DrHekier

And, I don't know about America, but I think we'd be naive to think that drug company "sales tactics" aren't a factor somewhere in the process.

The hospital buys the Lap Band and so far as I know all of the 3 different sized bands cost exactly the same, so I do not see any reason why there would be "sales tactic" factors involved.

You could try to call Walter Lindstrom and see what he says. Your case may be easier to handle if he has one success against Fed BCBS already.

My personal recollection is that I believe that Fed BCBS will not pay for the LapBand; however repoertedly Walter Lindstrom, an attorney specializing in obesity discrimination, has represented a client/patient and got Fed BCBS to pay for it and the hope is that all patients with Fed BCBS nationwide will be eligible for Lap Band.

Walter is an interesting guy, having had first the gastric bypass, and then the Lap Band, and I have heard him speak at a few conferences. (Not too many lawyers get invited to medical conferences!)

From his website at www.obesitylaw.com :

"A bariatric surgery patient himself (both gastric bypass and Lap-Band®) and personally having experienced the discrimination, physical and emotional pain of being morbidly obese, and now considering himself an "obese person in remission," and carries an empathy and passion to his representation that no advocate can share with regard to obese and morbidly obese clients. His personal battle to obtain insurance coverage for his treatment, combined with his extensive experience as an insurance law expert, make him the best qualified and most passionate advocate for those persons suffering from obesity and morbid obesity."

I believe it is labelled by the manufacterer for a maximum fill volume of 10cc, but on another board somewhere I read of people getting higher fills than that. [LEGAL DISCLAIMER ON] Of course, filling higher than the suggested maximum could lead to problems.[LEGAL DISCLAIMER OFF]

Hi I'm new to the group. I had my surgery in Oct 2004. I was given the 11cc Vanguard band. Even with 10cc of fills I can still eat just about anything. My surgeon told me today that the band may be too big and I should have the band removed and the smaller band put in its place. Anyone else ever have this situation??

Thanks,

Cathy

In another thread a while ago I referenced an article by Dr. Paul O'Brien.

http://www.gisurgery.net/OverviewObesityBariatricSurgery.pdf

In that article, take a look at figure 3, and you will see that at full inflation at about 10 cc, the VG band has a stomal opening, e.g. is about as tight, as the other bands.

Perhaps your surgeon could elect to hold the Coumadin for a few days to allow the INR to return to normal levels (i.e. let your blood clotting function return to normal levels), do your fill, and then restart the Coumadin afterwards.

I would just try to get a straight answer becuase it sounds liek you have a serious health issue in place. Sounds like you had a pulmonary embolism which is potentially life threatening, in fact in the USA about 200,000 people die from pulmonary embolism each year.

Often treatment with blood thinning agents (e.g. warfarin) can be stopped after 3 months, but before stopping some physicians will want to perform testing to check both the lungs and the leg and pelvic veins which is where the blood clot usually originates.

Ask your surgeon what his/her specific plan is.

Since the Band has only been FDA approved in the US since 2001, longer term reports from the US are only beginning to come out now.

As I posted in another thread, in this month's Journal of the American College of Surgeons, there is a report from a group in Atlanta, detailing their results with over 1000 bands.

See the thread :

http://www.lapbandtalk.com/showthread.php?t=10835

No operative procedure is without risks, but I think the data clearly shows that risk of severe complications, such as death, is much lower with the Band than with GB.

To each their own, when GB works, it works great. My personal opinion is that the Band has a much better safety profile for similar results.

In the October 2005 issue of the "Journal of the American College of Surgeons" is an article by a group in Georgia that has performed over 1000 Bands.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T91-4GTW92Y-4&_user=10&_coverDate=10%2F31%2F2005&_rdoc=1&_fmt=summary&_orig=browse&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c2f254ffea7d3c1eeafe02ce49c89872

The abstract is free and you can buy the entire article for $30.

Try some of the free templates from Microsoft for Office

http://office.microsoft.com/en-us/templates/CT010482871033.aspx

The one titled "Fitness Chart for Women" seems good.

Ditto what Vinesqueen said about the pain meds. I was told it was referred pain caused by the band rubbing against the diaphram. I don't know what really causes it, I just know it hurts! Hope you feel better soon!!

(Danger, the following contains boring medical information.)

The diaphragm muscle is supplied by cranial nerves 3, 4, and 5. If something irritates the diaphragm, it irritates those nerves as well. As it happens, cranial nerves 3, 4, 5 supply sensory innervation to the shoulder. So if something irritates the diaphragm then your spinal cord and brain interprete that pain as coming from your shoulder.

For example, long ago it was noted that people with a rupture of the spleen (such as in a traumatic event) complain of left shoulder pain. (This is known as Kehr's sign.) This is a result of blood and irritation of the left diaphragm causing referred pain to the left shoulder.

Dr. Hekier,

Thank you for responding to my question regarding the differences in band sizes. After veiwing your suggested article, it simply confused me even more. So, I conclude it will no doubt be my surgeons decision. Dr. Hekier, you are so young & handsome! It is such a pleasure and it is greatly appreciated that you are here for us!

