three full days, and have been able to lose 4lbs. So i’m very pleased. I wasn’t sure i’d be able to handle two weeks of only fluids. I think I will try two more days on liquids.
I usually do between 40 to 80 minutes on treadmill. So I will continue that.
I will have to go back to my Doctor in about a month, and see what has happened to my band/pouch.
I hope I can report good news to you then.
Nica
Comment by Nica — February 20, 2010 @ 10:19 am
You will do great Veronica, you will see…
Gracias
Comment by Dr. Arturo Rodriguez — February 20, 2010 @ 4:33 pm
Hello Doctor,
I was banded about 2 months ago and got my first fill about 2 weeks ago. I have never vomited and have lost about 25 pounds so far. For the past three to four days I have had a stretching/squeezing type of pain in my stomach, which is aggravated when I take deep breaths. My stomach feels sore. I contacted my doctor’s office and they asked if I am able to eat and drink – and because I can, they told me everything was fine. I am not so sure that all is fine and don’t know how to proceed.
-Lynn
Comment by Lynette — April 2, 2010 @ 6:10 am
Hi Lynn,
Take Maalox e/4 hrs for a couple days and in case there is not a change have also Azantac…
Comment by Dr. Arturo Rodriguez — April 2, 2010 @ 3:30 pm
Hello Doctor,
I had my band put in 2005 and have just had a band slippage in april 2010 just after easter and have had it repositioned, i feel fine but is there a risk if i eat soft foods too soon after the repositioning. I was told fluids for 2 weeks but was wondering if having soft foods would do any damage please help
Comment by Jenna — April 7, 2010 @ 6:31 am
Hello Dr. Rodriguez,
I think it’s great that you’re answering people’s questions! My surgeon is hard to get a hold of and not very responsive to questions when I do see him. My question is right now I’m in a weird situation where once I feel like I’m starting to get full (after a very small amount of food), if I keep eating, it seems to push the food through the band instead of having to throw up. Could this be a sign of slippage or erosion? I don’t think I need another fill because I DO seem to get the “full” feeling early on, I admit that I’m bad about stopping eating when I should, but I’m concerned about pushing the food through vs. throwing up.
Thanks so much!
Comment by Angel — April 13, 2010 @ 12:09 pm
Hello Angel,
You have to adjust your habits while eating and give you plenty enough time to eat.
Pushing the food down will make a big pouch that later on can turn to slippage.
Vomiting is also not good advice.
Best thing to do is give some good time to eat, chew very well your food and stop eating when you fill full. Have a cracker between meals and plenty liquids.
Take care
Comment by Dr. Arturo Rodriguez — April 13, 2010 @ 12:31 pm
I had my lapband put in 2 years ago. I throw up more than 3 times a week because I can’t seem to take control of over-eating. For 2 days I am in severe pain when I eat, it almost seems like my stomach is continuously “contracting” even when I have not eaten. I haven’t been able to keep anything solid down for 2 days – I’ve had a protein shake and maalox today. I’m schedule for a barium swallow today then to go see my doctor. Do you think this is a slip? I know I will probably have to wait to hear what they say but I’m scared, and mad at myself for not controlling my portions. I just need some insight.
Comment by JanetS — April 15, 2010 @ 7:07 am
Hello Janet,
First you should not is to take protein shakes and to avoid all kind of irritants as coffee, coke, etc.
Take 2 tb spoon of maalox e/4 hrs and a tablet of Zantac twice a day.
Vomiting either take you to erosion or slippage and need to be check with fluoro. If all is normal and without complications have some fluid be removed from the lapband and wait 1 month to fill it again.
Let us know
Comment by Dr. Arturo Rodriguez — April 15, 2010 @ 7:32 am
Thank you for your response. Did you say that I should NOT take protein shakes? What else can I consume if I can’t eat solid foods? I have a barium swallow that will be done today – is that the same as a Fluoro?
Comment by JanetS — April 15, 2010 @ 8:05 am
You can have a full liquid diet with soups, milk, gelatin, etc, but you don’t need protein shakes until you have the barium today and have a diagnosis on what is wrong.
Comment by Dr. Arturo Rodriguez — April 15, 2010 @ 9:48 am
Hello Dr.
I need advice. I had my lapband placed on 3/26/10 and have suffered horrible gas pain and the gas comes out of my mouth with such a force I sound like a monsterous machine gun. As can be expected I would feel my entire abdominal area tighten and it is as if I feel pulling internally. This has been going on since day two. If I eat less it gets worse and what comes up is a saline solution. The doctor mentioned that I could take GasX that made it worse. He then inquired on how I am eating and I mentioned that I was following the diet of liquids 4 ozs every two hours and he said it was too much. I shared the back pain and shoulder pain which he said is part of recuperation. I could not function normally for a week until I saw him and he loosened the band. Three days later it appeared a bit better. I progressed to soft foods and felt even better with less gas pain. Now I am on week three and began vommiting with uncontrollabe liquified bowels wondering if I may have contracted a stomach virus but I have been noticing a red irritated ring surrounding my incisions and although the are not oozing I am concerned. All the vomitting has left my stomach sour and sore with pain behind every incision. I have lost 15 pounds since the surgery but for the last week have been at a stand still number. What do you think this could be? I am in so much pain I am wondering if I should go to the ER.
