JaxBandster

For those who haven't been following my story............... I was diagnosed with an eroded band in November of 2011 and had it removed in March of 2012. I had to wait for six months before revising to the gastric sleeve as my surgeon wanted to wait for me to heal completely and do medical tests before confirming that I would be a good candidate for the sleeve. I have complete those tests and he was satisfied that I could have the sleeve. We also found that I had developed another hiatal hernia (the first one was repaired when I had my lap band surgery). My predetermination request for the sleeve surgery was denied. They stated that I needed to complete a six month weight loss program in order for them to consider my request. I asked my surgeon's insurance coordinator to appeal based on the reasoning that this was a repeat surgery for a lap band that had medically failed me and that I shouldn't have to complete the six month medically supervised weight loss program. She filed an appeal but no where in the letter did it address the six month weight loss program so of course they denied me again stating that we still hadn't submitted the records they had requested. Frustrated beyond belief, I took the initiative to write my own appeal letter. I used language from the BCBS-AL bariatric policy regarding repeat surgeries and their rationale for requiring the six month weight loss program and explained how I had met that rationale just by having a lap band for four years and that my waiting for six months before revising to another surgery was not conducive to improving my health. I just got off the phone with BCBS-AL and they have approved my surgery!!!!!! I am actually shocked that I succeeded in my appeal. I fully expected them to deny me and had already started the medically supervised six month weight loss program in preparation for that denial (and have lost 10 lbs over a six week period which is nice). I'm excited, relieved and nervous! I've been through this before so I don't know why but I am. I was very successful with my lap band (losing 94 lbs). I remember how wonderful it felt to be thin and feel good about myself and how I looked and not to be in pain anymore from carrying around all this extra weight (yes I packed the pounds back on after my band was removed). I can't wait to be there again! Yeah me!!!!!!!!!!!!!!!!

I had my band placed in February of 2008 so I had it for four years by the time I had it removed. It was diagnosed as eroded after a little over three and a half years.

[ That is wonderful news!!!! I'm so happy for the both of you!!!!!! I know you are relieved Keep us posted on your progress!!!!!!

Very cool! I know you will like him. He's very nice! Keep us posted on how things go!

I actually really like Dr. Baptista and would also highly recommend him for a lapband. The only reason I decided to go to someone else when I left Cywes was due to the complexity of my surgery from eroded band to sleeve. I wanted someone with a LOT of experience in complex surgeries. Dr. Baptista and very nice and a competent surgeon.

I am SO sorry to hear this! I was hoping that maybe you would be on the road to getting your band. I'm not sure where you are located but I am using Dr.'s Marema and Koppman with US Bariatrics in St. Augustine. They operate out of Flagler Hospital which has EXTREMELY nice facilities. They are VERY thorough and responsive. If I send an email I typically get a response with 24 hours. I have been very pleased with them so far (even though I haven't had my surgery with them yet). A co-worker of mine had her sleeve done with them and has been nothing but happy with them. Dr. Marema has been listed as one of the best bariatric surgeons in the country. I highly recommend them. Please keep us posted.

Oh trust me, there have been plenty of times when I've walked out of that office feeling like I made the right decision. There have been more times when I walked out thinking that I hadn't. With everything that I experienced and my continued frustration with communication, I decided that it was time for me to move on. My new practice is a breath of fresh air in comparison. I have been extremely impressed. I've only had one minor hiccup where I received a bill for my co-pay (which I paid at my office visit). I called about it and they promptly removed the outstanding charge. My pre-op tests and the appointment to review the results have been scheduled for over a month. It's been so much easier than having to constantly follow up and nag someone to do something. We are under enough stress as it is, we don't need to do someone's job on top of it. I'm actually very surprised at Dr. Pinnar's comment. I've never known him to be snippy like that. I too liked him right off the bat when I met him. He seemed very thorough and was more conservative than Cywes. I really and truly hope that you and your wife have a very successful surgery and get the outcome you both desire. I can tell you that when you are successful, there is no better feeling.