This smilie is just for you!

(Blushing smiley) My wife went to Yale and graduated with honors, got a perfect 800 on the SAT verbal (she missed a few on the math) so I tell everyone that between us, my wife is the brains, and I am the beauty!

The closure, whether absorbable suture, glue, or staples is the surgeon's preference.

Surgical staples are removed with a small staple removal tool that most patients don't feel at all. Some say it is like a mosquito bite.

The benefit of staples is that they are more reliable since they don't fall out or get pulled out, and they quicker for the surgeon. The disadvantages of staples are that they must be removed in the office, and can leave a couple of small pinpoint scars where the staple enters the skin on each side of the wound.

Is there a doctor in the house that can explain this to us? I will be banded Oct 25th and after reading several posts, I have come to the conclusion that I would prefer the smaller band if I have that choice. My observations from reading these posts over time is that the smaller band provides more adequate & sufficient restriction & less trips to the fill doc. My fill doc is in Mexico, so the scheduling & $ to get there could get costly. The other good question asked by someone earlier is how crucial is the preop dieting related to the size of the band?

Check out the following thread, especially the link to the article by Dr. O'Brien in message number 10 in that thread.

http://www.lapbandtalk.com/showthread.php?t=9192&page=1&pp=15

In that thread take a look at figure 3 which shows the diameter of the stomach opening for the three Bands based upon the volume of the fill.

Also, figure 2 shows the difference between a VG band and a 10cm Band.

Many surgeons will operate on people over 65 if you are otherwise healthy. (We have operated on three patients over 70.)

Ask your surgeon if he/she has taken out a gallbladder, or a colon cancer, on someone over 65? Of course the answer will be yes. So why not the Band?

I personally discourage people from having the surgery far from their local lap band surgeon, because I feel they should follow-up close to home. For example, if someone contacts our office from a fair distance away, we direct them to their nearest Lap Band surgeon.

To reply to the original topic of the thread:

Most doctors in the US will place a Band for BMI >35.

Recently Dr. Paul O'Brien reported results of a trial for Lap Bands for BMI from 30 - 35, and there are now some US Lap Band surgeons who will perform a Band for BMI > 30.

Maybe 'Fee' , who posted that he/she was from Australia could let us know what the criteria are over there.

But I understood the original question to be what about someone at a more or less normal weight now who has weight issues in the past.

I love the thought of Doctors reading the posts on here. That way they can see the patients sides of things. Good, Bad, or Ugly. Will probably make them better Doctors in the long run. Wonder how many read the comments on obesityhelp.com. Some of those comments are harsh.

I also like the little disclaimer DrHekier has on his post, wonder if we should do the same. Wonder if Dr's can sue us for slander????

I'm not on Obesityhelp.com; they wanted something on the order of $1000 for a doctor to be included.

(Don't get any ideas LBT moderators! )

I figure on this board I can learn a few things from the many people that post here, as well as clear up misconceptions or misunderstandings.

What is strange about those is that they are actually ICD-9 codes.

ICD-9 codes are diagnosis codes (International Classification of Diseases- 9th edition). In order to justify an intervention (such as surgery) you need to provide the diagnosis code.

CPT (Common Procedural Terminology) Codes are generally codes for an intervention.

What is strange with those set of codes is that those series of codes are ICD-9 codes for operations; and CPT codes are usually used for operations. For example for many insurnace companies we use :43659Unlisted laparoscopy procedure, stomach

I'll have my biller look into it. I'm particularly interested because my wife and I performed several Lap Bands for Medicare that they subsequently refused to pay for( :cross-eye ). Maybe if we use some of those codes they will pay for them. (I'll owe you lunch Sandybells!)

i know that there was a lap band doctor who posted to a recent thread. sorry, but i can't find the name/thread.

dr., do you think that lap bands will ever be approved as a preventative weight-loss tool for people who are not currently obese or overweight, but have a history of it?

thanks.

That's a radical thought and quite thought provoking. Can you expand on your question please. Do you mean a person who has a history of obesity, and has lost the weight?

I cannot TELL YOU how glad I am to hear a medical professional say that. That has always been my impression of RNY and in fact, I expressed this at a support group meeting and was scoffed at for not being "committed" to the weight loss approach. Hunh? As tho the band is disposable.

Thank you Dr Hekier!!!!!

Firstly, the quote above is Dr. O'Brien's so he deserves the credit.

Secondly, I personally think that the Lap Band requires a greater commitment and interaction from the patient than other WLS options. You have to work with your diet to find what works and what doesn't; you have to get a sweet spot on fills with your health care provider; you have to seperate liquids from solids, and on and on and on.

I think if you are going the Lap Band route you are as committed, if not more, than people that go another route for weight loss.

(I should be posting anonymously, because some doctors might be offended, but I hope not.)

In my personal opinion, there are a number of bariatric surgeons in the US who fit in the category as 'bait and switch.' They have you come to a seminar about the Lap Band, get you interested in their program, but then try to sell another surgery to you.