Please advise
Doreen
Comment by Doren — April 15, 2010 @ 12:59 pm
I have had a lapband since 2004.Ican,t take my pills without severe heartburn.Then I have aburning in my throat.I have tried putting pills in applesauce.I’ve also tried taking one at a time, them wait before taking more.I’ve aso been hurting across my stomach the pain is so bad I lay on the bed with my knees pulled up to my stomach,while my stomach is hurting. I also have bad pain across my chest.It last about 30min.As it gets to feeling better I will belch and have gas.I have vomited about everyday since I’ve had my band.Any ideas whats going on? Going to Dr.4/23
Comment by Mary Smith — April 20, 2010 @ 11:41 am
Hello Mary,
How many cc’s are in your band. You need to pull out some of it and start taking Maalox and Zantax to prevent erosion.
Your Doctor probably will remove some saline to make you feel better.
Comment by Dr. Arturo Rodriguez — April 20, 2010 @ 3:58 pm
Hi Doctor,
I had the lap band since March/2008, for five months I had it so tight that I started to have reflux and throwing up problems so I had all solution removed, and the doctor told me to leave it alone and change my eating habits. I have gained 25 pounds back in 8 months. Is it true that I should not have a fill if it slipped? Will it fix itself if I go on liquid diet for a couple of weeks? Is it dangerous to have an operation to fix? Please advise, since I am very depressed about my weight gain and I can’t seem to control my appetite I really do appreciate your help.
Thank you.
Comment by Hala Khalil — April 26, 2010 @ 11:50 am
Hello Hala,
Lapband Slippage is cause by forcing the pouch with more food then the pouch can hold and for been vomiting as a consecuence of over eating.
Did your doctor had some pictures taken of the pouch so I can see them?
How much of a fluid you have now in the Lapband? what model of Lapband do you have?
I would recommend to have the Lapband checked again in case you don’t have pictures and also during that check I would do an adjustment to have half of what you use to have and see if the pouch has gotten smaller.
Comment by Dr. Arturo Rodriguez — April 26, 2010 @ 6:59 pm
Hi again Doctor,
Thanks a lot for getting back to me so fast! But, the slippage happened while I was hardly eating since it was too tight. I’m guessing it happened because of a lot of throwing up. Right now I don’t have any fluid in there. Unfortunately, I don’t have any pictures. I think I have Johnson and Johnson band, but I’m not sure, please tell why that matters if it does. I have an appointment in 4 weeks, and I’m really hoping he would do a fill, would it help if I stay on liquids for the few weeks before my appointment so it would go back to the normal position?
Is it true that it should not be filled if it slipped, that’s what he told me? Thanks a lot for your help doctor, I appreciate it!
Comment by Hala Khalil — April 27, 2010 @ 3:49 pm
The Allergan lapband old models were prone to produce slippage because they were very rigid and they acted as a hernial ring. New model are softer and have a better balloon.
Been on liquids and soft food will help you out but only during the fill nex month your doctor will be able to determine how much of a fill you can have without complicating the slipp.
Increasing you normal activity will help to mantain the weight with smaller fills.
Comment by Dr. Arturo Rodriguez — April 27, 2010 @ 7:10 pm
I got banded in july of 2008 i lost about 60 pounds, in april of 2009 i became pregnant. I had my baby 4 months ago i have not been back to my surgeon because i had a c section which became infected and it was a whole mess! my question is i dont feel weird or anything i literally only vomited twice during my pregnancy, what happens if my band is stretched out or my stomach pouch i should say? I have lost weight the pregnancy weight but i still have 15 pounds to lose to get back to the weight i was before i got pregnant.
Comment by Carmen Garcia — May 13, 2010 @ 6:55 am
Hello Carmen,
I think you have done great!
What type of lapband do you have?
Did you have any fluid taken out during pregnancy? If you din’t you need to be check under fluoro to see the pouch’s status.
Let me know
Comment by Dr. Arturo Rodriguez — May 13, 2010 @ 9:06 pm
Thankyou for responding back. I’m actually not to sure which band i have but i think its one of the newer ones. I did not have any fluid taken out during pregnancy. I do have an appointment this month but there telling me i have to see the dietician first. I just feel like my weight is stuck not moving up or down.
Comment by Carmen Garcia — May 14, 2010 @ 9:04 am
Hello, I have a prolapsed band and have been like this for about 2 1/2 weeks. I have an appt for surgery to have my band removed in 2 weeks. Will this cause permanent damage? Will I be able to eat normally after the band is removed?
Comment by Nicole — May 16, 2010 @ 3:45 pm
Hello Nicole,
You will be able to eat normally one week after the lapband is removed.
Comment by Dr. Arturo Rodriguez — May 17, 2010 @ 7:17 am
Thank you for that info. Does a slipped/ prolapsed band cut off blood flow to the stomach? Im worried about permanent damage being done.
