drgthemd

I am a physician. I'm interested in communicating with Lap-Band patients who are having problems with achieving and maintaining a normal weight with the Lap-Band. Dr. G.

Helpful hint for the week: Avoid shopping when you're hungry. Shopping at those times increases the likelihood you will buy unhealthy foods and don't forget to read the label if you're unfamiliar with the contents of the food. If anyone out there is struggling with weight loss, let me try to help.

How many adjustments has your husband had and what type of Lap-Band does he have? Is it the AP Lap-Band and if so, do you know if it is the large or standard? Typically, in our experience, patients only need 2-4 adjustments to the band within the first few months after surgery to obtain the proper adjustment point. Typically, when properly adjusted, patients will only be able to eat 2-4 ounces of solid food, 3-4 times a day and should be losing approximately 2 pounds a week. This assumes the patients are eating healthy solid foods, exercising consistently, a minimum of 3 hours per week and avoiding fluids with calories, except on occasion. Your husband should certainly make a follow up appointment with the surgeon to seek his advice, these are just general guidelines. It could be he isn't properly adjusted or it could also be he is leaking Fluid out of his band, which happens on rare occasions.

I'm not your doctor and you should seek advice directly from your surgeon. However, I can give some general guidelines. If you have a 14cc band and you've only had 2 fills of .5 cc's each, you are underfilled. You definitely need more Fluid placed in your band. I would make another follow up appointment with your surgeon for an additional adjustment. We do the first adjustment at 6 weeks out and it usually takes 2-4 adjustments to get a patient adjusted properly, in our experience. Once you are properly adjusted, if you follow the simple rules of healthy eating, avoiding fluids with calories, consistent exercise of at least 3 hours per week, eat slowly and take small bites, chewing your food well, you should lose approximately 2 pounds a week. That has been our experience dealing with many patients over the last decade. Good luck to you and I wish you success with your Lap-Band.

This week's helpful hint for success: When you shop for processed foods (the foods in cans, bottles, packages), always read the label to be sure you are buying healthy processed foods which contain minimal amounts of saturated fat, trans fat, cholesterol, sugar and salt (sodium). Once you are familiar with healthy types of processed foods, reading the label won't be necessary unless it's something new you've never tried before. If anyone out there is struggling with weight loss, let me try to help.

I commend you for your great success. As you have experienced, the Lap-Band is a great tool for achieving weight loss. On average, our patients lose 8-10 pounds a month and you have lost even more than that. Congratulations. You are obviously compliant with the simple rules of healthy eating, exercise, eating slowly and getting a properly adjusted band. You are absolutely correct that success with the Lap-Band is behavior modification. In addition, it is extremely helpful to have a surgeon who is truly interested in long term results and gives proper education and post-op follow up care to the patient. Good luck to you in your ongoing efforts to achieve and maintain a healthy, normal weight!

In my experience, no matter what kind of WLS a patient has, if they are not willing to be disciplined enough to have some behavior modification, they will not be successful with any WLS. There is no magic pill, but, in my opinion, when you compare bypass, the sleeve and Lap-Band, there's no question the band is the best choice. I can say this with confidence because I've seen the results from all the above three bariatric procedures over a long term. I tell my patients that if they're not willing to make some behavior modification, then they are wasting their time and money with WLS. I have found that once I educate the patient on the pros and cons of all 3 procedures and explain in simple terms the guidelines they need to follow in order to be successful, most of my patients elect to go with the Lap-Band procedure. Once the procedure is performed, we are very diligent and persistent in our follow up care with the patient during the post operative years and this has resulted in the achievement of excellent success for long term permanent weight loss with our patients. There is no reason any patient cannot have total success with the Lap-Band. The real key is education, education, education and follow up, follow up, follow up. I agree that many doctors are unwilling to do the education and follow up because it takes time and commitment from the doctor. Also I agree that many doctors become frustrated with non-compliant patients and that's another reason they prefer other bariatric procedures where there is not nearly as much post-op follow up care involved. However, I have learned over the years that being persistent with follow up with my patients eventually leads to the goal of behavior modification. Behavior changes are not easy for the bariatric patient, as you all well know. It takes time, effort and patience on the part of the doctor and the patient to achieve it. But, eventually, with persistence, behavior change will occur and patients do have success. Yes, it is true that Lap-Band patients do develop scar tissue, which is a foreign body reaction.The amount of scar tissue that develops varies from patient to patient, sometimes requiring reoperation to remove the scar tissue. However, in our practice, the number of patients needing reoperation to remove scar tissue has been exceedingly rare. I mentioned in a previous post that a number of our patients have had all the Fluid removed from their band once they achieved a normal, healthy weight. Those patients continue to maintain their weight because they have changed their behavior. The ultimate goal of a bariatric practice should be behavior modification with healthy eating and drinking, consistent exercise and eating slowly. In our practice I've seen how we have dramatically improved the quality of life by eliminating comorbities and I'm sure we've also increased dramatically patients' longevity. It is gratifying to see those results. I encourage patients who are struggling with their Lap-Band to be persistent in following the simple guidelines previously outlined because eventually, if they are persistent, despite any failures along the way, they will ultimately achieve success.

