Shellyac

I chose the Lab Band because I didn't want to make a permanent change to my anatomy, although after the scheduling appointment with my first doctor left me in doubt on my ability to succeed with band so I considered having the sleeve. Fortunately my insurance doesn't cover the sleeve but while doing research about the sleeve I found out about plication which is basically a sleeve made from sewing instead of cutting. While the procedure is still investigational and not covered by insurance, if it is preformed along with the band it seems that insurances will cover it. What I am looking to about this procedure is that from initial studies, it seems to eliminate the negatives of both procedures while giving you the benefits of both.

I think that some of your blog post might be better off as topics, especially since you're looking for advice. Also for me the recent blog post show up near the bottom of the page on the right so unless I'm looking specifically for recent blogs or I happen to be scrolling down to see the other forum topic (which doesn't happen very often) I miss new blog entries

It looks like there is a doctor in LA that preforms it here is the link to his site http://blog.marinahospital.com/category/gastric-plication/

I agree that if you are going to mexico you should either get the sleeve or plication. In case you don't know what plication is, it is a procedure where the stomach is folded onto itself and sutured to form a sleeve like pouch. Like the band this procedure should be reversible and it has similar EWL as the bypass. Also like the sleeve and bypass you won't need to have as many follow up visits with a doctor

I think that success with the Lap Band depends on more factors than any other WLS. Some of them are in the control of the patient, some in the hand of the doctor, and some are just pure chance. Also you need to keep in mind that the adjustable band in still an evolving procedure and there are new procedures that are emerging, like gastric plication. It's not fair to say that patients with other WLS don't have to do anything when compared to the band. We have face similar issues, such as having to adjust our diets, the amount and type of foods we eat, and we have to deal with the relationship with have with food. We are all taking a risk when we decide to have surgery and I think that the first thing that we need to do is get over the idea that one surgery is better than the other. They all have their advantages and disadvantages and people have succeeded and failed with them all. It is up to each of us to decide which one we believe will be the best personal choice and we also have to realize that the reason one surgery was the best choice for you may not apply to someone else. Also we need to be realistic about what each surgery entails both for the procedure and for life afterwards.

I haven't been banded yet so I'm not speaking from experience yet but I think you are being too hard on yourself. You are human and it's only natural to indulge a little, especially this time of year. I personally think that it is ok to have a treat now an then, it's when you are so strict that when you have a slip you fall all the way down is what got most of us to where we are. I think that if you are feeling like you are on a diet then you are approaching it wrong. Remember weight loss is about burning more calories than you take in. The problem with bad calories is that they don't give you the energy you need to be able to burn them off. Don't feel bad about having one chocolate covered cherry, just be happy that you can't eat 10 or 15. It's feeling bad about that one that will lead you down that bad path. Also there are a few thread about eating and drinking at the same time and it seems that most people like you have a sip or two while eating. Like you I think it is unrealistic.to not drink at all but as long as you are drinking no more than a small sip or two then you are ok. When it comes to the pizza don't get too upset about it, first of all think about how much pizza you could eat before the band, now think realistically about how much you could eat now. Did you go from 3 (or possibly more) slices to 1/4 or 1/2 of a slice? If so that the power of the band, think about how many calories you just saved, realize that if you do only have 1/2 a slice that you will feel as full as you did before the band, and still have the same flavor. I don't think that there is anything wrong with taking a slice cutting it in half and eating the cheese and toppings first (protein!) and maybe a bite of bread if you know you can handle it. If you also plan your other meals of the day around that then you will not go over your calories, you can also build in a little extra exercise for the pay (park a little farther away or walk a little faster than usual) Your experience at Cheesecake Factory is a great example of how great the band is, you were able to eat out with a friend, have a totally satisfying meal, and didn't have a boat load of calories. I went to the Cheesecake factory this past weekend and I'm pretty sure that I blew 700 calories before we were done with our appetizers. It's good that you realize this early that you might be becoming obsessed with food in a bad way because now you try to stop it before it becomes a problem. I think the first thing to keep in mind is remembering how much you could eat before and how impossible it is to eat that much before. Also if I remember correctly you haven't been cleared to exercise yet so that hasn't been able to help you yet so imagine how much more you will lose when that comes into play.