According to information I've read on various boards and in speaking with Dr. Pinnar in person regarding his old practice in Virginia, it appears that after he sold his practice, the physician who purchased it went back through old records and was rebilling insurance companies in Dr. Pinnar's name or something to that effect. The reason I waited 45 minutes on him at one appointment was because he was speaking to his attorney. When he came in, he apologized and we spoke a little about the subject before turning our attention to the reason I was there. During my office visits with him, it was very apparent that he was not happy with the way the office was being run and often encouraged me to contact the Practice Administrator and voice my dissatisfaction which I did prior to finding another group to do my revision surgery. There is definitely something odd going on with that practice. When I first started going there, the waiting room was ALWAYS packed and you had to wait hours before being seen. Not so much anymore. A curious thing happened when I was in the process of getting my band removed. At one point I was scheduled to have my surgery performed by Dr. Cywes at Shands. About a week prior to my surgery, the office called saying they were going to have to reschedule my surgery for a much later date due to a mixup between Dr. Cywes and Shands about operating room times. They were not going to be able to schedule me for a month or more later. I asked about Memorial and they said that Pinnar could do it there (why not Dr. Cywes?). That was when I decided to go with Dr. Pinnar. In addition, for a little while I was speaking with another group that operates out of Memorial. In speaking with the bariatric coordinators there, they alluded to something going on with Cywes, but they would never come right out and say what the issue was. I really don't know what's going on there, but as messed up as things appear I would not recommend them to anyone that I cared about. I had my band removed due to 40% erosion in late March. Cywes told me he could revise me to the sleeve in six weeks. The surgeon I am seeing now won't touch me for six months! I hate waiting. I hate the fact that I'm packing on the pounds and I'm miserable in my body. But I'm thankful they are being cautious and allowing my body ample time to heal and allow the scar tissue to settle down and do a variety of tests to make sure I'm a good candidate so I'm not miserable for the rest of my life. I can wait a few more months to be safe. Pinnar once referred to Cywes as a "cowboy". I think reckless and cocky may be a more accurate description.

Best of luck to you!

Irene is Cywes' wife. I had more success with email than I did with the phone. Sorry that you are going through what I did. I know how frustrating it is.

I got tired of being compared to Lindsey Lohan (addict) and looking at his picture of him and McKenzie Phillips

Contact the Program Administrator. Here is her info. Irene L. Wolfe, LLB, LLM Practice Administrator Jacksonville Surgical Associates/Jacksonville Weight Loss Center 8825 Perimeter Park Blvd. Ste. 101 Jacksonville, FL 32216 (904) 399-4004 ext. 107 (904) 399-3489 fax (904) 412-3135 mobile Irene Wolfe [irene@jsapa.com]

It's not that they don't eventually get it done, it's that they tell you they are goiing to do something and then they don't. I didn't mind waiting. I'm having to wait an additional three months or more to have my revision surgery because Dr. Koppman wants to wait six months after my band was removed so the scar tissue will have a chance to settle and so I can have additional tests done to make sure I am going to be a good candidate for the sleeve. (Makes sense to me). Anyway, read my post (or not) and see if you would have put up with repeatedly beiing told one thing and then nothing ever being done. I used to be a staunch advocate and defender of Dr. Cywes practice but when he suggested that I get a fill when three weeks prior he had removed my gastric tube from my surgery, I decided it was time to move on. You need to have confidence in your surgeon.

