Posts Tagged ‘Gastric Banding’

My Life with the Lapband

Thursday, December 22nd, 2011

Tricia

My Life with the Lapband

My Journey…

Boy how time flies! 

As I approach my 5th year Bandiversary, I started thinking how the Lapband has changed my life or how I had to change my life to live with the Lapband.

First off, I thank God every day for showing me there was an option and giving me the opportunity to have the Lapband procedure.

Like most in my situation, I tried every diet that always ended in failure. I almost got to the point where I wouldn’t want to diet because I KNEW I would gain the weight back and probably gain more. It was a horrible vicious cycle that I lived in for years.

Living with the Lapband was a continual learning process for a while. I tested foods to see what I could eat and what gave me difficulties. I tested out drinking with meals and not drinking with meals. Unfortunately, I had to learn the hard way on a lot of these issues, but the key is I learned and now the changes that I have made in living with the Lapband are part of my normal way of living. I don’t even think about it anymore.

One of the most frustrating things about the Lapband is obtaining proper restriction level. On one hand, I wish doctor’s would be a little more aggressive with the fill amounts, on the other hand, I think that working your way up to the proper restriction level is the way to go to avoid getting filled too tight which can be very uncomfortable and dangerous. I think that more discussion needs to be made about preparing one’s self for life after the lapband which includes the cost of adjustments/fills and the expectation of how many fills it may require to achieve proper restriction.

For self payers, many people use all their financial means to pay for the actual Lapband surgery and then don’t have the funds to get adjustments afterwards. This creates frustration because you just paid a lot of money and went through surgery and now want to lose the weight. Sounds reasonable……. But many feel like they wasted money when they don’t lose weight after the surgery or they feel like they can eat like they could before the surgery which is true until the band is adjusted properly.

So if someone is scheduled for lapband surgery and they ask me about the band, I make a point of preparing them for after surgery. I also try to tell them that their patience level will be tested to the max until they get their bands filled properly. I’ve heard this said by many and it’s so true “It took us a long time to become this overweight, we’re not going to lose it all overnight” It may take some time to lose weight with the Lapband, but with a little patience and following some very basic rules, you will lose weight and you will be successful.

Things that have changed for me after I was banded…

I don’t drink with meals. I found that this flushes food from my small upper pouch into my lower pouch which enables me to eat more food. This kind of defeats the band doesn’t it? I don’t want to eat more food, because this little thing called weight gain occurs if I do.  Not drinking with meals was probably the hardest thing for me to get used to, but now I don’t even think about it.

I still take small bites and have slowed down while eating. I found that taking smaller bites and slowing down while eating actually fills me up quicker. I also don’t look like I’m inhaling my food anymore, which was a very unattractive habit that I got into pre-band.

I listen to my band. It tells me when to stop eating. Oh, I’ve tried to argue with my band in the past and tell it that I could eat more even when it warned me that I have had enough, but for some reason the band was always right. I paid a small price for trying to fight the band. I would feel horrible until the food passed through the band. Sometimes I would PB (not pleasant) and learned very quickly that it’s just not worth fighting the band. It knows best, so now I listen to it.

I try to stick to protein foods first. I’m not always good at this, but it’s something that I feel is very important for Lapbanders. I have also found that when I eat protein foods first like chicken, fish, etc… then I don’t require as much food to feel full and I stay fuller longer. Not to mention the benefits to my health for eating protein.

Since I can’t eat as much as I used to, my food choices have changed. Before the band, I would eat horribly. It’s because I could eat a lot of anything I wanted. So if I wanted to snack on chips before dinner, no problem. I would still be hungry enough at dinner to eat it, and then have enough room for dessert after wards.

I now chose quality over quantity. I do this because I know I can’t eat a lot, so what I DO eat becomes very important. I have found that if I eat chips now, I will fill up on them, and I won’t feel hungry to eat what I should be eating. Then I end up feeling awful because “foods” like chips drain my energy if I try to use them as my source of nutrition. Don’t get me wrong, I still eat things like chips, but I make a point of not eating them when I’m hungry because I know that I will fill up on them and won’t eat what I need to be eating. So I will have junk food occasionally, but usually with my meal and have very little.

I don’t eat dinner late in the evening. I have a cut off time for dinner. I make sure that I don’t go to bed for about 3 hours after I eat. I also don’t drink a lot of fluids at night and I religiously take 2 Pepsid AC chewables before I go to bed. I believe that these things have decreased my chances of having acid reflux at night.