In addition to slower results when compared to the bypass you will need to be prepared for all of the other things that come along with having the band like having to get fills and understanding that it is a process that at best takes several office visits and worst can be a constant series of appointments that may not only be affected by weight loss but my other factors, like an illness. You should know are you OK with needles, you will have to endure several needle sticks with this procedure, most times it will be no problem, other times there may be pain. You'll need to understand that being tight isn't a good thing because being unable to eat can be a reason that people start to gain weight, they are "eating" around the band. Also i think that it is important to read about what can go wrong, issues like erosion and slippage, You need to be educated on what the symptoms are so that you don't wait until it's too late to easily correct the issue. I have found it very useful to read the revision stories on this site as well on the vertical sleeve site (I haven't really read much on the RNY site because it seems that most people revise to the sleeve) Seeing what issues people have had has made me really think about what having a band means. Also make sure that when you do your research about other procedure make sure that to research the statements that are made, I have found that people with the sleeve have some misconceptions about other procedures, especially the band, that they use to sway people who are unsure of what procedure they want. And keep in mind that everyone that got a revision had a bad result from their original procedure but not everyone who gets that same procedure has a bad result. Also the lap band is still an evolving procedure, even though at it's core not much has changed (an band is placed around your stomach to form a pouch) many things have changed since it has first started, like the first bands were not adjustable, band sizes are different by manufacturers, some doctors are now also preforming gastric plication in addition to inserting the band, others are securing the band differently. There are so many moving parts when it comes to the band that you need to make sure that you are willing to take the risk. I am doing the band with plication next month and although I know it is still an investigational procedure, I am really encouraged by the initial results.

Congrats. I am scheduled to have it done in January. My insurance is covering it for me, I think that if you have it done with the lap band it is covered but if you just have the plication then I don't think they will cover it yet because it is considered investigational on its own Michelle

Congrats. i know you worked hard to get that approval

You should check out the ASMBS position paper on the sleeve (www.asmbs.org the paper is about halfway down the page) , especially if the reason you are being denied is having a lower BMI. The paper was just released at the end of October. A previous position paper is the reason that BCBS, an possibly other insurance companies, reason for requiring a 50 or higher BMI. This new paper now recommends the sleeve as a primary procedure. Even if the BMI isn't the reason the paper is good source of reasons why the sleeve is an effective procedure

Hi, if the reason that your insurance company isn't approving you is that your BMI isn't high enough, you should forward this position statement to them. http://asmbs.org/2011/11/a-pathway-to-endoscopic-bariatric-therapie/ BCBS based their requirement of a BMI of 50 or higher on an earlier position paper from this organization that essentially said that the sleeve is recommended for people with a 50 or higher BMI but further research is needed before they could recommend it as a primary method. However in the statement that I gave the link for, they now recommend it as a primary surgery. This statement just came out at the end of October so insurance companies have probably not updated their surgery requirement to reflect the change. I know that you are probably tired of the appeals process but this might be a good shot at being able to get your surgery done close to home and paid by your insurance.

You should see if you can find a cheap alteration place nearby, if their general prices are still on the high side for your budget, explain to them your situation and see if they would be willing to work a deal with you. Also see if there is someone in your church or work who knows how to sew and could make the alterations for you for a small fee or even in return of other services

I have never heard about not being allowed to be banded because you are still considering having children. I have heard some women say they are having WLS because they need to lose weight so they could have children. I know that we are told that we need to wait at least a year before trying to have children because of the effect of the weight loss on the pregnancy but that is about it.

I would tell them that your are big enough to have the surgery otherwise your insurance company wouldn't have approved you to have the surgery on their dime. Also tell them you are having the surgery because you don't want to get to the point where you really look like you need to have it done.

Sorry about that. The article should be found at http://asmbs.org/2011/10/statement-update-sleeve-gastrectomy-as-a-bariatric-procedure/ If that doesn't work, go to www.asmbs.org and you should see the headline for the paper about halfway down the page in the middle

Based on this quote from Dr. Watkins the same is true not only for plication but for all WLS

Regardless of your BMI, you should use the following position paper as part of you application to the insurance company. Currently BCBS and probably most other insurance companies use the ASMBS position paper from 2007 as the basis of requiring a BMI of 50. Here is BCBS's statement about the sleeve: However the updated statement that I linked to above, which only came out in October 2011, in summary says I'm sure that insurance companies haven't had the time to review the new position paper or modify their requirements but I'm sure if you bring it up to them you may have more success in you application.

I would also check out the revision forums on the bypass and sleeve boards you will find more people who have already done the revision. In addition, you may want to also consider plication or the band with plication. Plication is similar to the sleeve but instead of removing your stomach it is folded in on itself and sewn. It is a new procedure but it initial studies have shown weight loss similar to the sleeve. Good Luck with everything Michelle

If possible you should look into have the sleeve with plication from the start. Although plication alone has been shown to work on it's one, initial studies have shown that combining it with the band improves your potential for weight loss. I understand that you are concerned about fill, but the advantage of having the band from the start is that if you stop losing you will be able to get a fill to get additional restriction and you may also be able to go without ever getting a fill if you lose at a satisfactory rate. Also plication has been show to help lessen the some of the complications of the band, such as slippage and erosion.

