DrWatkins

Very equal bands in my opinion (both great). Studies show the outcomes to be very similar. There are subtle differences in the surgical technique but patients wouldn't perceive this. The REALIZE band port has a self-anchoring mechanism as opposed to stitching it to the muscle lining and some people think this may cause less port discomfort while it's healing. After healing they would both feel the same. The REALIZE port is less prominent and bigger around. The two companies are competing with value adds. The REALIZE company (Ethicon/Johnson & Johnson) has an impressive website ("mySuccess" on www.realizeband.com) that you have access to as a patient. I would imagine that Allergan will be close behind with their version of a patient website. I can honestly say that I'd have either one of them gladly. They are both superior products from great companies that will continue to innovate. Like most things I think having two companies competing is good for patients and surgeons. I think some practices will offer one or the other. We will always offer both. I'm a proctor surgeon for both companies and happy to answer any specific questions.

That sounds like spasm. I use a medication called "nifedipine" or brand name "Procardia". It is a blood pressure medication that relaxes spastic smooth muscle cells. Arteries have smooth muscle in the wall and so does the esophagus. They have extended release nifedipine that lasts all day. It works great in some patients and has no effect in others. Worth a try. Obviously talk to your doctor about it. Disclaimer: This is not medical advice. Message boards can never replace a physician evaluation.

As long as there is some saline in the band I wouldn't worry about the total volume. Any amount of saline means you don't have a leak and what matters most is that you are able to reach perfect restriction. As we do fills and add up the amounts in your chart you get a total number but over time the band rarely has that number remaining. The balloon is a permeable membrane and does lose tiny amounts of saline over time. Dr. John Dixon (Australia) did a bench study and came up with mathematical formulas for how much saline the band loses over time. The higher the volume and the smaller the band the more saline the band would lose over time. Also, with the newer bigger bands, it is hard to withdraw 100% of the saline so the Fluid check volumes are less meaningful. If, on multiple occasions, you have a fluid check and it's always zero despite having saline replaced each time, that means you have a leak and likely need a new port. If you are able to reach perfect restriction and it lasts a while then you're good and my advice is to ignore the number. Perfect restriction is when you are full on small meals, aren't hungry all the time, don't feel like you're on a diet, you use words like "sweet spot" and "ah, I get it now", you think your surgeon is a genius, you easily lose 1-2 pounds per week during weight loss or easily maintain your goal weight. If the band is too loose, you will feel like it's not working, you will feel like you're on a diet, it will be hard to lose weight, you will be able to eat a lot. Since the stomach tissue slims down with you, the band must be tightened during weight loss. Many patients get a perfect fill and when the stomach shrinks away and the band "quits working" they get all discouraged when all they need to do is to get another fill. If the band is too tight, you will have heartburn and everything you eat will get stuck and you will likely see it again soon, the only thing that wants to go down is bad stuff like ice cream and Cheetos. Leaving the band too tight is not good practice because this is what causes "slips". If your band isn't perfect, you should get it adjusted. Having said that it is usually not that simple. Many things affect restriction at a given moment, i.e. tighter in the morning, tighter after a commercial flight, tighter on menstrual period, tighter after high salt intake. Also, some patients have esophageal spasm that makes the restriction change every 15 minutes - one day you can eat everything, the next you can eat nothing. For spasm I use nifedipine to calm the spasm and this sometimes helps. hope that helps

I've had patients that were way too tight when they were on their menstrual cycle. For that I would advise against having surgery while on your cycle. If the band gets much tighter on your cycle it suggest that you're retaining Fluid and maybe a diuretic (pill that makes you pee) would be indicated while you are on your cycle. Also, salt intake can affect band tightness. Some patients are really tight the next day when they have a high salt meal. Also, if your thyroid has never been checked it may be a good idea to check it. Thyroid problems can cause fluid retention among other things. hope that helps

Over the past 20 years the cost of health insurance premiums has gone way up. Over the past 20 years the amount of money health insurance companies pay to doctors and hospitals has gone way down. The difference, the margin, insurance companies are getting is at an all time high. The problem with this is that patients and our healthcare system are suffering while the health insurance companies are making HUGE profits. Insurance companies make more money by denying claims or not paying claims. Insurance companies have a very powerful lobby. This is a really big problem.