So yes, the Lapband has totally changed my life. With 155 pounds gone I’m feeling terrific! I feel that the minor things that I have changed in my life (with eating) due to the band are so minor and so worth it to help insure that I keep this weight off. Don’t get me wrong, I don’t struggle to keep the weight off, which is fantastic, but I believe that the minor changes that I have made have contributed to this.

The Lapband won’t do it all. You’ll need to help it some, but once your band is adjusted properly, the band will work for/with you instead of you working for the band.

Life is wonderful!Tricia before Lapband
Tricia after Lapband

Starting BMI 43

Current BMI 20

Tricia
Banded July 16th, 2004
Lost 155 pounds

Dr. Arturo Rodriguez

http://www.thebariatric.com

http://www.bandstersforum.com

Originally posted 2009-03-11 18:21:38. Republished by Blog Post Promoter

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10 Ways to Succeed with the Lap Band

Thursday, November 17th, 2011

10 Ways to Succeed with the Lap Band

Here are some helpful tips to help you succeed with the Lap-Band on a long-term basis.

Before you have the Gastric Lap Band:

1. Search for the Right Doctor for You
Many companies or groups claim to be the Best Experts in Lap Band surgery.  However, it is important to check the qualifications and experience of your surgeon before making your decision.  Find out whether the doctor is a member of any medical organizations and whether they have any experience in bariatric surgery.  Make sure to research the company and the Doctor´s credentials, and look into the facilities and medical team.  You can also check with the companies that manufacture the lap band products, like Allergan or Johnson & Johnson, to find more recommendations.  It is very important to be in the right hands when you have surgery.  The experience of your surgeon can make a big difference in your weight loss outcome.  Surgery can be life-changing – Don´t play with your health.  Look for the right doctor, and not just the cheapest deal.

2. Double-check the Doctor´s Coordinators
Some coordinators will say anything to convince you that their team and services are the best. The personality of the coordinators or the medical team can tell you a lot about the kind of work they do.  When talking on the phone, check for signs of aggressiveness, or whether they speak poorly of other bariatric teams or surgeons.  If they tell you that they know “everything” about Lap Bands or bariatric surgery, this is probably not true.  Take your time to analyze their ethics and professionalism, and keep your ears and eyes open.  Be cautious of coordinators that seem too pushy or don´t respect your requests.  These coordinators are not looking out for your best interests – they are just looking for your money.  Instead, look for coordinators that demonstrate clear communication and professionalism, honesty, friendliness and a helpful and caring attitude.

3. Avoid companies that are just “moving patients through the border”
Some “coordinators” may contact you to promote weight loss surgery without an actual connection to a qualified bariatric surgeon.  They may not even work for the Doctor that they are promoting, and are just looking to make money.  They do not have your best interests in mind – you are a merchandize for them.  They might make promises that they can´t follow through with, and may get any Doctor for your surgery as long as they get paid for arranging things for you.  When researching into the company, find out as much as you can about all the details, including any hidden costs or fees.  Be sure that you feel confidant and comfortable with the people that you are working with before you make your final decision.

4. Communicate with other Banded Patients
Often, the best source of information is someone that has already gone through the experience before.  You can find out answers by asking other people that have had the lap band procedure.  Search for online forums, chat rooms, or message boards.  Some questions you might ask could be:

  • What kind of surgical weight loss procedure did they receive?
  • Was the surgery what they expected?
  • How did the Doctor and his medical team treat them?
  • Did they have any complications after surgery?
  • How long did the surgery process take?
  • How have they adjusted to life with the lap band?
  • Did they see the results that they were expecting or hoping for?
  • How soon did they see results?
  • Would they recommend their doctor to someone else looking for the same surgery?

After you have the Gastric Lap Band Procedure:

5. Begin the Journey: Develop Good Habits
After Lap Band surgery, you will need to make some changes to your diet and activity.  Small actions can results in big changes and lead to successful weight loss with your new lap band.  Make sure that you learn about what foods to eat and what foods to avoid after your surgery, and determine if you can make these changes.  You will also see better results if you include physical activity in your daily routine.  If you are always used to driving in the car or riding the bus, try going for a short walk or getting off the bus earlier. If you do walk, try walking faster.  Park your car farther away from where you are going so you can get some extra steps into your day. Use any excuse to move your body, like taking the dogs out or doing some gardening. Do anything that will help you to develop new, healthy habits.

