DrWatkins

We will accept any patient regardless of where they were banded. We do charge for those fills but I honestly can't remember what the Cincinnati office bills for those. I would have to call the office. For an insurance company to pay for the surgery and not pay for any of the follow-up care seems absolutely insane to me, but don't get me started on insurance companies. That's like donating food containers to a homeless person without any food in it and thinking you are helping the person. Anyway, we're all in this together. The cool thing is that it is extremely gratifying to help people lose weight. I feel extremely blessed. You guys do amazing stuff. It's changed my life and I haven't lost a pound.

I would recommend having your surgeon take a look. Have you been doing any heavy lifting or major exercise?

Opinions differ about how gastric banding actually works. My opinion is based on the fact that stretching the stomach wall shuts down the appetite hormones. When your stomach size is reduced from a football to a golf ball you are going to get stomach wall stretch and appetite hormone diminution on much fewer calories. Also, the food takes a while to empty through the restriction so the full feeling lasts longer. Some patients will forget to eat dinner because they are still full from lunch. We know about some of the appetite hormones floating around but we know that there are many more and that the way the stomach and the brain communicate is very complicated. The drive to eat is a very powerful biological drive. If the brain thinks for an instant that you're trying to starve yourself it will take drastic measures. The small stomach pouch above the band fools the brain into thinking you've just eaten a Thanksgiving meal. In some patients the appetite suppression is very powerful and some patients say they are never hungry after band surgery. Some patients deal with lots of "head hunger" which is a complex process and not easy to deal with sometimes. As you lose weight, the stomach tissue inside the band loses weight and that is why you need additional fills as you lose your weight. At your goal weight, the stomach tissue thickness stabilizes and the need for fills diminishes quite a bit. I read a lot of posts where patients do not have their bands perfectly adjusted. Here's my version: Perfectly adjusted - full on small meals, not hungry between meals, easy to lose 1-2 pounds per week, amorous feelings toward your surgeon and staff, send them a Christmas card that will bring tears to your eyes Too loose - hungry, can eat large amounts of food, hard to lose weight, feels just like you are on a diet. Too tight - everything wants to come back up including liquids, hurts to eat or drink, bad heartburn especially at night (when you lay down), the only thing that wants to go down is Cheetos and ice cream (bad stuff) I think if you don't fit the "perfectly adjusted" description you should call your band surgeon to make it perfect with an adjustment. Also keep in mind that each patient's band journey is very individual. Hope that helps brad

The original Allergan (Inamed/Bioenterics) bands were size 9.75, 10, 11 ("Vanguard") The 9.75 and 10 held 4cc The 11 held 10cc The latest Allergan bands are APS, APL for Advanced Platform small and large. The APS holds 10cc The APL holds 14cc Ethicon just received FDA approval on their REALIZE band which is only one size and it holds 10cc All bands can basically reach the same tightness; some just require more saline. Hope that helps. brad