We place the new REALIZE band as well as the new Allergan AP bands. Most patients get 3-6 fills in the first year and then much less the second year. The cc's at each fill and the interval between fills is really variable. We tell patients if they aren't losing weight for more than a couple of weeks they should come to the office for a possible adjustment. Flying does seem to cause swelling of tissues and a swollen stomach inside the band can make the band relatively tighter. I think if you are squeaky tight to begin with and you're going on a long trip away from any band doctor, I would take some Fluid out. Remember that if they wand you at the airport security check point they will find the port and you should take your wallet card. For anyone without a wallet card you could get one in your surgeon's office or by calling the tollfree numbers of the manufacturer. I believe they are 877-LAPBAND and 866-REALIZE. The websites will have this info as well. Welcome to LAP-BAND.com and www.realizeband.com. Also, I had a patient who went early to a store sale and when they opened the door and everyone jammed inside her abdomen was pressed up against one of those security scanners at the door and she set it off. The staff were perplexed at how she could have stolen something so quickly! All that to say, don't give those things a hug unless you want to create a stir. hope that helps

It is not uncommon for there to be less saline than what we think is in the band. When we record fills in the chart we just add the amount to the last total but over time the band balloon does lose a little saline. More important than the total volume is the restriction you have and are able to maintain. In my experience, if there is a leak, you repeatedly are unable to withdraw any saline from the band. The fact that 4cc were still there suggests that you do not have a leak. If they put 9cc in there and it repeatedly goes down to 4cc over a short period of time - this would suggest a leak as well. When patients have a leak they have great restriction when they leave the office and it's gone over 1-7 days depending upon how slow the leak is. Hope that helps

Hmmmmm...... Disclaimer: Message boards are not adequate for sound medical advice. Nausea is not normal at this stage. I would certainly mention the nausea to your doctor. No need for Zantac on top of Prevacid. Might want to get an ultrasound of your gallbladder. See the disclaimer. hope that helps

Isn't that outrageous!?

Most surgeons use absorbable (dissolving) stitches under the skin and then apply steri-strips (white tape) to reinforce. Sometimes the skin will "spit" out the dissolving sutures and it will feel like fishing line is sticking out of your skin. If this happens you can either wait for it to dissolve or have your surgeon trim it off in the office.

Hmmmm..... Are you recent post-op? Lots of causes for nausea. Are you taking any aspirin, Aleve, ibuprofen? (can irritate stomach) Do you still have your gallbladder? (common in weight loss) Any chance of pregnancy? Have you tried an antacid like Zantac? (calms stomach acid irritation)

liquid diet will certainly clean out the ole tubes for sure. Kaopectate is good for this as it gels the stool instead of paralyzing your colon like other agents that then lead to constipation. Another thing to keep in mind is antibiotic induced diarrhea (pseudomembranous colitis) which some people get after the intravenous antibiotics given prior to surgery. This typically causes really watery stool and doesn't get better until treated. So, if anyone gets persistent watery stool it would be good to ask your doctor if they think you may have pseudomembranous colitis.

The stomach is designed to store food for a bit while digestion takes place. The esophagus is not a storage organ, it's a transport organ like an elevator with two buttons - down and up. It always tries down first and when that doesn't work it switches to up. Typically, "stuck" is when poorly chewed food or too big a bite gets stuck to the point of backing up into the esophagus. Also, if you eat perfectly but eat too much, it will back up into the esophagus and want to come back up. hope that helps

It is true that some insurance companies do not cover the cost of the band itself (approx $3,000). Isn't that outrageous? It is true that some insurance companies do not cover band fills but they will pay for band surgery. Isn't that outrageous?