Let's take a look (perhaps a cynical look) at the disadvantages of the Lap Band:

1) After the Lap Band, the surgeon may have to see the patient every 6 weeks for the first year. For the gastric bypass or VBG, you are often seen only once or twice posoperatively and then never again. Much easier for the surgeon if you never have to follow up with them.

2) Weight loss is more gradual with the Lap Band, (although after 2 - 3 years several studies indicate equivalent weight loss when compared with the gastric bypass) and as a result more patience and long term follow up is required with the Lap Band. (see #1)

3) The Laparoscopic gastric bypass is a surgical tour-de-force with a fairly high degree of complexity. In all honestly after a few dozen Lap Bands, it's a fairly straight forward procedure. I believe there is some intellectual snobbery against Lap Band surgeons, since it is a procedure more accessible to more surgeons outside of major centers, where many, but not all, bypass surgeons are. Ironically, since the risks are so much lower with Lap Band when compared with the bypass, I feel that some bariatric surgeons look down on the Band as a 'less elite' procedure. Who is cooler and more macho, the guy shot out of a cannon through a ring of fire across the street, or the one that uses a crosswalk when the light is green to cross the street? The guy shot out of a cannon might be cooler, but guess what, both guys cross the street, and one with much less risk.

I know I would never perform any obesity surgery other than the Lap Band, given the options available now. I remember reading articles and interviews with Dr. Paul O'Brien. As many of you know he is (or used to be) the #1 Lap Band surgeon in the world, having put in nearly 3000 bands last I heard. He used to do all types of obesity surgery but has switched to an essentially Lap Band exclusive practice. He would always be presented different patient scenarios and what his choice for surgery would be, and it was almost always a Lap Band. As he told me over dinner at one of the courses; 'why would you choose to mutiliate the GI tract [his explanation of a gastric bypass], when you can perform a safe, reversible procedure for the same results.?'

I agree.

Thus endeth the sermon.

Dr. Hekier, do you think the "bar" for surgical intervention should be the same for all the various procedures? If it's essentially a risk/benefit analysis, I think the bar should be very different depending on the procedure, because the risks are so vastly different.

That may sound like a sensible thing to do, but would add a layer of complexity to an already complex and not necessarily sensible system.

Kat, according to the AMA, the FDA, and the medical communite at large, being so overweight that one's BMI is 40 or above IS a health problem all by itself. That's why that's a magic number. I didn't have any health problems (co-morbidities) either, but my BMI was 47 and that's all they needed to know.

A BMI of 30 is the level considered "obese" and per the National Institutes of Health (NIH) places an individual at high risk for Type 2 diabetes, hypertension, and coronary artery disease. Additionally per the NIH it increases the risk of stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers.

However, most if not all insurance companies follow the guidelines set forth by the NIH in a consensus statement in 1991. In that statement they set forth that potential candidates for surgery have a BMI over 40, or over 35 with comorbidities. At the time of this consensus statement in 1991, the two main bariatric surgical procedures were open Roux en Y gastric bypass, and the open vertical banded gastroplasty (VBG). Those open procedures certainly have more side effects than the Lap Band. Also there was certainly less literature and scientific study available with results from bariatric surgery in 1991 than there is today.

I would not be surprised if in a few years, as the scientific community is made more aware of the benefits of the Lap Band, when compared to other bariatric surgical procedures which have higher risk, we will see the "bar" for surgical intervention drop from BMI of 35 to BMI of 30 from the NIH.

Linda,

This will probably be one of the hardest things you will ever do... but have faith! YOU CAN DO IT!!!! So many have done this, and so can you!

I once read that it was easier for someone to quite a cocaine addiction then a tobacco addiction... YOU CAN DO IT!!!

I seem to recall Dr. C Everett Coop testifying before Congress when he was the Surgeon General, that nicotine was more addictive than heroin.

My mother in law quit smoking with the help of Zyban. That and the fact that she had a CXR with a funny spot that scared the s*** out of her.

I can't tell you about the number of patients I've seen with several complications of smoking that still can't quit. People on supplemental oxygen secondary to emphysema, still smoking; people with amputations secondary to vascular disease worsened by smoking, yet they still smoke threatening the other limb, etc...

Don't be discouraged if you can't quit the first time. Keep at it. In the long run the health benefits are worth it! Maybe you can use your Lap Band surgeon's support group to also discuss and encourage your tobacco cessation. Good luck!

Unfortunately we have found that several insurance plans will only cover the Roux en Y gastric bypass and not the Lap Band.

Makes no sense to me.

Let's see, one operation has a 10 - 100 times higher incidence of death, a longer hospital stay, is more expensive, and results in a permanent re-routing of the GI tract that can lead to nutritional deficiencies and other problems requiring surgery in the future. Let's cover that one!

Some routes to fight your insurance company include: appeals, you or your surgeon speaking with the medical director at the insurance company, law firms specializing in obeisty discrimination e.g. www.obesitylaw.com, your state's insurance commision.

Good luck!