6. Your Lap Band Expectations
Imagine yourself at the end of the “Lap Band Road” and keep Focused on that image. The vast majority of banded patients expect the band to work alone by itself, without changing any of their old habits. But the truth is that you do need to put a lot of energy into yourself and encourage yourself to improve your eating habits and activities in order to each your weight loss goals. The Lap Band is a tool to help you, but it won’t do the job alone. For the best results, you need to be committed to positive change.

7.  Find the optimum Lap Band Fill
My advice is to reach a “fill point” where you can keep enjoying the foods you like, while still being able to lose or maintain your weight. Too much tightness or restriction will have you at the border line for being de-banded, and stomach erosion can happen frequently in patients with large fills. Do not compete with the Lap Band by trying to force food to pass through the band. If you feel excessive restriction, visit your doctor to have your band adjusted. 

8. Maintain Good Communication with your Doctor
This is the most important of the 10 “keys for success.”  Make sure you can reach your Doctor whenever you need him or her.  The Bariatric Surgeons and Doctors are different than General Surgeons in the follow-up care.
Don’t hesitate to call your Doctor if you have any of the following symptoms: Heartburn, pain at the port area or in the abdomen, frequent vomiting, difficulty swallowing or reflux.  

9. Have a Barium Swallow or an Endoscopy atleast once a year
This can help to indicate the condition of your stomach, esophagus, and the lap band system, including the positioning of the band and port.  This may also help to detect any problems earlier, which can allow for more time to solve the problem. 

10. Have your Fills done under Fluoroscopy as often as possible
Office fills do not detect early, easily-correctable problems until it may be too late.  Slippage and erosion are more frequently seen in patients that have never had follow-ups under fluoroscopy.  Check with your Doctor to find out their process for lap band fills – if they only do office fills, ask your Doctor to recommend someone that can provide fills under fluoroscopy for you.

 

Arturo Rodriguez, MD
http://www.thebariatric.com
http://www.bandstersforum.com

Originally posted 2008-05-31 20:39:08. Republished by Blog Post Promoter

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Lap Band Erosion: Clinical, Radiological and Endoscopic Correlation

Wednesday, September 21st, 2011

Lap Band Erosion: Clinical, Radiological and Endoscopic Correlation

Erosion is a long-term complication of lap band surgery, and occurs when the Gastric Band fastened around the upper stomach gradually erodes into the stomach wall and extends into the gastric lumen.  Intragastric Lap Band Erosions have been reported at rates that vary from 0.6% to 10% depending of the operative technique, the doctor’s experience, the device used and the most important factor: the patient’s follow up.

The use of NSAIDS, alcohol and smoking have been proposed as three of the main factors contributing to hyperacidity and irritation of the mucosal layer of the stomach. This important layer prevents us from acquiring ulcers in normal conditions.  When the irritation is persistent, it can cause erosion of the wall layers of the stomach, which may allow the lap band to migrate into the stomach (“inside out” erosion theory).  Repeated vomiting has also been suggested as a possible accelerant, especially when a high degree of obstruction is present (For example, an over-filling of the lap band). Due to the erosion, saliva or food leaks through the hole or ulcer in the stomach and flows along the Lap Band tubing, causing the tissue under the skin of the Lap Band Port to become infected. 

 intragastric-lapband-migration
Figure 1.0 Intragrastric Lap Band Migration – Drawing of radiographic findings illustrates passage of liquid contrast material (Barium) around left section of band that has eroded into the stomach (small arrow).

In some cases, Lap-band erosion occurs gradually and may be silent or go unnoticed. However, several clinical symptoms may develop and should raise the suspicion of Lap Band Erosion: (1) cessation of weight loss, (2) weight regain with loss of restriction in the lap band, or (3) a port site infection. The Clinical Symptoms and Radiological or Endoscopic findings depend on the degree of Erosion.

The diagnosis of Lap Band Erosion can be made at the radiological evaluation performed under fluoroscopy during a gastric band adjustment in both symptomatic and asymptomatic patients.  If the radiological evaluation does not show signs of lap-band erosion and the patient has the symptoms, the doctor is obligated to perform an Endoscopy.

port-infection

Lapband Port Infection http://www.thebariatric.com

Figure 1.1  Lap Band Port Infection

Due to the fact that Lap Band Erosions usually open with a port infection (35%), the infection will continue after removal of the port, especially if erosion was not diagnosed.  In these cases of chronic infection, further radiological and endoscopic tests are needed to demonstrate the presence of Lap Band Erosion.