I would change to the highest plan available if possible, especially if you're the only one covered on the plan. What you may end up pay extra in premiums you will likely make up for in having to pay less in fees and deductibles and you are more likely to be covered in situations where you thought your insurance would cover something but it wasn't because it was out of network.. Also the best person to ask about what you will have to pay is the coordinator at your doctor's office. They will know what your insurance will cover and will let you know what you'll have to pay

I just posted this in the insurance forum. Hopefully this info can help I believe that one of the main reasons that people are being denied the sleeve is that they don't meet the 50 or higher BMI requirement. I was looking at BCBS Mid Atlantic's requirement information and found the following information. The company's policy is based on a position paper from the American Society for Metabolic & Bariatric Surgery Sleeve Gastrectomy, Update 2008, January: Sleeve gastrectomy has been proposed both as a stand alone gastric restrictive procedure, and as a first stage operation for the extremely morbidly obese patients, e.g. those with body mass index (BMI) exceeding 50, or for those with serious comorbid conditions that would increase risk for morbidity and mortality with the initial use of a malabsorptive procedure such as a gastric bypass with Roux-en-Y anastamosis or duodenal switch. Bariatric specialists believe that with the initial weight loss and improvement of comorbid conditions following the sleeve gastrectomy, the malapsorptive procedure can be performed at a later time if necessary with greater safety. In June of 2007, the American Society for Metabolic and Bariatric Surgery (ASMBS) published a position statement on sleeve gastrectomy as a bariatric procedure. The paper states that sleeve gastrectomy may be an option for carefully selected patients, particularly those who are at high risk or super-obese, and that the concept of staging bariatric surgery may have value as a risk reduction strategy in high-risk patients. The paper also suggests that surgeons performing sleeve gastrectomy prospectively collect and report outcomes data in the scientific literature. Finally, the paper suggests that surgeons performing sleeve gastrectomy inform their patients regarding the lack of published evidence for sustained weight loss beyond 3 years, and provide information regarding alternative procedures with published long-term (>5 years) data confirming sustained weight loss and comorbidity resolution. The ASMBS has updated their position as of October of 2011 I have posted the summary but the full report can be found here Since this position paper is so new it is very likely that your insurance company has not used it to update their policy. I would encourage those of you who have been denied to forward this report to your insurance company as part of your appeal.

Hi, I believe that one of the main reasons that people are being denied the sleeve is that they don't meet the 50 or higher BMI requirement. I was looking at BCBS Mid Atlantic's requirement information and found the following information. The company's policy is based on a position paper from the American Society for Metabolic & Bariatric Surgery Sleeve Gastrectomy, Update 2008, January: Sleeve gastrectomy has been proposed both as a stand alone gastric restrictive procedure, and as a first stage operation for the extremely morbidly obese patients, e.g. those with body mass index (BMI) exceeding 50, or for those with serious comorbid conditions that would increase risk for morbidity and mortality with the initial use of a malabsorptive procedure such as a gastric bypass with Roux-en-Y anastamosis or duodenal switch. Bariatric specialists believe that with the initial weight loss and improvement of comorbid conditions following the sleeve gastrectomy, the malapsorptive procedure can be performed at a later time if necessary with greater safety. In June of 2007, the American Society for Metabolic and Bariatric Surgery (ASMBS) published a position statement on sleeve gastrectomy as a bariatric procedure. The paper states that sleeve gastrectomy may be an option for carefully selected patients, particularly those who are at high risk or super-obese, and that the concept of staging bariatric surgery may have value as a risk reduction strategy in high-risk patients. The paper also suggests that surgeons performing sleeve gastrectomy prospectively collect and report outcomes data in the scientific literature. Finally, the paper suggests that surgeons performing sleeve gastrectomy inform their patients regarding the lack of published evidence for sustained weight loss beyond 3 years, and provide information regarding alternative procedures with published long-term (>5 years) data confirming sustained weight loss and comorbidity resolution. The ASMBS has updated their position as of October of 2011 I have posted the summary but the full report can be found here Since this position paper is so new it is very likely that your insurance company has not used it to update their policy. I would encourage those of you who have been denied to forward this report to your insurance company as part of your appeal.

Has anyone out there who has been banded and has a tongue ring ever accidentally swallowed a barbell ball? I've only had it happen to me 2-3 times in the 6 years that I've been pierced but I'm a little freaked out by what damage could happen if it happened after surgery.

My original surgeon tried to push me to the bypass over the band which I was not comfortable with. I did consider the sleeve for a moment because if I needed to do something irreversible in order to succeed I wanted to do the sleeve because it leaves the digestive system intact but my insurance wouldn't cover me because my BMI wasn't 50 or higher. Fortunately while I was doing research about the sleeve I found out about gastric plication. Although the procedure is still consider investigational at this point I believe that it holds promise. I am having it done in addition to getting the band. The early results show that the banded plication results in similar weight loss as the sleeve without removing my stomach and complications like slippage and erosion are less likely to happen. Also I will get restriction primarily from the plication and the band will serve as a back up. I hope to never need to get the band filled, which will probably eliminate having the usual problems with getting fills. I feel that with the WLS field is still evolving and I didn't want to make a decision that I could undo.

I have seen that some doctors do not want to take on patients who have had their surgery in Mexico. Is the same true for patients who have their procedure done in another state? I currently live in Maryland but i am planning of having my surgery done in Florida (I'm going to have the band with plication and there aren't many US doctors that are preforming it, the one in Florida was the most convenient for me), will I have problems finding a local doctor for fills and aftercare? Michelle