If you have the time, please read my experience with them.. It is very detailed but I share in your frustrations. I finally left and am having my surgery done by US Bariatrics in St. Augustine with Dr.s Koppman and Marema. http://www.lapbandtalk.com/topic/150134-dr-robert-cywes-why-i-left-the-practice/

This is a letter I wrote to the practice administrator for Dr. Cywes and Dr. Pinnar outlining the many reasons I decided to go with another surgeon even though it will cost me more money and time. I wasn't going to post it publicly, but since they seem inclined to ignore my repeated requests for my medical records, I feel justified in doing so. For what it's worth I do like Dr. Pinnar, but the accumulation of all the issues below finally motivated me to make the change. Dear ******, I am contacting you as the practice administrator to request that all claims submitted to my insurance provider be withdrawn and to outline the reasons for my decision to go with another practice for my surgery. I will apologize in advance as this may be rather lengthy but this has been a difficult decision and one that I have weighed for the past month. On February 7, 2008 I had lap band surgery which was performed by Dr. Cywes. I had considerable success until approximately two years ago when I began to be able to eat more and began to put on more weight. I then went to Dr. Baptista for maintenance fills primarily due to my past experiences of having to wait hours to get in for a fill with Dr. Cywes. It was faster and easier for me to get them done by Dr. Baptista. Last November, Dr. Baptista order an upper GI to check my band and discovered that my band had eroded. This was confirmed by an upper endoscopy in December. It was at this time that I decided I wanted the gastric sleeve but I was not comfortable with Dr. Baptista’s level of experience in this area so I made a call to Dr. Cywes as I felt more comfortable with him with a more complicated surgery. When I called and explained my situation to the person who answered the phone, she placed me on hold and then came back and informed me that Dr. Cywes felt I should have Dr. Baptista perform the surgery. In other words, he was not interested in seeing me since I went to his former partner. At this point, I decided to go to Dr. Webb’s practice to explore this option. When Dr. Webb’s office requested my records from your practice, I subsequently received a call from the office inquiring as to my reasons for pursuing another surgeon. I explained my experience to her and she assured me that Dr. Cywes did not mean that he was not interested in seeing me and that there were options out there that Dr. Cywes would like to speak with me about. She suggested that I come in with no obligation other than to hear what options were available to me and I agreed. After meeting with Dr. Cywes, I agreed to have him do the surgery to remove the band and subsequent repeat surgery. This was on 2/1/2012. It took a month to submit the initial pre-determination request and the subsequent appeal letter as a result of the initial denial by my insurance provider. We received the approval to proceed on 3/1/2012. Due to an issue at Shand’s with Dr. Cywes, I had to schedule the surgery for 3/29/2012 with Dr. Pinnar at Memorial. Everything went smoothly. I liked Dr. Pinnar immediately and felt comfortable with him. On April 6th, I had my post-op follow up appointment with Dr. Cywes in order to remove the abdominal drain that Dr. Pinnar had placed during my surgery. On April 27th (3 weeks later) I had another post-op appointment. In those three weeks I had put on weight due to my lack of restriction and not following the low-carb plan. As is typical for Dr. Cywes, he saw that I had gained weight and he gave me his usual talk about our relationship with food for 15 minutes and when he was done he said that he would need to tighten my band. I then had to inform him that I didn’t have a band. It appears that he hadn’t even looked at my chart prior to coming in. He just assumed that I had been not following the program. When I got back to my office, I wrote ***** and asked that my gastric sleeve surgery be performed by Dr. Pinnar. I am not comfortable having such an invasive and complicated surgery performed by a surgeon who doesn’t bother to read my chart in his office. On May 15th, after repeated attempts to contact ***** to inquire as to the status of filing a claim for surgery with my insurance company, I finally wrote a lengthy email expressing my frustration with the practice, lack of communication and lack of action in filing my claim. I copied you on this email and it is attached. At this point I finally received a response from ***** saying that she was having computer issues and had not been receiving emails. I responded to her expressing that I understood about computer issues and asked when she would file my claim. She wrote me back on May 17th and said she would be filing it that day. The next day (May 18th) **** wrote to me explaining that she had faxed clinical information to my insurance company. She stated that my current BMI was 35.8 and that if I had a BMI under 40 I would require a serious co-morbid condition to get approved for the sleeve. I wrote back to her explaining that since this surgery was a result of an eroded band that I didn’t believe my insurance would require me to have a co-morbidity. I didn’t hear back from ***** until May 25th stating that she had finally filed my claim. On June 1st, I had a follow-up appointment with Dr. Pinnar. Once again, I had gained more weight, but I wasn’t concerned about it as I knew the reasons why. While I was waiting for Dr. Pinnar, the nutritionist came in looking very concerned and asking me what was up? She also asked me if I felt I had sufficient restriction. I explained to her that I didn’t have a band. She then asked if I was a conventional weight loss patient. This was not the first time she had seen me but once again, it was a case of not reviewing a patient’s information before coming into speak with them. I also had a chance to speak with **** and express some of my frustrations and concerns about the filing of my claim. She assured me that she understood and that she would make sure my claim was filed properly (i.e. for a repeat surgery as opposed to a first time surgery). After **** left, I proceeded to wait approximately 45 minutes to see Dr. Pinnar. He knew I was there as I spoke to him when I first came in. I could hear him out in the hallway talking on the phone and waited patiently for him to finish his conversation. I justified that it must be an emergency since he knew I was there and was keeping me waiting. When he finally came in, he apologized and explained that he was on the phone with his attorney. I was aware of the issues he was having with the physician who bought his practice in Virginia and we discussed that matter for a few minutes. Thankfully, he was aware that I had had my band removed due to erosion. Still, I am a very busy woman. I manage the cash for ********** in their Treasury department. My boss depends on me a great deal. I understand that Dr. Pinnar has some serious issues going on, but he needs to address them on his time, not mine. On June 7th, I wrote to ***** to advise her that my insurance company had submitted a reply to their correspondence department stating that in order to approve the surgery for the sleeve I would have to complete a six month weight loss program with my PCP, which is standard for someone having their first bariatric surgery. Since this is a repeat surgery resulting from erosion, I feel that this requirement should be waived. In my email, I reminded her of this and asked her what the next steps would be for my appeal. I wrote again on June 12th and again on June 14th asking what the next steps in the process would be. To date, I have not had a response from her. ****, I hope you can understand my frustration with this process. I am frankly tired of being ignored and having to constantly remind my health care provider of my medical status and hand feed insurance policy language to support my claims. I have registered with another practice and have an initial consult this Friday with them. I would appreciate my records being sent to them as promptly as possible once they submit the request for them. Even though this is going to cost me a considerable sum of money and probably a little more time since I am basically starting over again, I feel I will be more comfortable with a practice who respects my time and communicates with me. I am a very patient person, but my patience has been pushed to the limit.