Hi Ellisa, $15,900 in the Cincinnati office covers anesthesia, cost of the band, operating room time and laparoscopic equipment, surgeon, assistant and a team of people to care for you after surgery including all of your fills for 13 months post-op. As long as you come in for your yearly evaluation we continue to provide fills at no additional charge. We have no program fee and offer free consultations with our surgeons. Psyche eval and any pre-op testing is separate and usually covered by insurance. No hidden fees. We are currently out of network with insurance companies. One of the great things about message boards is that you get a lot of valuable information and the more you know the better you will do with surgical weight loss. Here is something you should know about health insurance companies. Over the past 20 years the cost of health insurance has gone way up and what they pay hospitals and doctors has gone way down. Health insurance companies have been gouging the system to the detriment of providers and patients for a long time now. (Did you see what the CEO of United Healthcare makes every year?!) Here are some of the negatives to this predicament: It is expensive to run a surgical practice and if you accept payment below what it cost to keep your practice open you risk bankruptcy unless you make up the difference somehow. Some practices make up the difference by performing additional procedures that aren't necessarily necessary. Some practices do high volumes of band surgery and then can't afford to hire additional staff needed to take care of them during their weight loss. This affects weight loss and creates frustrated patients. Some practices make up the difference by only giving small fills so you can bill for more fills. Many insurance companies won't pay for a fill for 90 days so some patients have to wait to get going on their weight loss. This drives me absolutely crazy. Some practices only do small volumes of band surgery and make up the difference by doing other operations. They tend to not be as passionate about your weight loss as full-time band practices and patients get frustrated. Many patients like this end up in our practice after surgery due to our extensive post-op support. Some practices make up the difference by charging a program fee - at least this is an upfront cost and perhaps the noblest way to maintain a viable business for your patients. Anyway, the low rates cause a lot of game playing in the industry and this is not good for patients and it drives me crazy. I think the best way to approach it is to provide excellent care and extensive support after surgery and be up front with patients on what that costs. We are driven by doing whatever possible to acheive the best outcome and staying in business for our patients. Oh, and the band resolves diabetes just as well as the bypass. Since band weight loss is healthy and doesn't involve muscle wasting it may take a little longer to resolve the diabetes but your weight loss is healthy and natural and you don't have to contend with the chronic disease malabsorption and you can take medications normally and don't require complicated Vitamin regimes. Hope that helps. brad

Hi Nurse Niki, You're welcome to attend our Columbus support group. Our clinic is in West Chester, OH north of Cincinnati but we have lots of patients from Columbus so we have office hours there and a support group. You can call the office 513-939-BAND (2263) for details. Angie runs that support group and is a band patient herself. Hope that helps.

Hi Ellisa, We do not offer gastric bypass. I would never let anyone in my family have a gastric bypass. No surgeon would ever have a bypass on themselves. Obese surgeons choose the band for themselves and there's a reason for that. There are better operations now. We do offer the ROSE procedure which is an effective non-surgical treatment for patients who regain weight after gastric bypass. We specialize in gastric band surgery and have done nearly 4,000 procedures in our clinics. Dr. Osborne and Dr. Mobley are the surgeons in the Cincinnati office (located in West Chester). They are on staff at Good Samaritan Hospital and Bethesda North Hospital. We do nearly all of our bands as an outpatient procedure - home the same day. We do these at University Point Surgical Hospital. We charge no professional fees for revisional operations if you need a port revision or a slip repair. We are the only practice that has this "guarantee". Dr. Mobley and his wife and many of their family members are banded. All of the receptionists and nurses in the Cincinnati office are banded. We have a call center and all of the weight management specialists are banded. My band practice in Seattle did over 2,500 band procedures. Now I spend a lot of time traveling to our other locations in DC & Chicago and we have other band surgeons around the country that want to join Synchrony Health which keeps us busy. If you travel you will be able to have band adjustments in DC & Chicago & Seattle and more to come. I am also a proctoring surgeon for both band companies. We fix a lot of complications on people that went out of the country for "cheap" surgery. They end up paying way more out of pocket than if they had just come to a high quality practice in the first place. I don't recommend this approach. We feel strongly about offering the best support after surgery possible. At the moment, we do not sign insurance contracts when the reimbursement is below what it costs to provide the service. We have seen several band clinics close down after trying to provide good care on such low reimbursement and we simply won't do that. When those band clinics close down we end up taking care of their patients (gladly). We see many patients that were banded somewhere else and are frustrated with the post-op support and they end up in our practice to be successful. We're not the cheapest. You don't want the cheapest. We're the best. We'll always be in business to help you succeed. Many practices advertise a cheap cash price and then you learn about the hidden fees after surgery. We don't do that. Our price includes everything. It makes us look more expensive than other practices but you pay less overall because it includes everything. We don't believe in trying to be sneaky with prices. We know what it cost to provide the best care and that is what we do. We are working on our website - stay tuned! Hope that helps. Brad

Hi Cmeyer11, I would recommend following the food consistency instructions given by your surgeon. We all have our own versions of the "healing period" but that is why we start with liquids and progress to solid foods - to allow the band to heal. We have a nurse in our office that says, "just because you can doesn't mean you should". Basically, stick with the recommendations to allow everything to heal in there. The healing phase is tough because you have no restriction once the swelling goes down. Once you get your first fill you will see the power of the band. Hope that helps.

