GeezerSue

Some interesting questions/comments...especially since I DID have surgery in Monterrey and I also grew up two blocks from East L.A. (where I'd rather not have surgery, but where USC University Hospital and USC Medical Center happen to be located, so there IS a small chance I'd go there.) LOL!! And I've NOT had surgery in Beverly Hills--really, there are no hospitals of any size or reputation in Beverly Hills--but my "Beverly Hills-adjacent" (that means Cedars-Sinai) plastic surgeon did my boobs at St. John's in Santa Monica...Elizabeth Taylor's and Star Jones' favorite. Anyway...I had a choice and I had the money. (Don't anymore...spent it all...but anyway...) I went to Monterrey. At that time, there were few US doctors who did the band and of those even fewer with sufficient experience to do MY band. IN FACT, Inamed is doing such a good job of converting surgeons to LapBand Surgeons that there are MANY, MANY MORE surgeons who now lack the experience to do MY band surgery. I went to the hospital where any US President would be sent if he became ill in the area and to a surgeon who had already placed 1400 bands...not to Joe Bloe's Day Surgery and Bicycle Repair on THIS side of the border to see a US doctor who was about to do his fifth band. There are too many people who think that ANYTHING this side of the border is automatically superior to anything in any other country. They are wrong. Back in the 1960's, if you had a heart transplant anywhere other than South Africa, you were not only an idiot...you were dead. I didn't know about the Tijuana LapBand surgery problems being picked up at the border, but that's why I went to a real, full-service, state-of-the-art teaching hospital in the third largest city in Mexico. You just never know when you might need a hospital to have that kind of capability. Editing to add---> gadgetlady...when Quebbeman did bands at Hoag, I might have gone there...but Huntington Beach Hospital? You'd pick THAT ahead of a major hospital in Monterrey? To each his own, but there is just NO comparison...at all. Editing AGAIN to add a link to info on what Yale has to say about one of the hospitals in Monterrey: San Jose Hospital, Tecnologico de Monterrey Hospital San José Tec de Monterrey is a private non-profit hospital that has been offering health services since 1969. During the past 36 years it has been a leader in several medical procedures (such as multi-organ transplants), always supported by its Medical Staff, and now it is considered as one of the best high tech specialty hospitals in Latin America. The hospital works cooperatively with the Medicine School of Tec de Monterrey to promote medical talent through programs for residents. http://www.yale.edu/career/students/intern/mexico_companies.html#hosp

Or, lacking correct spelling, something resembling a complete sentence would be a move in the right direction. This "coagulation" of words is lacking a subject, which--in grammar circles--generally indicates the lack of a complete thought. I'm just sayin', Sister Mary Angela would not have expected ANY of us to diagram* THIS. diagram*--an archaic skill...see: http://www.lifestreamcenter.net/DrB/Lessons/TS/diagram.htm

It would depend on the pills. Small pills can be taken normally. Some pills/capsules--extended release and the like--cannot be broken or chewed. You have to go to a non-extended release form if you can't handle the pill. Capsules can be held on the tongue to soften, and then swallowed just as the the Gelatin is about to dissolve. Some pills come in a dissolve-on-the-tongue form...like Claritin Redi-Tabs. And changing to liquid is not the solution to everything. With NSAID's, especially, it isn't the size of the pill or how long it sits in your stomach that causes the problems. It's the chemistry of the NSAID that makes the pain go away, that also reduces the mucous lining of the stomach, making it more susceptable to irritation and ulceration.