The main purpose of losing weight before surgery is to shrink the liver. When you are overweight, the liver is overweight and we lift the liver to put the band in. If the liver is large it makes the surgery more difficult, harder to see high up on the stomach where we're working. The first weight you lose comes right out of the liver. It is easier for the body to mobilize liver fat than the kind that makes our clothes tight. You wouldn't believe the difference it makes in the ease of surgery when patients lose even 10 pounds before surgery. The biggest livers are in men, diabetics and BMI>50. I tell patients to lose 10 pounds for each of these. So for example, a female, non-diabetic, BMI<50 is an easier case as far as the liver is concerned. There have been instances of surgeons not being able to put the band in due to the size of the liver. Leaving a "fatty liver" for many years can actually cause cirrhosis - the same liver disease that alcoholics get. Fatty liver can cause elevations in liver enzymes on blood tests. Losing weight is amazingly great for your health for many reasons. It also is great for your liver.

I think if you're easily losing weight and don't feel like you're on a diet, it is okay not to get a fill. We've had patients that reached their goal without a single fill. The band journey is very individual. If you reach the point of being hungry and hard to lose or maintain weight and you feel like you're on a diet and you feel like the band's not working then get a fill.

The volume in bands to reach perfection is really quite different from one individual to another. I tell patients to not worry about what other people have in their bands. We have patients that lose all their weight with no fills and we have some patients that get filled a bit beyond the max amount of saline to reach perfection. I think that regardless of how much saline is in there, if you can eat a lot and are hungry and it is hard to lose weight you probably need more saline in your band to help you out. A lot of patients reach perfection on the fill but then get discouraged later because the perfect restriction gradually goes away. This is caused by the fact that the stomach tissue inside the band is losing weight with you and you need another fill to reach the same degree of restriction. hope that helps

If not full on solid foods you may need another fill. It would also be helpful to do a Fluid check i.e. pull all the fluid back into a syringe and see how much is really in there. VG stands for "Vanguard". This band was called the "11cm" band outside the United States. The smaller sizes (9.75cm, 10cm) were FDA approved in the U.S. in 2001. They had issues with the 11cm band so they re-designed it and got it FDA approved several years later. The company didn't want people to call it the 11cm band because they of the earlier problems so they gave it a name instead of a size. hope that helps

If it helps, we have a band practice north of Cincinnati and my partner, Dr. Mobley is banded himself as well as his wife and half his family. The entire office is banded and we do fills (by a banded nurse) in Columbus, OH.

I don't know if this helps but you can attend our band support group in West Chester, OH north of Cincinnati. From south Dayton the drive is less than 30 minutes. You could call the office for details 513-939-BAND (2263).

Thank you for posting this. People considering leaving the country for "cheap surgery" need to know a couple of things: When you leave the country for "cheap surgery" you are not buying the aftercare. Most U.S. surgeons do not sell the surgery without the aftercare and that is one reason why it cost more. Many people who leave the country end up paying more money in total and struggle to find aftercare. Also many people just have the surgery and no aftercare and end up spending money for nothing other than frustration. The least expensive route, I would argue, is to find a great U.S. practice near your home. You have the greatest chance for success under this scenario and the least amount of frustration. hope that helps

If the redness and discomfort resolve completely with antibiotics that's a good sign. If redness and port pain return within a few weeks of stopping antibiotics this would be suspicious for a port infection. Time will tell. hope that helps

Good point. Certainly every patient's symptoms are different. Many people feel that erosions make you really sick due to intestinal contents leaking out into the abdominal cavity. It is true that most erosions do not present this way. They typically present with weight regain. I have heard of "asymptomatic" erosions where patients continue to lose weight despite seeing an eroded band on endoscopy. Over time, however, the erosion tends to continue to the point of loss of restriction. The good news is that erosions are so rare nowadays we don't have much experience with it.

I saw that he is in Coos Bay, Oregon but I do not know him. The best way to research a surgeon is to call the hospital or surgery center where they work and ask the operating room nurses what they think of a particular surgeon. You will get great information from the people that work with surgeons (and are not in their practice). That's always good advice for any operation. hope that helps Merry Christmas!

Try Dr. Robin Blackstone (band surgeon). She is excellent and she will know excellent plastic surgeons in the area. I was just at a meeting with Dr. Blackstone last week regarding the new REALIZE band. Here's her info from American Society for Metabolic and Bariatric Surgery website. Robin L. Blackstone MD FACS (Center of Excellence) Regular Member Surgeries Performed: LB LGBP Scottsdale AZ USA 480-391-3885