Hi Andielmt, My opinion is that the band restriction should always be perfect. It is adjustable so I see no reason why it can't be perfect all the time. In my opinion, if you have your first fill and you can still eat a lot and you feel as hungry as if you were on a diet and you find it hard to lose weight, I think you need more saline in there to help you out. I think a lot of band clinics don't get it perfect soon enough. perfect = full on small meals, not hungry between meals, easily lose 1-2 pounds per week, think your surgeon is miraculous, send your surgery practice a Christmas card that will bring tears to your eyes too loose = hungry, able to eat a lot, feel like you're on a diet, hard to lose weight too tight = heartburn, everything hurts to eat and wants to come back up, the only thing that will go down is ice cream and Cheetos Hope that helps.

Dootson, Regarding sleep studies: Screening for sleep apnea prior to surgery is to prevent a potentially dangerous situation whereby you send a patient (with untreated sleep apnea) home with narcotic pain pills (which lengthen deep sleep where sleep apnea occurs) and you stop breathing for dangerously long periods of time (people have died for this exact reason). Some surgeons screen everyone for sleep apnea. Some surgeons ignore it completely. I fall in the middle and order the test only for high-risk individuals. In my mind, high risk individuals include obese male diabetic patients, neck circumference >43cm (17inches) or observed sleep apnea (your sleeping partner says, "you scare me because you stop breathing when you sleep"). Any of the above are at very high risk for having significant sleep apnea and should be screened prior to surgery and treated if found to have it. What is sleep apnea? Obesity increases the amount of tissue around your airway. While you are awake and upright your airway stays open. When you lay down to go to bed at night there is increased pressure on your airway and your laryngeal muscles work harder to keep your airway open. When you go into deep sleep, however, the laryngeal muscles relax and you get airway collapse (breathing stops). Sleep apnea interrupts your deep sleep causing daytime sleepiness and a host of other medical problems. Most people don't know they have it because it occurs in your sleep. Since you don't complain about it to your medical doctor, it is one of the most under-diagnosed serious medical conditions out there. So, if a patient has significant, untreated sleep apnea and you send them home with narcotic pain pills, which lengthen deep sleep, you may cause long periods of no breathing resulting in death. This is the scenario all surgeons are trying to avoid. Sleep apnea also causes pulmonary hypertension (high blood pressure in the lung blood vessels) and right heart ventricular strain. Treating sleep apnea prior to surgery puts the heart and lungs in the best state of health prior to anesthesia. The typical treatment for sleep apnea is a CPAP machine (Continuous Positive Airway Pressure). This is a mask you wear at night while sleeping that will prevent airway collapse with positive air pressure. Most patients will cure their sleep apnea within a few months of weight loss and are able to discontinue the CPAP machine. My opinion is that only moderate or severe sleep apnea needs to be treated prior to surgery. I do not treat mild sleep apnea. Screening typically involves an overnight stay in a sleep lab with many monitors connected to your body. Home screening does exist. Some insurance companies don't cover home screening and some pulmonologists do not utilize this method. Some patients that don't want to bother with screening will rent auto-titrating CPAP machines to alleviate this concern quickly. It can be difficult to find a place that will rent an auto-titrating CPAP machine without a sleep study. Hope that helps.

Hi Anitak33, Give yourself some credit. Learning the band takes time and you are early in your experience. You will become an expert over time. Typically, people lose weight right after surgery due to stomach tissue swelling, then the swelling goes away and people get frustrated and then you have your first fill and everything is wonderful again. Here's a previous post of mine: Don't be so hard on yourself. The stomach tissue swelling that may have given you some restriction and therefore appetite suppression after surgery is gone at this point. This is the classic time of maximal frustration after gastric band surgery. Give yourself a break. Once you've had your first fill and are perfectly adjusted, you'll be full on small meals, not hungry all the time and the dieting mentality (and being hard on yourself) will be over. Hang in there. You're doing better than you think. Focus on the fact that you're in the healing phase. The weight loss phase begins after your first fill. Celebrate the fact that you have this powerful tool healing inside that is going to help you achieve your goals like never before.