I had heard--from patients--about patients being treated this way and was somewhat skeptical. Then I was treated this way, so I asked another surgeon. It seems that this concept was proposed at an ASBS conference, until the doctor proposing it was shouted down by his (banded) colleagues. I sent this message to the doctor who tried this with me. Please note that, at no time, did I accuse him of engaging any inappropriate behavior, INCLUDING this practice. He wrote back and was livid. Feel free to jump to your own conclusions: The "Psychological Lap-Band Adjustment," a Patient's Perspective There are those doctors within the community of surgeons specializing in the adjustable gastric band, who are promoting the adoption of the "Psychological Fill" or "Psychological Adjustment." Although their motives are pure, they could not be more misguided. Inadvertently, they are doing a disservice to their patients, to the manufacturer of the band and to themselves. The theory appears to include the following false assumptions: 1) there is not a physical cause component of obesity; 2) what patients most need is to retrain their brains to believe that they are full when they are not; 3) obese people are below average in intelligence; 4) obese people respond positively to negative intimidation tactics; 5) the Lap-Band patient is unable to determine when restriction wanes; 6) obese people do not speak to each other or compare experiences with each other; 7) it is ethical for surgeons to mislead or withhold information from patients; 8) training as a surgeon prepares one to practice psychology; and, 9) surgeons are competent actors. The technique being suggested includes the surgeon's telling the patient that s/he is "the only patient" who is not cooperating, or "the worst patient," or "the least compliant patient" encountered by the surgeon. The surgeon then removes saline from the band, and subsequently replaces essentially the same amount of saline, but threateningly advises the patient that s/he will barely be able to tolerate food. In some cases the surgeon insists on a follow-up appointment to remove saline a month later, insisting that the fill is so tight that the patient will have to return to have the band loosened so that he or she does not cause damage to the esophagus. There is a placebo precedent in medicine, but if it is appropriate at all, it is appropriate in rare occasions. In the proposed situation, however, the patient is required to be dim-witted enough to believe that the surgeon would intentionally over-fill the band and announce that s/he is overfilling it. The patient is supposed to be psychologically needy enough to do anything to gain the surgeon's approval. The patient is expected to believe what the surgeon says is sufficient restriction rather than his/her her own sense of satiety, when one of the prime benefits of the adjustable band is the restoration of the sensation of satiety. The patient is expected to refrain from communicating with other patients, 'lest numerous patients discover that they all have been declared "the least compliant patient." The patient is expected to present for the band adjustments devoid of any training or experience in the field of psychology. The patient is further expected to present for band adjustments devoid of any training or experience in critiquing dramatic performances. Some surgeons might easily be seduced into thinking that this kind of false paternalism is helpful to patients. So many patients arrive in deep states of need due to their histories or habits of not attending to their own needs sufficiently. However, it is incumbent upon caregivers to have EXCELLENT boundaries and the "Psychological Adjustment" is a clear violation of said limits. One of the biggest advantages of AGBs is the degree to which they empower patients. Patients have control over the rate of weight loss. The band supports change on every level and each patient changes at the rate and in the order that best fits each one's individual needs. The feedback loop is positive and the patient gains confidence, learning to trust oneself over time. A lifetime of psychological undermining regarding food and eating patterns can be healed, and more. By deceiving patients, the "Psychological Adjustment" DIS-empowers patients, making them dependent upon the surgeon's wisdom. The patient is left NOT trusting him/herself and is, in fact, incented to NOT trust him/herself. Faced with the"Psychological Adjustment," the more easily intimidated patient merely drops out and BELIEVES that s/he has become a Lap-Band failure, damaging both the patient and the manufacturer of the product. The other patients--either alone or in discussion with each other--conclude that the surgeon who practices the "Psychological Adjustment" has limited understanding of--and even less respect for--the obese patient. Inevitably, the surgeon will have damaged his own reputation most of all. Three damaged parties in a situation which should have included the concept, "First, do no harm." A shame. So, in case anyone received this kind of treatment, there is precedent. And feel free to complain. Sue

No, it means that you have not (yet) documented that you have already tried "two years of medical management" of your obesity/morbid obesity.

Because it's again time...