Comment by Nicole — May 19, 2010 @ 9:52 am
Hello,
I had surgery last Wednesday to remove my lap band (put in 12/08) because I was experiencing gall bladder type pain (pain in chest, throat, left side of face) but my gall bladder was taken out (12/08). I had also been experiencing dry heaves since November 09 which had gotten progressively worse. The suregon found the band to have eroded into my stomach and liver which meant part of the stomach and liver had to be removed in addition to the lap band. My question is what caused this? After the band was put in I lost 25 lbs (by end of March 09)and did NOT lose anymore until March/April 2010 (yes, over one year) because of a change of medication for depression then I lost 10 more pounds and then the surgery. Also what advice do you have for life after lap band removal and living with internal scar tissue that could cause eating problems.
Comment by Ann — May 19, 2010 @ 11:05 am
Yes, in rare cases when the pouch gets very big and distended there is a chance of perforation…
Comment by Dr. Arturo Rodriguez — May 19, 2010 @ 12:53 pm
Hello Ann,
You should be able to eat regular food in a couple of weeks.
You can have a Gastric Sleeve or a GBP but once a bariatric procedure has failed your chances of failing again are increased unless is a comminment to chage your bad habits. Second procedures aren’t that easy and you should review very well your doctor’s experience in these procedures.
Comment by Dr. Arturo Rodriguez — May 19, 2010 @ 12:58 pm
I had my surgery 2 1/2 weeks ago. My eating habbits were 1 1/2weeks of liquids and I felt like I was going to die. Switched to soft foods and liquids until a few days ago. Then I began somewhat solid foods, grilled chicken salad etc. My portions are the same as before surgery. I have an appointment for an ajustment tomorrow, could this be slippage so soon in the process? Do you think it’s to soon for an adjustment?
Thank you!
Ashley
Comment by Ashley — May 31, 2010 @ 10:53 pm
Hello Ashley,
I think is very soon to have a lapband adjustment. Chances of stretching the pouch increases when the lapband is filled sooner than 6 weeks after having the lapband procedure done or by over filling the lapband system.
You need to do 5-6 small meals a day if you are hungry.
Comment by Dr. Arturo Rodriguez — May 31, 2010 @ 11:02 pm
Hi Doctor,
You did my band on April 27, 2010. I’ve lost 32 pounds so far, and I think it is great!!!! My problem is the acid reflux. I just started a couple of days age. No vomiting, just the acid refulx. Any suggestions are much appreciated!! Thanks
Comment by Cindy — June 2, 2010 @ 10:21 am
Hi Doctor,
I was banded March 2009, and I recently got a fill because i wasn’t feeling much restriction, there were 3.5 CC’s in there, which is strange because i had those CC’s for a while and was able to eat small portions and feel full, but I had to go in because of minimal restriction. I had 4 CC’s put in with a total of 7.5 now, and hardly feel restriction, I started to burp a lot, not very loud but small burps, sometimes i feel food or water coming up, they symtoms got worst within the last couple of days. The burping is so bad my throat burns. I do get some nauseas but they are still developting. Can it possibly be a Band Slippage, but I am unsure because I was told that with a slippage you could barely eat and drink, and I can still do both.. Please advise …
Thanks Marcos…
Comment by Marco Lozano — June 2, 2010 @ 7:55 pm
Hello Marco,
I think you need to have the lapband be checked under fluoro and pull out at least 1 cc to improve your gastric reflux.
I also think that you need to take acid bloquers and Maalox.
I would be worried about you stretching the pouch for have the lapband been overfilled and that is why you need to check the lapband under fluoro.
Comment by Dr. Arturo Rodriguez — June 2, 2010 @ 9:32 pm
Hello, I got my Realize band 38 and about three months ago I started getting awful shoulder and neck pain. I don’t have much trouble eating but I do think I eat too much. Could my band be eroided? Could that or scar tissue be causing my pain? Thank you! Sincerely, Darlene
Comment by Darlene — June 3, 2010 @ 9:21 pm
Hello Darlene,
Shoulder pain and back pain could be caused by erosion or just pouch swelling.
You should take Zantax and Maalox and have your gastric band checked under fluoro.
Comment by Dr. Arturo Rodriguez — June 4, 2010 @ 3:24 am
Hello Cindy,
Just avoid irritants and take some Maalox. That will work for you.
Comment by Dr. Arturo Rodriguez — June 4, 2010 @ 3:49 am
Dearest Dr. Rodriguez,
Regards! I’ve had my band since July 2004 and lost 80 pounds, it was 100 pounds up until one year ago. Suddenly I started gaining weight. I live in the middle east and my band was installed in Mexico. Last summer 2009 I visited my doc and did a fluro. He said the band was fine and it did not need filled. I returned to the middle east and in January 2010 I was not convienced, and went to a lap band doctor where I live. The band is an Inamed 9.75/10cc previously it had been filled to 2cc and at this time it was 1cc. no leaks visable on fluro all fine, I asked if the saline can evaporate he said yes and filled it to 1.5cc. At first the restriction was very high and I started vomiting. Now the vomiting has stopped and I’m getting constipated, and still not losing weight. What should I do?
Thanks so much,
Marianne
Comment by Marianne Alsarraf — June 7, 2010 @ 7:50 am
Hello Doctor,
I was banded in September 2009. I have a realize 11cc band with 8cc’s of fluid. I have
lost 68 pounds and have not had any problems.Over the weekend I started
running a fever and aching like I had the flu. The next day the aching stopped as well
as the fever, but I now have this dull aching pain just under my ribs. When I try to get
up on my stool at work it is very sore and when I put pressure on that area it is very
tender. I am able to eat and drink, but I don’t seem to have much of an appetite. I
feel I get very little help from my bariatric Dr. Does any of this sound as though it
could be band related?