Hi BettyBoop68, As you know the port is actually stitched to the muscle fascia (the tough white stuff on top of the muscle). The good news is that it will keep the port sitting upright and easy to access. The downside is that if you overdo it a bit, sometimes the stitches can cause a little muscle ache right at that spot. The treatment is just like you would with any muscle ache: muscle rest, anti-inflammatory drugs such as ibuprofen or Aleve, and heat (heating pack, hot tub soaks) Hope that helps.

Hi Bellesmommy, I practice at Synchrony Health Ohio in West Chester. We have clinics in Seattle, DC & Chicago as well and I travel a lot. I'm always happy to see patients that request and we also have two talented (and banded) nurses there, Gemma and Kristina who do most of the fills. We also have two full-time surgeons in the office, Dr Osborne and Dr. Mobley. They are both excellent surgeons and are very kind. Dr. Mobley has had the band himself as well as his wife and nearly his entire family. I think the Synchrony Health staff do a wonderful job. We strive to offer the best care after surgery imaginable and have been doing band surgery since 2002. Our band cases are nearing 4,000 (including all centers). We have lost over 125,000 pounds. You can read about the staff on the website, Synchrony Health :: Home. It sounds like you are way too tight and need an unfill. Band adjustments: Perfect = feel full on small meal, not hungry between meals, easily lose 1-2 pounds per week, think your surgeon is miraculous, send your surgery practice a Christmas card that will bring tears to your eyes Too tight = heartburn, everything wants to come back up, hurts to eat, only high calorie liquid foods will go down like ice cream and Cheetos (bad stuff), hurts to eat Too loose = feels like you're on a diet, hungry, can eat a lot, weight loss very difficult Hope that helps. Brad

We are happy to provide band fills at our clinic in Oak Brook, IL. The phone number and location are listed on our website, Synchrony Health :: Home Dr. Duane Tull is the surgeon there and he is banded himself. Most of the staff is banded as a matter of fact. I visit that clinic several times a month as well.

Amen to that. Good luck with your surgery. We are proctors for both band companies as well. We accept all patients for fills regardless of where they were banded. Over time you will see more and more surgeons doing band surgery. Our hope is that more and more surgeons will provide superior care after surgery which we take very seriously. The fact that all of our receptionists and nurses are banded and one of our surgeons is banded is awesome for our patients. It's truly hard to beat post-op support like that.

I can't find a photo on the web. It used to be called the Swedish band or the Obtech band before Ethicon bought it. Their website (www.realizeband.com) has no photos currently, but I suspect they are coming soon. The announcement says, "December 2007" so I would watch that website for more info.

Well I tried again and it came out the same. Apologies. Let me know if you need me to retype it - argh!