Okay, AND...a lot of you are taking Calcium Carbonate which is not used as effectively as calcium citrate. And, depending on your age, you may need to supplement the Calcium AND Vitamin D, even if there is some in your multis. Pre-DS, I took two Trader Joe's Childrens' Chewables and supplemented the Calcium and D. Now I take a Multivitamins (in DS'er dosages) and special Vitamins that are made for DS'ers who need a special way to get in Vitamins A, D, E and K. And I take about 1600 mg of Calcium Citrate over and above what's in the multi's. MAY I ADD HERE THAT MY BEST FRIEND IS MOSLTY HOUSEBOUND AND OFTEN IN HORRIBLE PAIN DUE TO OSTEOPOROSIS (NOT WLS-RELATED) AND, EVEN THOUGH I'M NOT AS ETHNICALLY PREDISPOSED TO OSTEOPOROSIS AS SHE IS, IT HAS ME SCARED. LADIES--ESPECIALLY LADIES WITH NORTHERN EUROPEAN ANCESTORS--TAKE ENOUGH OF THE RIGHT CALCIUM AND SAVE YOURSELVES A TON OF HEARTACHE. And, I have found Protica's Profect to be the least objectionable (because it's less than three ounces)--except that it isn't cheap--way to get extra Protein in: http://tinyurl.com/lyccw (Disclosure: I'm now an "affiliate" for the protein product because I'm buying it for two households. Even if no one else buys any, I save a couple of dollars.) I first became interested because my 82-year-old mother thinks that half of a Healthy Choice Sirloin Tips and Portobellos meal is "enough" food...and wonders why she is losing weight and getting sick.

When I had no problems with the band, I had no problems "hosting" the band. Once I had problems, my perspective changed and by the time I went for a revision, I was WAY ready to have it out. So now, I have dental fillings, crowns, root canals (these things happen as we age) and about six jillion gastric staples and who KNOWS what the plastic surgeons have left in there? But I think the "I don't want a foreign obect in my body" line is just silly. My husband didn't want a foreign obect in HIS body either, but once he had his heart attack he was DELIGHTED to get that stent implanted.

I saw my DS surgeon today. Initial conversation: Dr: "How are you doing?" Me: I'm so cute! (laugh) You have created a monster! Dr: That's HIS problem! (gesturing toward my husband) Me: And I have Body Dysmorphic Disorder, but backwards. Most patients still think of themselves as fat. I feel so good that when we pass by a mirror, I wonder who the fat chick is who's holding hands with my husband!! I need to add one Vitamin tablet (Dry ADEK's.) I asked if I needed additional Protein. I was told that almost EVERYONE--wls or not--needs more protein. (And I'm trying a new product as soon as its delivered.) My ferritin stores are fairly low, but as I have been post-menopausal for almost thirty years, he doesn't see that as a problem, so he doesn't recommend Iron at this time. I'm to return in six months. On his high-rent-district scales, I weigh 75 pounds less than I did a week pre-op. But I had just been unfilled, so we KNOW what kind of a Last Supper week that was. That was MY day...how are y'all doin'?

I've got a 24-pack right here! They cost a fortune...but. I got them because I'm trying to get SOME protein into a mother who thinks a Healthy Choice Beef Tips and Portobello Mushroom meal (280 calories) should be split between lunch and dinner. I UNDERSTAND that she is not going to live forever, really I do. I just want her to be as healthy as she can be and then surprise all of us by "waking up dead" some morning. She's been on a waiting list for a very nice Assisted Living place, but--good news/bad news--everyone there is HAPPY there and no one there is dying there...SO...there are no openings. My sister visited here and took her a Protica Profect this morning. I'll take another tomorrow.

I'm sorry, Elizabeth. I just "read over" the part that said your band was out (or, I FORGOT it between the time I read and and when i responded.) Dennis Smith in Atlanta has a good reputation, too. He won't do revisions of other doctors' work, but since your band is out...that probably would not apply. I DO know that my surgeon says that revisions are the most difficult for him, but NOT because of the physical part...because they are sure they will "fail" again. I don't know if I'll get to goal. Hell, I don't even know what my goal weight IS. But as far as losing weight out the starting gate...this is EXPONENTIALLY easier than thae band.

