Jean McMillan

Deborah, What are you eating now that's hard to get down? Are you back on solid food? As long as you're able to drink plenty of liquids, you'll be OK while you figure out what's going on and whether you need a small unfill (which can make a big difference in your ability to eat without compromising your restriction). It seemed like I had to re-learn my band eating skills (take tiny bites, chew very well, eat slowly, etc.) after every single fill I had, but there are some things you can do to minimize problems. #1 - When you have a stuck episode, PB, sliming, or other eating problem, stop eating as soon as you start feeling discomfort. Continuing to eat will just irritate and inflame your upper GI tract even more. #2 - After one of those eating problems (see above), follow a liquid diet for 24 hours. Then transition gradually to purees, soft foods (that you can cut with the side of a fork), and then solid foods. #3 - Pay attention to which foods give you trouble. Animal Protein that's cooked too dry is a culprit for many bandsters. If you've been choosing lean cuts because they're lower in fat, consider trying a cut with more fat - for example, eat chicken thighs instead of chicken breast, and cook the chicken with the skin on so that the fat from the skin seeps into the meat to keep it moist. Be extra careful when eating very fibrous veggies (especially if raw) and fruits (especially with the skin or peel left on). A little bit of gravy, plain yogurt, sour cream, salad dressing, mayo, tomato sauce, salsa and the like can help problem food go down (and add to the flavor, too). If you're still struggling in 2-3 days, I'd call your surgeon's office and schedule an unfill. More fill is not better if you can't eat healthy solid food. I gained weight a few times when my band was too tight because I ended up eating easy slider foods that offer no satiety and are often junky (potato chips, ice cream, mashed potatoes, etc.).

Welcome, Eric, and congrats on the start of your WLS journey. Are you having the surgery done in Bahrain? I ask because if you're having it done elsewhere in the middle east, I'd be concerned about the need to travel there for fills, unfills, and other aftercare. I realize that Saudia Arabia is close by, but I've been to parts of the world where a seemingly short, 50km trip was a complicated expedition. Anyway, best of luck to you! Jean

Weight loss is hard work no matter how you do it. WLS is supposed to make it easier, but it doesn't make it automatic. I know you're anxious to get rid of the excess weight as fast as possible (aren't we all?) but you're actually doing very well. 47 lbs lost since June 5 works out to a loss of 2.35 lbs/week. The average weight loss with the band is 1-2 lbs/week, so I think you need to give yourself credit for the great success you're having so far. Have you asked the NP specifically why she's reluctant to give you another fill? Have you told her you're getting hungry 2 hours after eating? Have you tried keeping a food log (so you can verify just how much and what you're eating)? Are you avoiding slider foods and liquid calories? The early and prolonged satiety that the band is meant to provide won't happen after eating soft and slider foods. solid food (animal Protein, non-starchy veggies, fruit, etc.) does that trick.