Comment by Debra — June 7, 2010 @ 12:15 pm
After a barrium swallow today at the Dr.’s office, was told that my stomach was enlarged and some conclusion to my band. There was no fluid to deflate in my lapband. He put me on a liquid diet for 2 weeks. He was not positive about the situation. Is it possible to resolve even though there was nothing there to relieve pressure?
Comment by Angie LaPointe — June 7, 2010 @ 12:20 pm
Hello Marianne,
You have the small model of Lapband ( there are other 4 newer models now) and that is why you don’t get many more cc’s to put in.
The saline does not evaporate because it is a closed system.
You should drink more liquids if you are constipated and have another lapband fill in 3 weeks.
Comment by Dr. Arturo Rodriguez — June 7, 2010 @ 3:21 pm
Hello Debra,
You should take some Maalox and to avoid all kind of stomach irritants as aspirin, coke, etc.
In case you continue with tenderness at the level of the port you will need to have an unfill.
Comment by Dr. Arturo Rodriguez — June 7, 2010 @ 3:26 pm
Hello Angie,
How big is the pouch enlarged?
What kind of Lap band do you have?
Why you didn’t have any fluid? How much have you lost?
Some times takes longer than 2 weeks to the stomach to become smaller but the questions that I asked before can give a better picture of your problem.
Comment by Dr. Arturo Rodriguez — June 7, 2010 @ 3:30 pm
Dr. Rodriquez, how much saline does my Inamed 9.75/10cc hold? In my previous post I stated it had 2cc in it and when it was checked 1 year later the dr. said it had 1 cc. now it has 1.5cc. What would you recommend for the next fill? What are the possiblities of erosion and/or slippage. Would I know it? I appreciate your time Dr. and thank you so much for your kind help.
Comment by Marianne Alsarraf — June 8, 2010 @ 1:41 am
Hello Marianne,
You lapband is a short Inamed Lapband with a small balloon of 4.5 cc’s.
I recomend you to have your fills done under fluoroscopic view to have the proper amount of cc’s for your case and at the same time your stomach, the pouch, etc. can be evaluated.
Comment by Dr. Arturo Rodriguez — June 8, 2010 @ 8:05 am
Thank you Dr. Rodriguez and best wishes
Comment by Marianne Alsarraf — June 8, 2010 @ 10:30 am
Hello
I had my lapband place 2 weeks and 5 days ago. My stitches seem to be healing. I have a constant pain on my left side almost under my rib cage. I did not expect pain to last this long because they said I could work in 3 days. Anyway, I am trying to decide if I need to see a doctor or if i should wait for 6 weeks and see him/her at a fill time. I do not throw up and i do not think i ate to much. I am eating mostly liquids and soft food like soup, noodles, mashed potatos. It seems more painful when irritated and I have had some painful gas in that area before. I real wish this pain would stop and I have no reflux but I have take Advil since my doc said it was ok.
Thanks for you help
Ilene
Comment by ilene — June 16, 2010 @ 10:07 pm
Hello Ilene,
The lapband port can be painful when twisting or bending over.
Since is just 2 weeks after you have the lapband procedure I will recommend you to alternate hot and cold at the port area.
Comment by Dr. Arturo Rodriguez — June 17, 2010 @ 6:42 am
I had the lapband installed on the 16th of June 2010. I’m a little worried because I did consume a small amount of solid food (very small). I have not eaten anyother item but liquids since that point. I am now worried that I may be in slippage. Am I just peranoid?
Comment by Josh Cason — June 25, 2010 @ 6:09 am
Yes, unless you had a big meal you should concern.
Comment by Dr. Arturo Rodriguez — June 25, 2010 @ 7:15 am
No, it was not a dinner plate of a meal. I consumed a piece of meat (chicken)very small bite but, I did actually feel it. From that episode I worry. I recently consumed some sugar free jell-o and I did feel full after a tea size cup amount. Should I be concerned?
Comment by Jash Cason — June 25, 2010 @ 5:42 pm
Hello Jash,
You shouldn’t be concerned at all for what you did.
What kind of a lapband do you have?
Comment by Dr. Arturo Rodriguez — June 25, 2010 @ 6:01 pm
My lapband was place in October of 2003. Since the beginning I had trouble eating anything that was not soft or “soupy”. I have never been able to eat meat of any kind unless it is chopped fine and has a sauce or gravy on it. I also had frequent vomiting episodes. About 4 years ago, an X-Ray showed that I had a hiatal hernia above the band, and the doc. said I now had two restrictions, but did not recommend doing anything. I should also mention that since I have left the health network where the surgery was done, I have not been able to return to the Doctor who placed the band and other doctors seem reluctant to take me on as their patient. Since the band was placed, if I eat anything too heavy or dry, my stomach seems to go into “overdrive” producing a thick mucus which cause me to vomit that up, and sometimes the food I’ve eaten also comes back up. For the past week I have been unable to eat anything solid at all without the mucus and vomiting. I called the bariatric surgery clinic and was told that the doctor I saw a few years ago was “out of town” and to go to the ER and have them do a workup to see if the band had slipped. It was recommended that I go to a hospital outside of my network (which my insurance won’t pay for) because the ER I would normally go to does not have a bariatric surgeon on call. I take nexium, and am on a liquid only diet at this point, but even the liquids cause belching and burping. I do not have any stomach pain, and yes I’m quilty of drinking carbonated beverages before this last week. Could I be having a reflux “flare-up” that will heal on it’s own? I don’t have stomach pain, or could the band have slipped?