Weighing in...80 pounds down, at that. Insurance. Well...I don't know. I SUSPECT that if the band is causing any problems, then the removal of the band would be covered. Frankly, though, I think it's a pretty extreme surgery for 50-60 pounds...even though we both know that some people (yours truly) are capable of regaining all the lost weight. You will not "fail" at losing weight with the RnY or DS. Beyond that, I can't speak for the RnY. Your DS challenges would be to take the supplements as though your life depended on it...because it does. And, generally speaking, getting those last 25-40 pounds off and then keeping them off is a challenge from what I observe. My more experienced DS buddies tell me that what is different is that they walk into WW's needing to lose 10 or 15 pounds, not 150 or 200. There's a visible end in sight for those who use that plan. They achieve their goal, they go on with their lives, they gain 10 or 15 again next year...and go back to WW. "Like," they say, "NORMAL people." I can't verify this story, but it's what I've been told. But, I'm 59 and don't have the same concerns about long term complications as someone yonger might have. Visit the OH /DS message board--available through here--for info on the self-pay out-of-country surgeons: http://obesityhelp.com/forums/DS/ And encouragement? Well...when our daughter was in high school I realized that while we had always told her that school wasn't over until she graduated with a Bachelor's degree...neither of her parents had actually done that. So I went back to school and got the degree, so that I "had the right" to keep saying that. So, I'm going to tell you what I feel I have the right to say: Give it your best. But do NOT start beating yourself up if your best, with this approach, does not take you where you want to go. Sue

As an atheist, I always feel somewhat 'invited out' of these discussions, but here I go... 1--what Alexandra said about marketing; and, 2--when a minister points out a family that has material wealth as a family others might want to emulate...it tells me a lot about what is really important to the minister.

I was 55 when I was banded in Mexico and lived through it. I have 3-D friends who were banded in the US, and France and Germany and friends who had RnY in the US and had the DS in the US...years ago...and still haven't had a sleep study done. While a sleep study is a good idea for any morbidly obese person, I'd vote for manometry as a pre-op test for someone considering adjustable gastric banding...especially an older person. While none of my over-50 friends died from being banded without a sleep study, a few are suffering from the late complication of dysmotility, which seems to be more common in older patients. They are, several years out, having to have revision surgeries and THAT is also more dangerous. The danger is not in the geography...

Roberto Rumbaut Cute Banded Banding Surgeon I was Rumbautized

I really tried But, what a pity For way too long I just felt uncomfortable.

Karla, That YOU would have a question for ME is a riot. G'friend, you were my hero...I think I read every page of your journal...I "knew" you before those babies and all! Too funny! Anyway, au contraire!! There is almost no limitation of any kind. And post-band--because of the limitation I had--it feels like I'm at a banquet all the time. I can eat--but am sorry the next day that I did because it means several extra bm's--most everything except large quantities of wheat flour. I just get full--and SATISFIED--faster than I did pre-band. (Some of this will catch up with me...but because there is more malabsoprtion than with RnY, the problem is less than with RnY...I think.) Yeah...and the anti-foreign-body-argument holds even less Water when we realize how many of us have or may have arterial stents, implanted birth control, and dental fillings!!

I don't completely concur on the gastric resection info. I've met two of these patients and I DO think it's more like 60% of the stomach that is removed. The RnY leaves a 1-2 ounce POUCH. The DS--and for some the gastric sleeve is Stage 1 of a DS--leaves a 4-6 ounce, but regularly configured, STOMACH. http://www.columbiasurgery.org/divisions/obesity/surgical_sleeve.html And I'm confused about the opportunity to "eat around" a gastric sleeve. To "eat around" the band, all I'd need would be a Wendy's chili or Baskin Robbins sundae. The liquid nature of those foods would send them right through the stoma without any restriction and into the larger part of the stomach. If the gastric sleeve on its own is like the upper part of the DS I've already had, I can tell you that once your 4-6 ounce stomach is full, it's full. Just like Thanksgiving, pre-band.