BIG NEWS IN THE BAND WORLD On October 30, 2012, a Reuters article revealed that Allergan is considering selling the Lap-Band® to another medical device company due to declining sales of the band. Not surprisingly, this news has caused some excitement in the bariatric surgery community. When I first read the article, my immediate thought was that I don't have enough information to make it the subject of an article of my own. I'm still missing a lot of information, but have plenty of opinions about it (which can come as no surprise to you), so I've decided to give you my opinions with you in this article from today’s special edition of the Bandwagon® on the Road e-newsletter. ALLERGAN PEDDLES THE BAND I have a hard time drawing any conclusions (pro or con) about the band itself based on the Reuters report. The decline in Lap-Band® sales could be the result of management or other business problems rather than due to a problem with the band itself. It's highly unlikely that Allergan will ever reveal the whole story to anyone but their team of attorneys and board of directors. So, what could this hot news story mean? As you read on, please remember: these are only personal opinions from an ex-bandster who’s fairly well-informed but not a medical professional and in no way associated with Allergan or any other medical device or other company in the world of bariatric surgery. For what it’s worth, here’s my take on the story. The US economy is in tough shape, the popularity of bariatric surgery in general is leveling off, and insurance coverage for bariatric surgery is still a challenge. Allergan is not alone in this - Johnson & Johnson must face the same challenge in marketing the Realize™ Band. The story of what's really behind all this is clouded by the reactions of the media and of band-bashers who sing the "I told you so" song because they assume (without any credible basis at this point) that Allergan's decision is related to the safety and/or efficacy of the band. SO, WHAT’S THE REAL STORY? All the other bariatric surgery procedures now performed in the USA can have serious complications and failure rates, but it's easier to point the finger of blame at a single manufacturer of a medical device than it is to blame the thousands of surgeons who are doing bariatric procedures that don't happen to use a medical device. The FDA isn't looking over the shoulders of all those surgeons the way it scrutinizes Allergan or Johnson & Johnson. When Dr. John Doe stops doing bariatric surgery and goes back to yanking out gall bladders, no one leads a parade down Main Street waving banners about the dangers of the procedures Dr. Doe was doing. Except in rare cases (such as the sad story of my original surgeon), nobody's even discussing Dr. Doe's surgical expertise or behavior. It's an example of what I call the David & Goliath Syndrome. A big company like Allergan is an easy target thanks to its size and visibility. The general public may step on Dr. Doe's fingers but otherwise will kick him to the curb in eagerness to throw rocks at Allergan. One of the hurdles facing any manufacturer of an adjustable gastric band is that it is (in my opinion) the bariatric procedure that requires the most patient education, aftercare, and support. In the 5 years since I was banded, I have encountered plenty of evidence of bariatric clinics doing a great job of that, but I've also encountered clinics that are failing at it, to the detriment of their patients. Not because they're doing something wrong, per se, but because they're directed by a surgeon (or team of surgeons) who was trained to think of surgery of any nature as an in-and-out deal. They're used to seeing the patient 3 times: a pre-op visit; in the operating room (with an unconscious patient); one post-op visit; and never again unless the patient experiences a complication that requires more surgery. That's fine when the surgery involves removing a gall bladder or a mole or a wisdom tooth, but it's a set-up for failure with band patients. The bariatric surgeon who vetted Bandwagon told me several years ago that the band manufacturers make few demands on the surgeons or clinics that buy their products because they don't want to marginalize the customers who don't follow the manufacturer's advice but have acceptable patient outcomes. Avoiding marginalization of customers is a smart business decision but a poor medical decision, and I think it's a mistake for us to view surgeons only as super-wealthy, super-powered medical demi-gods anointed by a Supreme Being and the ASMBS. They're also customers, and just like you and me when we're shopping for a new car, they're looking for a product that has reliable quality and performance at a price they can live with. They are business people who want to make money (to pay their staff, their malpractice insurance premiums, their colossal student loans, and their kids' college funds). Sure they want to practice the art (and science) of medicine, but they can't do that very well if they can't pay their bills. Finally, keep in mind that someone, somewhere is going to end up with the Lap-Band in some form. It is highly unlikely that Lap-Band® research & development, its technology and FDA approval, to say nothing of the existing customer base, will drop to the bottom of the bariatric pond and never be seen again. Both Allergan and the new owner will legally and ethically have to stand behind their product, with the details of that worked out to the last detail by teams of expensive attorneys and insurance companies. Even surgeons who stop doing band surgery to concentrate on other procedures will still have the basic skill and knowledge to provide fills and other aftercare to their band patients. Although I lost my beloved band in April 2012, I do not regret having Lap-Band® surgery and if I were starting my WLS journey today, I would ask my surgeon's opinion about the Allergan decision and also ask how (or if) it will affect his/her practice. The answers to those questions would be towards the top of a long list of questions I'd be asking before deciding to have surgery. And if I still had my band, I'd be asking my surgeon the same questions so that I could go forward with some degree of comfort (if not 100% satisfaction) that I'd have someone to turn to should I need band help in the future. I most certainly would not be rushing off to make an appointment with the Speedy Weight Loss Surgery Revision Center, or at least not until I'd done plenty of homework on the procedures offered by the quacks at Speedy. Trading in a car just because it's 2 years old has never made sense to me, and if it isn’t broke, why fix it? Although my journey from Lap-Band® to vertical sleeve gastrectomy ended up taking 6 months, I'm still nagged about it by a little doubting voice, especially when my sleeve is giving me trouble. Should I have chosen the sleeve, or not? Should I have risked the return to morbid obesity, or gamble on more surgery? There are no easy answers to questions like that. If there were a cure for obesity, I'd be first in line for it, but until that cure is invented, I'm making the best of what I've got.

The port is stitched into the fascia surrounding the abdominal muscles. That's why the area surrounding the port itself (as opposed to the incision) tends to feel more tender and take longer to heal. Also, it's hard to do even simple things like turning over in bed and getting up from a chair without using your abdominal muscles.