Comment by Linda Sowell — June 26, 2010 @ 10:46 am
Hello Linda,
You have the old Inamed model of Lapband.
You need to go to a fill center (fillcentersUSA.com) around you area and to be checked there and to remove all the fluid inside the lapband.
How much have you lost?
Comment by Dr. Arturo Rodriguez — June 26, 2010 @ 3:21 pm
I was banded a year ago, July 2009, with a Realize band. I have lost almost 45lbs, but in the past 4 months have not lost any weight. There are days where I can eat a lot of food and there are days that I cannot eat anything, where I vomit after even eating just a small amount of food. At the beginning I was really good about staying away from soda, but that habit has come back with my long hours and travel. I try to shake the carbination out so it is flat when I drink it but not sure if that makes a difference. My Dr. has never done any x-rays or flourscopy since the band placement. I am worried that my pouch has enlarged. Thanks for your help!!
Comment by Joe E. — July 8, 2010 @ 7:32 pm
Hello Joe,
You need to be checked under fluoro now that is over a year after your lapband surgery.
You also have to protect the stomach with pepcid complete at nights because drinking coke or soda will make you swell at the level of the lapband.
Comment by Dr. Arturo Rodriguez — July 8, 2010 @ 8:35 pm
What does one do when one has a very rude, uncaring doctor? I have had my band two years. After the last two fills I felt no difference in the amount of food I could consume. Would a new doctor take me as a patient? Returning to my original doctor is not an opption do to his intolerance of my plight. Some of my food cravings has returned.
Comment by Susan — July 12, 2010 @ 7:56 am
Hello Susan,
You can look at: http://www.fillcentersUSA.com
You can have your lapband filled out there. Make sure they do it under fluoro.
Comment by Dr. Arturo Rodriguez — July 12, 2010 @ 4:52 pm
Hello, Dr. Rodriguez,
I would like to get my band removed. I´ve heard the procedure is more invasive than when it is placed initially, is this true?
Thanks,
Eva
Comment by Eva — July 13, 2010 @ 4:13 pm
Hello Eva,
Removing the lapband is the same as placing one if is done laparoscopically.
Comment by Dr. Arturo Rodriguez — July 13, 2010 @ 4:38 pm
Hello, Dr. Rodriguez,
Thank you for your prompt response. So the same scars are used again?
I have another question and I appreciate your help since I´m out of the country right now. Three nights ago, two hours after I had a very soft cookie, it started coming up. It bothered me so much I threw up a lot. Since that night I´m having great difficulty keeping food down, even drinking water. Foods that I eat normally without a problem are a problem. These past two nights lying down and trying to fall asleep has been hard because I keep burping and food keeps coming up. Last night I went to bed at midnight and at 4 am, gastric juices came up all the way to my throat. The way I feel reminds me of how I felt post op. I´m going to try to be on a liquid diet today. I had my lap band placed in Oct. ´05.
Thanks again,
Eva
Comment by Eva — July 14, 2010 @ 7:51 am
Dr. Rodriguez,
Hello, I got my lap band about 5 years ago. In those days it was considered Ok to get a fill soon after the surgery. I lost 30 lbs right away, however I developed a prolapsed stomach because they kept filling the band too tight. I had the fills lessened to almost nothing and the issue went away. The center fired the tech who kept causing so many prolapses. I eventually lost 30 more pounds with very little fluid in my band. I was told I had a very small stomach and even the smallest band was not right. I developed autoimmune issues and had a stroke. Found out I had 4 blood clotting disorders and Lupus. I had to take asprin, coumadin etc so I had all the fluid removed. Now I take the blood thinner Arixtra. After years of being ill and tons of steriods I have gained all but 30 pounds back. Two months ago I went on a malaria medicine used to treat Lupus. They also did another round of steriods. I’ve noticed a lot of stomach pain when I eat, pain under my left rib, chest pain, I have a dry cough and my voice is hoarse. I am having trouble taking a big breathe and I get winded easily. I went to a pulminary specialist and my lungs are fine. I go to have the band checked with a Barium swallow tomorrow. My question is can I have a prolapsed stomach with out a fill? Also, how would I know if erosion has occurred. I have no acid reflux and no vomiting or nausea. No pian in the port area, but sometimes it feels like the port is uncomfortable. It hurts when I eat or drink, but it is pain, not pressure or fullness. Can a lap band affect breathing? I want the band removed anyway. What do you think? Thank you, Karin
Comment by Karin Smith — July 14, 2010 @ 5:52 pm
Hello Eva,
You have to be on liquid diet, take Maalox e/4 hrs and have some pepcid or any other acid blocker available for you. There should be an improvement in a couple days.
