bronco

Saw Dr. K today, the band is half in half out and will need to be removed. He's indicated that the removal can be either very simple if the stomach can be closed or it could be very complicated if the erosion is in the esophagus. Gave me a strong course of antibiotics to address the infection, put me on liquids, and scheduled surgery. Outlook is a month or more on liquids following the surgery. In retrospect I continue to try and understand when this might have initiated so that I could share with others, but am unable to pinpoint it. Possibly as long as 18 months ago when I went in to see the PA and she removed saline, but could be as recent as 4 months ago when I had a hard time keeping food down. Clearly from what I have read, an infection at the port site is a key indicater as the infection often starts at the band then travels to the port site. Will keep you updated as I go thru this.

My background: I am a male, 52, in good health otherwise but am obese. I walk and even run/walk at least every other day, take not meds except baby aspirin and some niacin. BP today was 117/71 today. I was banded in early summer of 2007 by Dr. C in Boise, the whole process went very well and I lost from 305 to 285 just prior to the surgery (his requirement), then continued to lose over the next two years down to about 235. That's 70 pounds total. Dr. C left the area so I began seeing another bariatrician - Dr. K for annual follow up visits. In the fall of 2010 I had some pain in the band area and even up in my left shoulder a bit. Went to see the PA - A for Dr. K who removed 4 of the 7 ccs of saline thinking that I may have had some dilation. The pain subsided and things seemed to go fairly well for about a year but my weight started to creep up towards 250. I noticed that the scar above my port site was tender, and occasionally uncomfortable but didn't give it much concern. In Feb 2012 I went back for a fill because the weight was creeping again to 255 and the scar (on my right side) was red on the outer 1/3rd. This time another PA -B looked at it and rather than accomplish the fill, he was concerned about what appeared to be an infection and proscribed a course of antibiotics. I completed the course of antibiotics and then over the next couple of weeks the infection came back and the outside corner of the scar opened up about the size of a pencil lead and began to secrete creme colored Fluid and occasional blood (sorry for being graphic) then healed over and a week later repeated. I called and went back in and saw Dr. K who was concerned there may be erosion as the primary concern that manifests as an infection at the port site. He ordered an endoscopy as soon as possible and I went today to have it done. I have attached are some of the photos they took. (see attached) It appears as if the lap band (black item with port tube) has come all the way thru the wall and is obstructing the path. I will go and see Dr. K tomorrow and I expect for him to tell me it must be removed. What a disappointment! While the results I got from this may not have been dramatic compared to others, the band has helped my be more functional, have greater energy, and improved my overall health. If I could I would try to save it, but this looks pretty bad. Not sure how this happened, nor what could have been done to prevent this, but I hope this may help others who have initial symptoms from their band. Its possible mine started back in the fall of 2010 and I just didn't realize it. We'll see what the doc has to say tomorrow... Lap Band Endoscopy.pdf

Just a couple more things. Instructions are to take one multivitamin per day rest of your life - suggests children's chewable. Also, have a protein shake daily (I do this in am). I use the big bottle of "body force 100% whey protein" powder that you can buy at Walmart - very low price - you can even mix it with other protein shakes for better flavor if you find one you like. It provides significant protein for the day. Also have to commit to 30 minutes of activity per day (walking, swimming, biking, etc.) The one thing that stands out in my mind is how simple these instructions have been and they are very affordable.

My doctor requires 3 - 3 week periods of diet. First 3 weeks is before surgery to shrink the liver and make it easier/safer to insert the band. The target is to lose 10% of the total weight and consists of 3 Slim Fast and all the vegetables you want to eat. Following surgery there are 3 weeks of clear moving to cloudy liquids. Juice, broth, popsicles, protein shake, Slim Fast (High Protein), yogurt, etc. The last three week are after the follow up visit to dietitian and surgeon. Consist of mushies, purees, cottage cheese, etc. The intent here is to allow the surgery to fully heal and prevent the band from moving or causing other problems. Then the first fill occurs and you get to "experiment" on different foods by doing lots of chewing. Doc says to eat off of a bread plate, divide it in half with one part being protein an the other complex carbohydrates (salad, vegetables, etc.) No more white bread, white rice, pasta, or high glycemic foods. My opinion is that two weeks in each phase would be sufficient, but I'm not the doc.