Bandista, we have patients in our practice with arthritic pain who have been able to adequately control pain with a combination of appropriate arthritic anti-inflammatory medication and swimming as an exercise. As you're aware, alcohol should be minimized. It is true that the Lap-Band seems to have fallen out of favor with both patients and doctors in the last few years and that, in my opinion, is very unfortunate. In our practice, we have performed thousands of bariatric procedures, i.e. gastric bypass, gastric sleeve and Lap-Bands. In my opinion, the adjustable Lap-Band system is the very best procedure because it is safe, the least invasive, the least expensive and also the most effective for long term, permanent weight loss if the patient is properly educated, has good post-op care and follows the simple guidelines of healthy eating, exercise and eating slowly. Unfortunately, some patients don't comply with the simple rules and many doctors do not want to take the time to properly educate and provide the effective post operative care for patients because it takes significant time and effort to provide good follow up. We have seen many gastric bypass and gastric sleeve patients who although they lose weight initially, after a few years, they gain all or a good portion of it back again. This is because they can overeat and stretch out the stomach and thereby can consume larger quantities of food. We have placed a Lap-Band in some of those patients as a secondary operation with great success. In summary, in our experience, the Lap-Band is the very best WLS tool for long term, permanent weight loss. With time, I'm sure a lot of the negative press about the Lap-Band will be reversed.

If you totally eliminate exercise, you will lose more muscle than necessary during your weight loss. Exercise should consist of aerobic and resistance (anaerobic) training, such as weight training. The weight training will allow you to retain and not lose excess muscle during your weight loss efforts with the Lap-Band. I hope that information helps

It sounds like the band is working well for you and that's great. I think you will find you'll need to add the exercise component to have ongoing success in reaching a normal, healthy weight. Also, occasional drinks and alcohol are fine, it just can't be excessive or it will definitely hinder your weight loss efforts.

I couldn't agree more. Being too tight is never good. It only leads to complications, as you well know. I also concur that the endpoint where a Lap-Band patient should stop eating should not be when they are experiencing pain. That is beyond the proper endpoint. It should just be a feeling of fullness, never pain

Kate, thank you for your response. It does not surprise me that the food you eat passes quickly through your band because you have an older 4cc band with perhaps only 2cc's of Fluid in the band, plus you follow the simple rules of eating slow, taking small bites and chewing well and apparently eat healthy foods. You're to be applauded for that. Regarding satiety, or fullness, in a Lap-Band patient, I honestly don't think anyone has the real answer. There is a lot of speculation and difference of opinion and that debate will probably continue on, but in my opinion, realistically it doesn't matter what the precise mechanism is, because we know that the Lap-Band does work if a patient complies with the simple guidelines for success. If they are not followed, patients will either have marginal or no success. Over the years, we've had patients who've used the Lap-Band as a temporary tool to achieve a normal healthy weight and then they've requested to have the fluid removed from the band. Most of those patients have maintained their weight because they changed their behavior by eating healthy, consistently exercising, avoiding fluids with calories and eating slowly. However, the majority of patients we've operated on over the years prefer to maintain some fluid in the band, which is fine. I think that's because they've been up and down so many times on a variety of diets and they have a fear they will not maintain necessary behaviors. I wish you ongoing success with your Lap-Band and I would encourage you to continue your efforts at helping others who may be struggling with their weight loss.