I have had my band since February 2007. Yesterday, I went in for an upper GI to check and make sure my pouch hadn't stretched. I haven't had any pain or discomfort, no vomiting, or acid reflux. My only complaint was that despite having an almost full band, I could at times eat much more than I thought I should be able to. Hence the decision by my doctor to do the upper GI. As reference, I began at 277 before my lapband surgery. I got down as low as 183, bounced back up to 223 and am now sitting at 211 with a BMI of 32. My goal weight is about 165. This is in a period of almost four years. When I drank the contrast liquid, we watched as the Fluid went down the esophagus, into the pouch, and through the stoma. We also watched as some of the liquid went AROUND my band! The only way that can happen is if a portion of the band is now INSIDE of my stomach. Preliminary diagnosis is band erosion. Next week I will be scheduling an endoscopy to determine the extent of the erosion and see how much damage has been done to my stomach. In the brief conversation I had with my doctor after the discovery, he stated that the only option for treatment is removal of the band. You could have knocked me over with a feather. I have become dependent on my band and to think of not having restriction is a scary thought for me. Like others, the thought of going back to the weight I was at before is not an option. My doctor has indicated that once the band has been removed and I have healed from that surgery (after about four months), I can either be re-banded (I don't think so), or I can do a revision to either bypass or gastric sleeve. I am not keen on the idea of bypass. It just seems so extreme and there's no where to go after that surgery. So I am leaning towards the sleeve. From everything I have read, the majority of people who have had this procedure are very happy with it. Yesterday was spent trying to wrap my head around the prospect of having two surgeries next year. Talking with my family and trying to understand my options. I am fortunate in that my situation is not an emergency. There is no infection and I can eat properly. (The doctor did deflate my band completely). I also have insurance through my company and the enrollment period is coming up in the next couple of weeks so I can make decisions accordingly knowing that I am going to have these surgeries. It is still yet to be determined if my insurance company (BCBS AL) will cover either surgery (scary thought), but I'm willing to fight for it. I was self pay for my band so I don't know if that will impact their decision or not. I know they do cover WLS and have the typical six month waiting period (not sure I would have to do that given the circumstances). I will be posting here with my progress and experience for the benefit of others who may encounter similar complications and decisions. I would very much like to hear from others who have had band erosion and have done the revision to the sleeve or those who have the sleeve and what their experience has been with that type of surgery. I can't believe I'm at this point again. Ugh.