Inamed makes and markets bands for the US market and for the world in general. The fact that a particular model is not FDA approved DOES NOT MEAN that it is "FDA-disapproved," so to speak. It means that Model A (for lack of a better name) was presented and approved in the US and then they decided to tweak it a little and made the "new and improved" Model B available to the international market...but didn't want to hassle with the FDA again because the Model A had already been approved and was "good enough."

I'm so glad things have worked out. My sister went through that series of shots--but that was over 50 years ago. (Surely things have improved, right?) Monday through Friday, she went to the doctor's office. But on the weekend--in those days--she had to show up at the county health department. She came in the door crying and squirming and screaming and the nurse grabbed her by the shoulders and yelled at her, four years old, to stop crying. My mother FIRST asked, if another nurse was on duty. The nasty nurse said, "Yes, but she isn't going to want to hear this either!" My mother drew back her arm and hit the nasty nurse--really hard--with her purse and said, "But SHE isn't busy licking her own wounds and YOU are. Get her." Editing to add...these days, they'd BOTH have gone to jail. But really...grabbing and yelling at a four-year-old who was smart enough to know she wasn't going to like what was about to happen...

Yeah...Monterrey...Rumbaut or Sanchez. I think Sanchez does more than one kind of band and that Rumabut does Inamed only. On the day before surgery, rumbaut meets with his patients and they SEE the box, with their band sealed in it and the serial # and get the book. Also check out Ponce in Dalton, GA. He, too has been doing these a long time. If your BMI is low enough, you can have it down at the outpatient surgery place and costs < $14,000. If he's a lot closer than Monterrey, you'll break even given the travel and all.

Trop--where are YOU? Here's the link to the belighter crowd. Rumbaut is the Monterrey surgeon. But depending on where you are, it could be almost as cheap up front--and cheaper in the long run--closer to home. http://www.belighter.com/cost.html

I'm off of them now. One day off. But my surgeon told me not to expect the side effects to go away immediately. They beat the stuffing out of having to use a walker and being unable to get up off the toilet...which is where I was two weeks ago. But they DO extract their price. The manic feeding frenzy thing is irritating, even when I'm sitting here alone.

It's NOT my fault. Ice Cream Demons are hidden INSIDE the little steroid pills.

Irishrose.. One of Cantu's shills comes on here now and then, pretending to be a happy patient and trying to drum up business. Leaves a kind of nasty taste in my mouth. But I don't get why anyone would be attracted to some of the "lesser gods" in Mexico. Some of their places are DAMNED rustic (I like the "McSurgery Shack" term) and even the newer, cleaner places are still NOT full-service hosptials. Sure, most of the time, nothing bad happens. But if something bad DOES happen, doesn't everyone want to be in a real hospital with real emergency services and all that? And it's not like there's a huge financial difference. A cheap surgery south of the border PLUS arfare, PLUS hotels, PLUS follow-up airfare and hotels and sometimes cars...OR...finding out that the only local doctor who will do the follow-up will charge $3000 up front or $1000 per adjustment. I just don't see the bargain. I paid about $10,000 for Rumbaut which included follow-up EXCEPT for radiology, which is extra...$50 or $100, I don't remember which. It did not include airfare or hotel. I'm just saying that if the money is a big part of the decision-making process, count it all first...don't assume that the price of surgery gets anywhere NEAR the actual cost. While I still adore Rumbaut, if I lived on the east side of the country, I could learn to love Jaime Ponce in Dalton, GA or, closer to home, Paul Cirangle, in San Francisco, CA. Having an experienced surgeon who's close to home, works in modern facility and whose work OTHER US surgeons aren't going to back away from is a HUGE plus. This is a lifelong committment...it's worth a few more dollars up front for the benefits you'll receive.