I've been using "body fortress 100% whey protein" from Walmart. Very inexpensive and tastes relatively good. Virtually no carbs. I mix a scoop in about 8 oz milk in am and pm to get my Protein while in the liquids phase. I expect to use this the rest of my life. That "whey" I get all the protein that I need. Sometimes you might mix it with Slim Fast optima or another powder if the taste bother you. Also use Dannon light and fit yogurt and cottage cheese. One thing I learned from others here was to start in the am if your tight with a warm liquid. I use 8oz of broth when I take my liquid IB gel caps in the am.

I had never seen a psychiatrist before. When I went he had me take a personality type test. Then visited with me for about 45 minutes. Asked about emotional eating history - my family, diets, etc. Also about meds, my commitment to change and continueing to understand the emotional side of this process. Also recommended the book "Body Intellegence". I thought it was painless and at the same time introspective. He deals primarily with eating disorders and weight loss surgery candidates and I can see why he is part of the screening process so that the Surgeon doesn't operate on someone who isn't able to cope with this new tool. In the support group that I attended, one person had figured out a way around the band (cookie dough and milk shakes) and another was continueing to purge even after banding. I also had him send a copy of his report to my Primary Care, you might consider asking him to send copy to your regular psych Doc. Afterwards he mentioned that this visit would be coded to insurance different than a typical psyc visit because it was for screening for surgery. Hope this helps.

There are two doctors that do Lap-Band in Boise, $19.500, Drs Cahan and Anderson - they work together. (208) 706-5285 Another in Blackfoot/Idaho Falls, not sure but approx $11,000, Dr Avila, (208)782-3955. Good reputation on this forum. There is also a person attempting to get approval for fills in Pocatello, Cyndi Rice - fillusa. Not sure of her status but we be nice if she would schedule appointments in Boise once or twice a month to do fills here. Looks like there are many who went elswhere due to cost and need fills.

I am interested in knowing how some of your labs changed from pre to post op. I have elevated cholesterol and have had high triglycerides ever since I can remember. Other than that my labs have been fine.

I have not been banded, however in the seminar I attended the Doctor indicated that a main purpose of the pre-op diet was to shrink the liver (remove fat) and allow better access during surgery to the lap-band location. Does this sound right to those who really know?

As this is open season for Federal Employees, I have been considering which insurance to select in large part based on their willingness to do LapBand. I currently have Mail Handlers and spoke with a nurse who sent me their checklist - they do cover this procedure. The difficulty she indicated is "documentating that the patient has failed to loose weight (10% from baseline) or has regained weight after participating in a 3 month physician supervised multi-discipinary program within the last 6 months" . GEHA also covers this procedure but requires documenting failure to lower BMI after a 6 month medically supervised program of weight loss. The point is that they (FEHB providors) are now covering this procedure but it will require navigating their process which can be daunting.

As this is open season for Federal Employees, I have been considering which insurance to select in large part based on their willingness to do LapBand. I currently have Mail Handlers and spoke with a nurse who sent me their checklist - they do cover this procedure. The difficulty she indicated is "documentating that the patient has failed to loose weight (10% from baseline) or has regained weight after participating in a 3 month physician supervised multi-discipinary program within the last 6 months" . GEHA also covers this procedure but requires documenting failure to lower BMI after a 6 month medically supervised program of weight loss. The point is that they (FEHB providors) are now covering this procedure but it will require navigating their process which can be daunting.

As this is open season for Federal Employees, I have been considering which insurance to select in large part based on their willingness to do LapBand. I currently have Mail Handlers and spoke with a nurse who sent me their checklist - they do cover this procedure. The difficulty she indicated is "documentating that the patient has failed to loose weight (10% from baseline) or has regained weight after participating in a 3 month physician supervised multi-discipinary program within the last 6 months" . GEHA also covers this procedure but requires documenting failure to lower BMI after a 6 month medically supervised program of weight loss. The point is that they (FEHB providors) are now covering this procedure but it will require navigating their process which can be daunting.