Hi Bunkie, I wish I knew how to describe the pulling and twinges I had. They were in the esophogial area right below my sternum. I described them to my surgeon and he pretty much dismissed the symptoms explaining that erosion usually doesn't have any symptoms. (shrug) My surgery was on March 29th and with the exception of being able to eat most anything I want I am doing really well! I actually still have a minimal amount of restriction from where the band used to be. I still have to eat slowly and chew well or I get uncomfortable. In fact, I got stuck really hard on steak a couple of weeks ago. I was miserable! So don't expect to go right back to being able to eat "normally" after you get your band out. Unfortunately I can and do eat much more than I was able to before but that will come to an end once I revised to the sleeve. :-) With the drain, I was fortunate that I like to wear long flowing skirts and I simply pinned the drain to the inside of my waist band and it hung down from there. It was annoying as hell and I was glad to get it out but it didn't hurt or anything. I don't know what I would have done if all I had were tight skirts or pants. Maybe worn a long sweater or jacket?

This is the weirdest thing and I hope someone can help me figure it out. I had my band removed 3 weeks ago due to erosion. I am back on regular food and last night we had steak. It was very tender and I still tried to chew well but I think I may have taken too large of a bite because I got stuck! I mean majorly stuck! Sliming, burping, some pain, the whole nine yards. This lasted for a couple of hours! I finally got past it but today I am taking it easy and having Soups and Protein drinks etc. I noticed when they did the fluroscope at my post op that the area where my band was is still very narrow. In fact, when I watched the Fluid go through the esophagus and into the stomach, it looked and acted like there was still a band there. I attributed it to post-op swelling and the fact that I had 40% erosion of my into my stomach but figured it would ease up eventually and I would be able to eat like I could pre-band. I'm just wondering if this type of restriction will continue or ease up after time. I'm planning on revising to the sleeve once I have healed from the 1st surgery but at the moment, I still feel like I have a lap band! LOL Definitely going to take it easy on the meat going forward!

Hi Jill, There is a lot of speculation about this subject. There are some theories that say it is from filling the band too quickly and too tightly. There are some that say some people are just predisposed to erosion. There are others that say it's due to patient non-compliance. To sum it up, no one really knows for sure.

Hi Jenn, I'm not real certain if they are going to make me go through the pre-surgery requirements or not. I have another follow up appointment next Friday and am hoping they will go ahead and start the pre-determination filing after that. I will have to let you know as I go along. Yes, I was born and raised in Jacksonville (with a 20 year stent down on the Gulf coast) and had my surgery up here. Dr. Cywes put in my band, his partner Dr. Pinnar removed it. How did your barium swallow go?

Doing great three days after having my band removed due to erosion. (My band was 40% eroded) The abdominal drain is still in and will be until Friday but the color of the Fluid is changing from pink to yellow as it should. There is a little irritation around the area where it is placed in my stomach but the surgeon assured me today that is normal. The only complaint I have right now is that the more the swelling goes down the hungrier I get and I am still on Clear liquids until Friday and I can only go to mushy foods (baby food consistency) until then. I'm not starving, oddly enough, but the head hunger is incredible. I have lost ten lbs from the day I came home from the hospital (IV fluids) and am currently at the same weight I was at when I was admitted and six lbs down from when I began the pre-op diet. So far so good

Hi Jenn. Dr. Pinnar did my surgery. I have BCBS-AL through a private employer. It definitely depends on the plans that your employer chooses to offer through the insurance company. Fortunately, I know for certain that my plan covers the sleeve.