endoscopy-findings1

Lapband Erosion, http://www.thebariatric.com

Figure 1.2  Endoscopic View of Lap Band Erosion

endoscopy-findings-tips2

Lapband Erosion, http://www.thebariatric.com

Figure 1.3 Intragastric Lap Band Erosion – Note the “tips” of a Swedish band into the gastric lumen

erosion-xray

Lapband Erosion, http://www.thebariatric.com

Figure 2.0 – Intragastric Lap Band Erosion – Radiological evaluation shows 2 channels of contrast material, instead of one, clearly demonstrated in the later view of Fig. 2.1

erosion-xray2

Lapband Erosion, http://www.thebariatric.com

Fig. 2.1 – Intragastric Lap Band Erosion - In this lateral view you can see the “bridge” between the upper (the pouch) and the lower stomach, the barium contrast material bypasses the part of the lap band that has eroded through the stomach’s wall.

missing-port

Lapband Port infection http://www.thebariatric.com

Figure 3.0 - Missing PortAP plain film shows a lap band without the port. The Patient had a history of port removal secondary to port infection with a persistent infected fluid coming out from the port area.

fistulography

Lapband Fistulography http://www.thebariatric.com

Figure 3.1 Intragastric Lap Band Erosion demonstrated by fistulography.
Note the injected contrast material at the skin level is going through the fistula into the lower stomach.

The upper GI x-ray does not reveal lap band erosion in its early stages. However, the radiological appearance of late-stage intragastric band erosion on the upper gastrointestinal series is pathognomonic when the “stair sign” is observed. Barium swallow during the upper GI shows a flow of contrast fluid around the portion of the band that has eroded into the stomach. As mentioned before, in cases where the radiological findings are missing, an endoscopic evaluation is mandatory.

stair-sign

Lapband Erosion, http://www.thebariatric.com

Figure 4.0 Intragastric Lap Band Erosion – Radiograph from upper gastrointestinal series shows characteristic appearance of intragastric lap band erosion. Note the liquid contrast material on both sides of penetrating portion of the lap-band, “the stair sign”.

 

band-migrated

Lapband Erosion, http://www.thebariatric.com

Figure 4.1 - Radiologic evaluation shows a complete eroded gastric band – Note the location of the migrated band; the lap band device is found in its totality intragastric at the level of stomach antrum (the lower stomach). The patient had not been loosing weight for 3 years.

band

Lapband Erosion, http://www.thebariatric.com

Figure 4.2 – Complete erosion of the gastric band (seen in Figure 4.1) the gastric band was removed by endoscopy

Treatment of lap band erosion requires removing the lapband by laparoscopy or by endoscopy.  Weight regain typically occurs following this procedure. However, it is necessary to remove the gastric band in order to avoid further complications.  It is recommended to treat Lap Band Erosions with another bariatric procedure 6 to 8 months after a de-banding procedure (Lap Band removal). This is due to the high incidence of complications and failures when the procedure is done immediately following removal, or sooner than 6 months after removal, since the portion of stomach that has been eroded is weak and prone to leaking.

It is true that Lap Band Migration means the failure of the operation and leads to a second bariatric procedure; however, erosion is considered a complication with a benign course if it is managed properly.

Susana González M.D.

Radiologist

http://www.thebariatric.com

 

Originally posted 2008-08-09 23:51:53. Republished by Blog Post Promoter

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The Laparoscopic Journey: Past and Future

Wednesday, August 31st, 2011

The Laparoscopic Journey: Past and Future

Our History

The knowledge that we have today about laparoscopy has developed through the patience, hard-work and determination of dedicated doctors and individuals. When we started doing laparoscopic surgery, many doctors without laparoscopic training argued that open surgery had a better view through the large incision, than from the tiny camera’s panoramic view. They also thought that the sense of touch was lost by using instruments instead of fingers tips. They stated we were introducing unnecessary risks to any procedure by doing so. However, over time we have discovered that laparoscopic surgery is a very safe method.  The view is much better with the cameras moving in all possible directions, and the tip of the instruments act as well as finger tips do after you have been trained to use the instruments.

We also were discouraged from performing laparoscopic surgery in the elderly, in the young and in the morbidly obese patients. The patients under this category were unable to have laparoscopic procedures of any kind in all major hospitals.  However, time and experience have also demonstrated the safety of this technique for higher-risk patients.  Now, everyone recognizes the laparoscopic method as the best option for many surgical procedures, and many people are now are surprised when procedures are not done using laparoscopy.