Comment by Dr. Arturo Rodriguez — July 17, 2010 @ 10:19 am
I was banded in 2006, started having acid reflux and not losing weight, gained a few pounds and after checking with fluro doctor said I had slippage. Had removal and replacement surgery in October 2009, no weight loss… no fill until around Feb. 2010 (waited for fill due to hystorectomy in late December). When I got the first fill in February, I left the office and after about 15 minutes the water they had me drink after the fill was coming up and I felt sick. Called that night because I could not hold any liquids down, went back next morning and some fluid was removed. As of June, no weight loss – actually gained about 20 pounds since surgery (was 255 replacement time, now 275). Went back to doctor, he checked fluro and said he thought I had a slip again. He said to do liquids 2 weeks and come back, but a month later… I haven’t returned yet and was on liquids for about a week. So…..I never had vomiting or pain, only weight gain and very slight acid reflux this second time around. Do you think it is slipped? If so, I am kind of afraid of surgery again since during my revision surgery, my liver had to be cut into due to so much scar tissue and I had to have 4 blood transfusions and I am scared of complications such as this happening again. Can I just leave it there as is? Or will I have to have it removed down the road anyway? He is wanting to go in and “reposition” what do you think of all this? Thanks, Monica
Comment by Monica — July 19, 2010 @ 9:01 pm
Sorry, left out that my original weight was 304 – i did originally lose down to 236 at one point then didn’t watch my eating habits so well and gained up to the 255 in mid 2009. Thanks, Monica
Comment by Monica — July 19, 2010 @ 9:03 pm
Hello Monica,
I think your lapband has slipped again.
You probably have an old model of lapband which favors slippage when is forced with food.
I do recommend a de-banding procedure plus a gastric sleeve since already twice the lapband has slipped.
Comment by Dr. Arturo Rodriguez — July 20, 2010 @ 4:46 am
Dr. Rodriquez,
I was doing water aerobics and deeply stretching out the top half of my body in the water, stretching as far as I could in all directions. That night, the left side of my back, under my shoulder and my ribs and chest were extemely sore. Anything I tried to keep down, including water, caused extreme pain in my upper body, from the rib cage up. I threw up for the first time with the lap band. It has gotten better over the past few days, but there is blood in my stool. Could I have moved the lap band while stretching my chest area too far?
Thank you for being available to answer questions,
K.S.
Comment by K.S. — July 23, 2010 @ 7:15 pm
Hello! I was banded on 5/12/2009, to date have lost 95lbs. I was filled to 9.5cc and started struggling with nausea, hearburn, acid reflux, and lots of vomitting. Reduced the fluid to 9cc and problems persisted. Two weeks ago all of the fluid was removed to heal for 4 weeks and then we will do a fluro to see if it is healed. I am still having nausea every day, all day and I have a feeling of fluid sitting at the back of my throat. The heartburn and reflux has stopped in the last week. My question is whether this sounds like I am on track with healing (was told my puch was slightly stretched). I am concerned with this continued nausea and pressure at the back of my throat. Does it typically take 4-6 weeks to heal and be free of symptoms when empty or does it sounds like something else is going on and symptoms should have eased completely when all the fluid was removed. Thanks for your help!!
Comment by Joan Cronk — July 27, 2010 @ 11:28 am
Hello,
Fresh blood or red in color means low bleeding (far behiond the lapband area)
Black stools could possible mean blood from the stomach.
You have to see your doctor to determine where the bleeding came from.
Take care
Comment by Dr. Arturo Rodriguez — July 29, 2010 @ 3:01 pm
Hello Joan,
You should be without any symptoms 3-4 days after all the fluid was removed.
I think 9.5 cc’s was too much for the lapband.
I recommend you to have a barium swallow and have the lapband be checked.
What mnedications are you actually taking?
Comment by Dr. Arturo Rodriguez — July 29, 2010 @ 3:04 pm
Hello Dr. Rodriguez, I’ve been reading your posts and it’s so great that you make the time to answer all of our questions. My question is, I just had the Realize C (11cc) band put in on July 20th of this year, only 12 days ago, and I will start a college swim class at my 6th week post op, the swim class is very rigorous with a lot of fast full body movement for two hours twice a week, do you feel it is safe so soon after surgery, I’m afraid of causing a slippage. Thank you very much your time is appreciated.
-Monica
Comment by Monica Espana — August 1, 2010 @ 2:27 am
Hello Monica,
You will do great without any problem doing exercise.
Slippage is cause by forcing the stomach with more food than it supposed.
Have a great weight loss!
Comment by Dr. Arturo Rodriguez — August 1, 2010 @ 9:39 am
Thank you!
Comment by Monica Espana — August 1, 2010 @ 9:51 am
I had my 6th fill August 2, 2010 and was doing good. Then on August 8, 2010 I was outside and got to hot and vomited…and since then have had reflux at night and some during the day. At my visit on the 2nd my band and pouch all were positioned fine. I have vomited before, but did not continue to experience reflux a few days later. Maybe I was heat sick or had a stomach bug, do you think I need to go in an have them check for slippage?
Julie
Comment by Julie — August 11, 2010 @ 10:39 am
Hello Julie,
You need 1 or 2 cc to taken out from the lapband and take Pepcid Complete and Maalox, one month later you can come back for a fill.