I got my band on February 7th 2008 and was extremely successful with it. I started at 277 and my lowest weight was 183. Man I looked great!!! Slowly but surely, I began to be able to eat more so I would go in for fills but they didn't really seem to have much effect. Last October my doctor recommended an upper GI to make sure everything looked okay and sure enough they discovered that my band had eroded into my stomach. I then had an upper endoscopy to confirm it and the pictures are lovely. Not! The recommendation was to have it removed and revise to another type of procedure. Fortunately, our company was doing our annual benefits re-enrollment at the time, so I upgraded my insurance and also did a flex spending card for the co-pays. After the beginning of the year we submitted the documentation to the insurance company for the predetermination and after an initial denial they approved the appeal. Also, according to their policy, they will also cover repeat surgery if the removal was due to erosion or slippage so I am also having to make up my mind about which procedure to revise to. I was initially completely sold on the sleeve but there is also a new procedure called banded plication which I am taking a close look at. Anyway, I finally have my date for the removal of my band. It will be gone on March 29th. Then I will have to wait at least six weeks before revising to whatever surgery I decide to revise to. I have gained back a bunch of my weight (currently at 240) so I am eager to get back on plan. My problem is that I eat because I can. Without that tool inside of me, I don't feel like a need to comply with anything so I don't. I have learned to depend on it. Once I have it, I am am exemplary patient! I will check back in after my surgery and let everyone know how it went. I am specifically posting my experience here since my removal is due specifically to erosion and I want others who may eventually have the same situation to have something to refer to. As far as pre-op goes, a week before my surgery I will have my consult with my surgeon and he will give me diet instructions at that time in order to shrink my liver. I will also be doing the surgery at Shands Hospital in Jacksonville and will be staying overnight as he wants to be able to observe me for any leaks due to the perforation and repair of my stomach. The surgery will be on Thursday, I will go home on Friday and I will probably wait until Tuesday to go back to work just because I don't want to push it. I was up and around fairly quickly after getting my band placed so this should be pretty comparable as long as there are no complications. If anyone has any questions, feel free to ask and I will try to answer them to the best of my ability. I want to be able to help others who may be going through the same situation. Karen

Sorry about the above post, I copied and pasted a reply to a friend of mine who just got the sleeve. I meant to copy a revised version of the post. Blame it on the pain meds!

Hi you! I'm home!!!! Sorry I couldn't write before but it's hard to send messages on Facebook via the phone when you are on pain meds. It probably wouldn't have made a whole lot of sense. I am really glad to hear that you are doing better. My understanding is that the first three days are the worst and then things begin to slowly get better. Has the nausea gone away? Are you hungry? Will you be going back to work next week? My procedure seems to have gone pretty smoothly. I wasn't nervous at all. Didn't have any nausea. Dr. Pinnar said that everything looked the way he anticipated it would look. The drain was a bit of a surprise. I wasn't expecting that. He said it was a last minute decision on his part. Now I have to figure out how to deal with that while at work. I went yesterday morning for my leak tests. They said everything looked fine but it took until 7:00 for Dr. Pinnar to let me know it was okay for me to drink. Then I had to drink a certain amount within a couple of hours before he would let me go home. I drank what I was supposed to, was discharged around 11:00, them we had to run around getting perscriptions filled. I was really tired by the time I got home. My only real complaint is the dry mouth I get while I'm sleeping. I don't have a lot of pain, just soreness. Oh, I gained 10 lbs in the hospital!!!!!! It's beginning to go down slowly but they really kept me hydrated! LOL