Differences between REALIZE and ALLERGAN bands Clinical outcomes (slip rate, erosion rate, weight loss, etc) are very similar between the two bands. The Allergan band is the original band (Allergan bought the Inamed band company which bought Bioenterics company - these are the old names of the same band) Surgically, there are subtle differences such as: The Allergan band comes in many sizes, REALIZE band is one size. Allergan has two port sizes; REALIZE is one port size. Allergan ports are stitched to the muscle fascia (the tough white stuff on the outside of the muscle); REALIZE port has neat technology that attaches itself to the muscle fascia and may have slightly less port pain the first few days after surgery. The REALIZE ports have a neat tool that places the port and secures it with a handheld instrument making it really easy on the surgeon. (Don't tell anyone but they could teach monkeys to do this stuff.) Allergan band tubing has little arrows printed on it pointing the surgeon to the tab end of the tubing which is a nice feature in the operating room. Allergan ports are smaller around (circumference) and taller - perhaps easier to palpate for fills. REALIZE ports are bigger around and less prominent. Think small stack of silver dollars versus taller stack of quarters to create the mental image. Allergan tubing is closer to the septum (the area that you aim for with the needle for adjustments/fills) and perhaps more susceptible to needle sticks requiring port replacement. REALIZE ports have the septum farther away from the tubing - the tubing is a little more protected. Both bands are now easier to unbuckle in the event a surgeon has to reposition the band. The REALIZE band comes with a neat instrument that helps to pass the band around the upper stomach. The Allergan AP bands have "pillows" in the inflatable portion of the inner balloon that prevents balloon-to-balloon contact. The REALIZE band does have balloon-to-balloon contact. Some people think that this contact may cause issues years later but long-term studies have not shown this to be the case. Basically, we have two wonderful technologies and I would not hesitate to perform either surgery on friend or family. I'm hoping that with two band companies on the market the price of plastic will start coming down. I know companies have to recoup their R&D dollars but they've got some pretty pricey plastic at the moment. Hope that helps.

Whoa, That cut and paste came out really funky. If you take out the "FONT" garbage it is sort of readable.

Hi TreTre, Differences between REALIZE and ALLERGAN bands Clinical outcomes (slip rate, erosion rate, weight loss, etc) are very similar between the two bands. The Allergan band is the original band (Allergan bought the Inamed band company which bought Bioenterics company - these are the old names of the same band) Surgically, there are subtle differences such as: The Allergan band comes in many sizes, REALIZE band is one size. Allergan has two port sizes; REALIZE is one port size. Allergan ports are stitched to the muscle fascia (the tough white stuff on the outside of the muscle); REALIZE port has neat technology that attaches itself to the muscle fascia and may have slightly less port pain the first few days after surgery. The REALIZE ports have a neat tool that places the port and secures it with a handheld instrument making it really easy on the surgeon. (Don't tell anyone but they could teach monkeys to do this stuff.) Allergan band tubing has little arrows printed on it pointing the surgeon to the tab end of the tubing which is a nice feature in the operating room. Allergan ports are smaller around (circumference) and taller - perhaps easier to palpate for fills. REALIZE ports are bigger around and less prominent. Think small stack of silver dollars versus taller stack of quarters to create the mental image. Allergan tubing is closer to the septum (the area that you aim for with the needle for adjustments/fills) and perhaps more susceptible to needle sticks requiring port replacement. REALIZE ports have the septum farther away from the tubing - the tubing is a little more protected. Both bands are now easier to unbuckle in the event a surgeon has to reposition the band. The REALIZE band comes with a neat instrument that helps to pass the band around the upper stomach. The Allergan AP bands have "pillows" in the inflatable portion of the inner balloon that prevents balloon-to-balloon contact. The REALIZE band does have balloon-to-balloon contact. Some people think that this contact may cause issues years later but long-term studies have not shown this to be the case. Basically, we have two wonderful technologies and I would not hesitate to perform either surgery on friend or family. I'm hoping that with two band companies on the market the price of plastic will start coming down. I know companies have to recoup their R&D dollars but they've got some pretty pricey plastic at the moment. Hope that helps.

Docop, You can do it! The band can help! (like Home Depot slogan)

Lynsay, Glad you're seeing your doctor. Keep me posted.

Lynsay, Also, you could take a photo of the incision with a digital camera and send it to me via private message and I'll take a look at it but you should also call your surgeon's office.

Hi Lynsay, The simple answer is that you should call your surgeon now and either get an appointment to see them today or have them call in some antibiotics. The larger incision is typically the port incision and you certainly don't want a port infection. We have had patients with superficial wound infections (ie the port itself is not infected) that cleared up with a week of antibiotics. Keep me posted.

We only use the AP bands when we place an Allergan band. We really like them and think they should be used over the "old" Allergan bands. We also are among the first in the country to offer the new REALIZE band from Ethicon. It too is a nice band.