Comment by Dr. Arturo Rodriguez — August 11, 2010 @ 10:51 am
Dear Dr. Arturo Rodriguez,
I had my band placed in 2006 everything was fine I dropped about 70 lbs. no complications whatsoever. I became pregnant in August of 2007 and when I was 2 months I went to go see my Dr. to get fluid of the band emptied, and every thing was fine I would normal portions and intake variety of foods. I had my son and waited till i was done breast feeding to go back and thighten up again because I had gained about 100 lbs, this was in the late fall of 2008. My doctor didn’t gradually fill my band up like he did when i first had the band placed in like 5cc every time. He put be back to where I was when i was pregnant which was about 3.5 cc the time I went in to have to have my fluid removed. I have no problems I followed the rules did my liquids, soft foods, lean meats. One day while out of town stopped to grab some grilled chicken for dinner and while eating I accidently swallowed a piece without chewing it. I felt it was stucked and neither vomiting or driking water worked. For 3 days I could not intake anything including water, so I went to the clinic and had all the fluid removed. I had no problems intaking food right after the loosening of the band but gradually throughout the year I had small problems not getting food down,burping,some nausea, some vomitting, had to intake smaller portion, but despite that I was not losing any weigth. I did not pay attention to it I just refrained from eating hard solids, but the symptoms kept progressing, I finally decided to go in and see him I had an upper GI done and it came back normal with no signs of slippage or pouch dialation just some acid reflux. Two weeks after the upper GI the vomiting and burping has increased even when I drink water, specially at night, at times I cant keep food down such as soups, I don’t even mess with any soft solids, I have dropped 25 lbs in 6 weeks since I’ve had the upper GI. I saw my doctor again he mentioned that if I’m not eating I should have melted away already. I feel like he doesn’t believe me he also said that its possible i am experiencing this problems is because my band is a small one and I am 50 lbs heavier now than at the time the band was placed in. He said he would remove it if i couldn’t tolerate the discomfort its bringing. My only concern is what can really be happening and the long tern health affects. Could you please offer me some advice as to other steps to take to find out what is happening to me?
Thank you,
Evelyn
Comment by Evelyn — August 14, 2010 @ 7:01 pm
Hello Evelyn,
Your doctor is right when he says your Lapband is a small lapband model but the thing is that I am not sure in your case if changing the lapband to the VG lapband model or to the Realize gastric band which are longer models of gastric bands will solve your problems.
I recommend you to be in a very strict diet with no irritants at all and avoiding all kind of medications including vitamins.
Take for 2 weeks Maalox e/4 hrs and Pepcid Complete e/12 hrs.
Should be a change after these initial 2 weeks and then have your lapband checked again for gastric reflux but not for tightening the lapband.
Comment by Dr. Arturo Rodriguez — August 15, 2010 @ 7:20 am
Thank you for your recommendations Dr. Rodriguez I greatly appreciate it. I just wanted to ask you if you recommend that I drink my protein shakes, jello, and chicken stock for now, or what constitute as a strict diet? By getting my band checked again did you mean have an Upper GI done again?
Thank you,
Evelyn
Comment by Evelyn — August 15, 2010 @ 10:41 am
Hello Evelyn,
I do not recommend protein shakes or vitamins when patients had the lapband procedure done. These can make the pouch swollen and can also give you gastric reflux.
I do recommend soft food with no irritants or medications other than the ones strictly needed.
Yes, an Upper GI done again in 2-3 weeks to evaluate the changes.
Comment by Dr. Arturo Rodriguez — August 15, 2010 @ 6:46 pm
I finally found out that my band was partially eroded. I had surgery this weekend and was de-banded. How long will it take for the erosion to heal completely. Why I am still vomiting? I am currently on a liquid diet. How long will it need to take before I can eat solid food? Will I ever be able to eat normal again or will I have to stay away from irritants for the rest of my life. Thank you for your previous comments.
Evelyn
Comment by Evelyn — August 26, 2010 @ 6:53 pm
Hello Evelyn,
The stomach will heal in about 10 days completely after a de-banding procedure.
You shouldn’t be vomiting at all so check with your doctor about it and see if you need another upper GI.
You will be able to eat everything after one month including irritants.
Comment by Dr. Arturo Rodriguez — August 27, 2010 @ 4:53 am
Dr. Rodriguez,
I got my band in August 2009. I had my 1st fill in October (1cc) and my 2nd fill in November (2 cc). Everything was fine until April and I started having problems with reflux and keeping things down. I had 1 cc removed. It was better for several weeks and then it started again. In June I had another 1 cc removed. Again things were better for about a month. Some days I could eat or drink with no problem and other days I can’t eat or drink anything. I get a thick saliva/mucus/slime that comes up when I burp. I also get a sharp pain between my breast that goes all the way through to my back. I went in 3 weeks ago for an upper GI with a barium swallow and the doctor said everything was going down, it was just really, really slow. No slippage or hernia. I was ok for a week or so and now I can’t eat or drink without getting the pain and throwing up the saliva/mucus/slime. Do I just need more fluid taken out? I’ve been taking Prilosec OTC for several days and the reflux is better.