My port revision was far more difficult to recover from than my original band surgery, because my surgeon had to deal with all the scar tissue from the first time around. I'd say it took 5-6 months for me to feel comfortable again.

To me, it'd be worth paying out $300 to another surgeon in the hope that I'd end up in a bariatric clinic that doesn't resemble a cattle yard. I guess I'd favor a clinic with more than one surgeon, in case the one I interview doesn't click with me.

Your incision may not be directly over your port. My port started out an inch or so to the side of my incision (can't remember which side), and after surgery to correct a port flip, my port was an inch or so south of my incision.

You're the one who's been swinging the baseball bat through this thread. But thanks for stopping by anyway. We always look forward to a civilized discussion. Maybe you could come prepared next time.

I feel your pain. Been there myself. I guess that's why we call it Bandster Hell!

You can also buy both books (at a lower price than Amazon) by going to jean-onthebandwagon.blogspot.com and clicking on one of the purchase options on the left hand side of the page. thanks for your interest!

Dude, Doing some exercise is great, but did you know that one of the causes of band slips is failure to follow the post-op diet progression?

The book title is Bandwagon, and it has a companion cookbook called Bandwagon Cookery. See my signature line for more info. You can buy either (or both) book(s) by clicking on the Bandwagon ads here on LBT - there's a big one at the upper right corner and a pair of smaller ads at the bottom of the page.

Tips and advice? Wow, I could write a whole book on that. But wait! I DID write a whole book on that. Sounds like you're off to a good start, but why are you doing this on your own? Does your surgeon not offer any patient education and support?

Huh. I know a lot of bandsters (icluding me) whose slips were fixed with a complete unfill and rest period before gradually re-filling. So, is this a really bad slip, for it to require surgery? 41 out of 3000 is a pretty slow rate of slips, but it's no fun for you being #41! And I guess adding plication will indeed be the silver lining to having more surgery.

Oh, now I see which thread you're talking about. When I was researching Bandwagon, every single bariatric surgery professional stated that most band problems are the result of patient non-compliance. Of course, it's easy for them to say that, since most of them don't know what it's like to be obese and living with a band. The issue is also clouded by the fact that patients aren't always honest with their surgeon about what they're eating and the problems they're having - for a variety of reasons: they're afriad of disapproval, afraid of being denied fills, feeling some shame, and/or are unaware of the problem behavior. Yet another contributing factor is (in my opinion, which is shared by the founder of LBT) is inadequate patient education, support, and aftercare. For the past 5 years I've believed that most band problems are the result of user error, but I also know from personal experience that some band problems can come out of the blue. My belief and my knowledge may seem contradictory, but I guess I'm more comfortable with living in life's grey zone than I used to be. I'd like everything to be black and white, I imagine that it would make life easier, but reality is seldom black and white.

I think it depends on what you mean by Lap-Band failure. Do you mean disappointing weight loss? Side effects? Complications?

I didn't have a bloody nose related to my surgery. When I do get a bloody nose, it's always because my nasal passages are very dry. Maybe the oxygen they gave you during surgery dried you out.

Wow! November 2nd is just around the corner! You might get more responses to this thread if you change the subject line to something like: Anyone else getting banded on Nov. 2?

Average weight loss with the band is 1-2 lbs/week. That average includes people who lose a lot faster, people who lose nothing, and people who gain weight. My weight loss was very uneven (down, down, up, down, up, down, down, etc. etc.), but it did start slowing down as I got closer to my goal weight. That's due to several reasons, perhaps the #1 being that we burn more calories when we're heavier and less calories as we get lighter. One thing that affects my weight to this very day is sodium intake. I can gain 5 lbs overnight from that, and depending on what was on top of that pizza, it could be extremely high in sodium. Drinking a lot of Water helps get stored Fluid flushed out.

LOL! Been there, done that!

When I was worried about insurance coverage for my revision, my surgeon told me that her insurance specialist would find a way, and she did. I'm hoping the same for you. Also, some hospitals have a charitable fund that can help pay for hospitalization for uninsured, underinsured, and other needy patients. That kind of fund might not pay for the surgeon's fees, but for the hospital services (which are often far more costly than the surgeon's fee). Worth checking into...

If you can stay awake after you take it, you could try taking a Benadryl before your next walk.

I am a very itchy person, so I sympathize. How was the temperature outside? Hot, warm, cold? Are you taking any new medications (pruritis might be a side effect)? Using any new laundry products? New bath soap?