Advancement in the quality of lap band products has continued over the past 30 years.  The first lap band model in the United States was the Inamed Lap Band, approved by the FDA in 2001. Doctors in the States began using this band as it was the only approved model in the US.  We initially promoted another type of Lap Band that was developed in Europe, with a softer ring, and a bigger, low-pressure balloon to adjust to any stomach size.  This type of Lap Band was approved by the FDA in 2006, and has now become the most widely used type of lap band in the world.  A few years ago, this band was purchased by Johnson and Johnson and is now known in the US market as the Realize Band. Inamed (Now Allergan) has five different models of the Lap Band, which have been designed to emulate many of the characteristics of the Realize band.

What´s Next?

Initially, there was much resistance against treating patients with a BMI less than 35, with bariatric procedures such as the Lap Band.  The medical community now supports preventative medicine, by encouraging patients to be pro-active rather than waiting five or tens year and developing co-morbidities before they treat the medical problem.  Today, there are various procedures acceptable for patients with a BMI of less than 35, including the Gastric Band, as well as more drastic procedures such as the Gastric Bypass, Duodenal Bypass, Gastric Sleeve and Duodenal Exclusion.  These procedures are also helpful if you are looking for your patient to obtain the Metabolic Effect from these procedures, and to improve blood sugar control for patients with Type2 Diabetes, High blood pressure and High Cholesterol (Metabolic Syndrome).

Arturo Rodríguez, MD
http://www.thebariatric.com
http://www.bandstersforum.com

Originally posted 2008-06-02 00:35:50. Republished by Blog Post Promoter

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Is the Lap Band Procedure for Anyone?

Monday, September 13th, 2010

Is the Lap Band Procedure for Anyone?

Almost 95% of individuals with a BMI of 30 or more are unable to lose weight using only diet, exercise or drugs. Actually, all individuals with a BMI lower then 35 are not accepted into any Bariatric Program and those with BMI between 35 to 40 are only accepted if they have co-morbidities such as Type 2 Diabetes, Hypertension, Heart Disease, Sleep Apnea, Asthma, etc.

The question is if we want the patients to wait 5 to 10 years until they have gained such a weight and also to wait for high risk co-morbidities to show up in order to accept them for a Lap Band, which is a surgical procedure that takes 30 minutes and has proven to be the safest surgical technique to treat obesity and overweight.

I strongly believe that Lap Band Surgery is a good option for those individuals considering losing weight on a long-term basis, to improve their overall health and well-being.  Gastric Banding or a Lap band can be used to safely treat morbid obesity, and can also be a preventative measure for morbid obesity by individuals with a family history of Obesity, Diabetes, High Cholesterol, or other co-morbidities.

 

Arturo Rodriguez ,MD

Bariatric Surgeon

http://www.thebariatric.com

Originally posted 2008-04-23 18:43:22. Republished by Blog Post Promoter

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Lap Band Office Fills

Monday, August 30th, 2010

Lap Band Office Fills

Your Lap Band fills are the most important part of the follow-up care that you need to succeed in your Weight Loss Journey. There is very little written about Lap Band Office Fills. Many people assume that the “office fill” is the best way to have the Lap Band adjusted.  Take some time to read through this information about office fills, and contact your Doctor if you have any questions.

Facts About Lap Band Office Fills

  • It is a fast profitable growing medical business as the Lap Band population increases in number
  • It is very rare that the Bariatric Surgeon is involved with the lap band fills
  • The Office Fills are cheap for most of the patients
  • No need for Doctor’s infrastructure (fluoroscopy)
  • It is easily done at the Doctor’s office
  • The Nurse is often in charge of doing the fills for patients
  • There is a learning curve to adjust the band properly
  • The fill might go into the fat instead of the port, and the need to return for another fill is frequently seen
  • You can get a leak from the hose due to needle puncture or penetration (due to multiple intents to reach the port’s target area) 
  • The Doctor will not know your lap band status with an office fill
  • The Doctor can’t detect early avoidable complications

 Office fills are an option for lap band adjustments. However, we do recommend having lap band fills done under fluoroscopy guide. If this is not possible, have your lap band checked under fluoroscopy at least once a year to determine the status of your lap band system and to check for any complications.

 

Arturo Rodríguez, MD

Bariatric Surgeon

http://www.thebariatric.com

http://www.bandstersforum.com

Originally posted 2008-07-19 22:32:22. Republished by Blog Post Promoter

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