Comment by Sharon — August 27, 2010 @ 8:59 pm
Hello Sharon,
Do you have the old Lapband model of 4.5 cc?!!?
Your symptoms are related to severe reflux.
Before you do start with lapband fills again you should wait at least 3 weeks without symptoms (pain, reflux, vomiting).
You have to make a list of what you eat, what you drink and what meds you are using and check with your doctor if any of them were aggravating your symptoms before you do the fill again.
Comment by Dr. Arturo Rodriguez — August 28, 2010 @ 6:31 am
I don’t know what model I have, he just told me it holds about 10 cc of fluid. I began with 4 at surgery, had to 2 fills to bring it to 7 cc and I’ve had fluid taken out twice to bring it down to 5 cc. I’m wondering if I need to have it taken back down to the 4 cc? He told me that he thought I just had previously had a bad case of gastritis that has never healed. Should I continue to take the Prilosec and go back on liquids & pureed food for a week or more? It’s bad enough that I can’t really eat anything, but I’m really getting tired of hurting and having to throw up to feel better. I know that throwing up is not good and I don’t want it to become a habit.
Comment by Sharon — August 28, 2010 @ 7:38 am
Hi Doc
I was banded Feb 2008 and had 13 fills by Oct 2009. At that point I was well restricted and pushing up a lot of undigested food. Almost imediately after that fill, I lost most all perceived restriction. An endoscopy in Jan 2010 by my gastroenterologist indicated the band was placed too high but the bariatric surgeon disagreed. Since Oct 2009, I have had 8 more fills from 1-4cc and they estimate I have 15cc in a 15cc band but still no restriction. They are recommending a diagnostic laparoscopy to determine the problem. The band seems to hold pressure and shows no sign of a leak in the system. What are the possible causes of my problem?
Thanks!
Dave
Comment by Dave Gimbert — August 28, 2010 @ 11:16 am
Hi Sharon,
Throwing up will just make your symptoms worse.
You need to find out what is triggering all your symptoms. The fill you have shouldn’t cause restriction at all.
Comment by Dr. Arturo Rodriguez — August 28, 2010 @ 12:06 pm
Hello Dave,
I don’t know what kind of a lapband you have and is very important to know.
I am assuming you had office fills done at the doctor’s office.
During a fill the doctor can pull out the fluid to measure the cc’s you have and not need to be guessing about it but 15 cc seems to me very much fluid.
The lapband has to be placed very high up in the stomach and is normal that is misinterpreted.
Barium swallow is the best way in your case to make the proper diagnose like lapband erosion or lapband slippage.
Comment by Dr. Arturo Rodriguez — August 28, 2010 @ 12:18 pm
Since I have had the barium swallow and they determined that everything was fine how do I find out what is causing my symptoms?
Comment by Sharon — August 28, 2010 @ 1:14 pm
Thanks Dr. Rodriguez
I believe that it is an Allergan with 15cc capacity. All fills are at the doctor’s office and he has recently pulled most of the fluid out to determine what’s on board. He says that you can’t get 100% out so it is still an estimate but he’s thinking it’s at capacity. He did say that recent research shows that it is safe to exceed rated capacity somewhat. I believe that he also said that the gastro doctor was misinterpreting the band placement as too high. We have now added many cc’s to what felt like a full band before it “released”. Besides slipping up to a narrower part of the anatomy, what could explain this with a band that holds pressure? When you push the fluid in and release the syringe, at least 2 ccs will push back into the syringe, indicating the pressure. If band position is the likely problem, it seems that the swallow would indicate it, rather than resorting to a diagnostic lap. Besides slippage, what might you discover with the diagnostic lap, consitant with my symptoms? I am very frustrated to have lost all benefit of my band.
Thanks for your time.
Dave
Comment by Dave — August 28, 2010 @ 1:38 pm
Hi Sharon,
I recommend you to write down what you eat and drink and go over with your doctor. If you want to send me a copy I can tell you what could be causing your problems.
doctor@thebariatric.com
Comment by Dr. Arturo Rodriguez — August 28, 2010 @ 5:57 pm
Hello Dave,
Sorry to tell you but 15 cc in any Allergan model is too much and is not safe at all.
Your doctor should be able allways to recover all the fluid in the lapband system
I recommend you to have a barium swallow instead of a laparoscopic diagnostic procedure and to look for lapband erosion. It is the cheapest way to know what to do next.
Comment by Dr. Arturo Rodriguez — August 29, 2010 @ 7:38 pm
Dear Doc,
I had my band placed 1 week ago, initially I could only tolerate 64 oz of fluid a day but today I feel hungry and never full. Today I consumed fluid all day with the exception of dinner. My dinner was if rice and some shrimp, I chewed it very well and thought that I would feel full but as of yet I haven’t. I have not consumed anything since dinner but I am afraid I have caused damage to my band or worse my pouch. Please help me I feel hungry and confused.
Comment by Angelica — August 29, 2010 @ 10:03 pm
Hello Angelica,
1 week after lapband surgery and been on liquid diet you can start soft food diet for 2 more weeks. Between meals you can have a cracker as a snack in case you are hungry. Nothing will happens this way and avoiding also irritants as coke, coffee, alcohol, etc.
Comment by Dr. Arturo Rodriguez — August 30, 2010 @ 9:20 am