Kate, as I mentioned in the previous post, there are a number of factors involved in the rate of passage of food through the band. If a Lap-Band patient doesn't have a dilated upper gastric pouch and lower esophagus and they are still able to consume large quantities of food at one time, it could merely be because the band does not have a lot of fluid in it, the type of food the patient is eating, size of the bites, amount of chewing and how fast they're eating. It sounds like you are eating slowly and are chewing your food well and taking small bites, so those factors would definitely increase the rate of passage. What type of band do you have and how many CC's of fluid do you have in it? When you eat, do you focus on healthy solid food? It sounds like you do.

Kate, in my experience, the patients who can overeat and consume larger quantities of food when they have a properly adjusted band are patients who have a dilated upper gastric and lower esophageal pouch which usually results when patients do not stop eating when they feel the fullness. Additionally, those patients usually have a history of multiple regurgitation episodes. I've found the key to avoiding this problem is to eat slow, take small bites and chew well. It's very easy to not be able to recognize the appropriate endpoint of fullness if one is eating rapidly. When eating rapidly, the food is almost always consumed with large bites and not chewed well. The diagnosis of a dilated upper gastric pouch and a dilated lower esophagus is easily made with an upper GI x-ray. If there is significant dilatation, it can easily be reversed by removing the fluid in the band for a rest period of 4-6 weeks. The intestinal tract should return to normal in that time and then the patient can have fluid placed back into the band for a proper amount of restriction. In my experience, patients with a properly adjusted band and who do not have a dilated upper gastric pouch and lower esophagus should only be able to consume approximately 2 ounces of solid chewed food at a time. That amount will vary somewhat from patient to patient and can also vary based on a multitude of factors, including time of day, menstrual cycles, etc. Patients with a dilated gastric pouch and lower esophagus typically will be able to consume larger volumes of food and if they eat late at night they oftentimes have night night coughing which can potentially lead to pneumonia because of aspiration. I applaud you for your success with the Lap-Band by following the simple rules. I do not know if you may have dilation of the upper intestinal tract above the band, but as mentioned, it can be easily diagnosed with an x-ray. In summary, the real key point, in my experience, to staying out of trouble with dilatation issues and regurgitation of food is to eat slowly so you can recognize when approaching fullness.

Kate & Cherie, thank you for your responses. I am fully aware of the debate going on regarding food passing through the Lap-Band. There is still much disagreement on this issue, despite the studies that have been done. In my experience over the last decade with many patients, I believe the Lap-Band is a restrictive device and it does slow the passage of solid food through the stomach and also causes an early feeling of fullness if adjusted properly. The factors involved in the rate of passage of chewed, solid food through the Lap-Band are many, but not limited to: 1 - Consistency of the food, i.e. doughy and fibrous foods would pass more slowly 2 - The size of each mouthful of food 3 - Amount of chewing 4 - How fast one is eating 5 - Tightness of the band Nonetheless, in my opinion, the important simple things to remember to achieve success with the Lap-Band are as follows: 1 - Be sure the Lap-Band is in proper position 2 - Have the band adjusted correctly 3 - Eat healthy solid foods 4 - Avoid fluids with calories 5 - Exercise within your target heart rate zone a minimum of 3 hours per week 6 - Take small bites, chew well and eat slowly 7 - Stop when you feel the fullness In my experience, the Lap-Band is a great tool to achieve and maintain a healthy weight if the above simple steps are followed. Expected weight loss should be about 2 pounds a week. I have followed this protocol diligently with many of our patients and have had great success. If there is noncompliance with the above steps, it is unlikely that success will be achieved.

B-52 I concur 100% with your post and I applaud your success. You're absolutely correct that the best indicator of a weight is not BMI. We have been doing hydrostatic body fat testing for many years and that indeed is the best indicator for a healthy weight. The Lap-Band certainly does stop you from overeating if the simple rules are followed and I couldn't agree more that the exercise component for success with the Lap-Band is absolutely critical. You sound like you would be a great coach for others struggling with their weight after the Lap-Band procedure. Lose2be I am a licensed, practicing physician in Southern California with well over a decade in bariatrics. I do have a desire to help people with their weight loss post WLS and have done so for years with many patients. Our patients encouraged me to post some useful information, which has helped them, on Bariatricpal so that other post WLS patients who are struggling with their weight might also achieve long term success. Yes, the advice I'm giving is based on my experience and have no motive other than to impart some of the useful information I have learned from treating our patients over the years.

I apologize, I had no intention to be offensive. I was merely attempting to pass along some helpful information. Please accept my apology for any offense. I wish you the best of luck in your efforts to identify food allergies and intolerances.

Thank you for your response. In my experience over many years, I believe the band does cause restriction when it is appropriately adjusted and patients are eating solid foods. I'm aware that there's a difference of opinion and some people now state that everything that is chewed passes through the band quickly. I do not believe that is the case. Some foods pass through quicker than others, depending on the consistency, how well the food is chewed and how fast the patient is eating. One thing for sure, when a patient with a properly adjusted Lap-Band eats solid foods, it will definitely pass more slowly through the band than it would otherwise. I've counseled many patients over the years with success by telling them that by following the simple rules I outlined previously, combined with stopping any further food intake once they feel the fullness, they will avoid problems of dilating the upper gastric pouch and the lower esophagus and also avoid regurgitation. If a Lap-Band patient is eating too quickly, they will not recognize the point of fullness, and that is where they get into trouble with stretching out the upper gastric pouch above the band and the lower esophagus and also regurgitation of food problems. Let me know if that helps.

You're right Kate, the issue is education, so patients know what they need to do to have success with the Lap-Band. The Lap-Band is not a magic pill. Cherie, I would suggest you get a second opinion from a physician specializing in allergies, not a nutritionist. It's unlikely that you would be allergic to all those types of foods. You may be intolerant to some foods, however, true allergies manifest themselves as skin rashes with itching or breathing problems.

In my experience, if a Lap-Band is properly adjusted, patients will not be able to consume excess amounts of any healthy solid food. They will reach the endpoint of fulness after consuming much smaller amounts. People can cheat and get around that by eating unhealthy foods and also by consuming fluids with calories. Most fruits and vegetables when eaten in smaller quantities are excellent because they tend to have a lot of bulk which will fill you up and do not have a lot of calories. There are some exceptions to this, avocados for example have a lot of calories and a lot of saturated fat, but the majority of fruit and vegetables are great. Processed foods are ok as long as you buy healthy processed foods. Read the label on the product and buy processed foods which contain minimal amounts of sodium, sugar, cholesterol, trans fat and saturated fats. I guarantee you can find healthy processed foods which contain minimal amounts of the above that also taste good.

Regarding body contouring, I would recommend not doing anything until you reach a normal BMI range. At that point, I suggest contacting a plastic surgeon for a consult. There are many excellent plastic surgeons that deal specifically with body contouring after weight loss and many of them offer free consultations. I suggest contacting several to make a good decision.

No, I'm not looking for business at all. I'm trying to help people with their Lap-Bands. My patients suggested I come on here and read/view/post and I believe I can offer assistance to others who may be struggling/have issues with the Lap-Band.

Thank you for your responses. You're absolutely correct. Normal is not an absolute number. It is a range dependent upon your height and weight. As you probably know, height and weight can be used to calculate your BMI (Body Mass Index). Normal BMI is approximately 18-25. As far as my reference to permanent weight loss, the goal with the Lap-Band should be to lose enough excess weight to arrive at a normal BMI range and maintain that range. If the Lap-Band has been properly placed and adjusted, (btw adjustments are VERY important to Lap-Band success and in my experience more of an art than science to arrive at the proper adjustment point and that endpoint varies from patient to patient) patients should need only 3-4 adjustments to the band until they reach the ideal point of losing 8-10 pounds a month, consistently. That kind of weight loss, in my experience, assumes a properly adjusted band and patient compliance with three simple rules: 1 - Take small bites of solid, healthy foods (fruits and vegetables and healthy processed foods), chew it well and go slow when eating 2 - Avoid fluids with calories the majority of the time 3 - Consistent, effective exercise at least 3 hours per week, ideally the exercise should be aggressive enough so that you are exercising in your target heart rate zone For head hunger, in my experience the most effective way to deal with the issue is to be regularly involved in an active post-op support group. We have done that for years and has been very effective