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Congrats! I will be renewing my wedding vows 30th on a South Pacific Cruise in early 2014! And I will be at goal!

Agree with posts, and actually we all have a food addiction. Addiction is something hard for any person to face no matter what the drug of chose and all of our drug happened to be food. You are correct in saying that bariatric surgery will not fix the addiction thinking of any of us, only we have the power to change our behavior and we need help to do that. You do need to seek professional help with your addiction, the band will work but you have to make it work, it is just a tool and it will allow you to eat what ever you chose to put in your body. The only person who can help you develop positive coping skills is a professional and shame on your doctor for not suggesting this unless he already has. I am sorry there is no magic answer or pill we can take for our addiction because if there was I am sure all of us would be taking it. Good luck to you, I know it took courage to ask for help, this is a positive step in the right direction.

I’m in total shock. My deepest sympathy to Philip and her family. I’m sadden and my heart feels heavy in grief. I remember when Blossom came into lives, I remember her posting pics of herself and asking us to vote which one to use as an avatar. Then I remember her picture gone and I asked her why and she remarked “I live in a small town and a bariatric doctor just opened an office here and will be doing bands. I don’t want to be recognized.” I know she often talked of gardening and I’ve decided to plant a flowering tree in her honor. It will grow in view of the lake. Carolyn you will be missed.

does anyone have bcbs of new England (MA)...... how are they???? Have your letters come from your pcp or the bariatric surgeron that is going to do your surgery? Do the insurance companies listen to the surgeon that is going to do the surgery or do they go outside and get another bariatric surgeon look at the paperwork without even getting to see the patient in person? From paper what the heck can they tell or see??? Just wondering how it works.

You poor thing!!! I was wondering where you went. Sure NOW you tell me about the whole 'chest pain' code words LOL! We'll have to compare bruises, but you win (OK not) on the 4 days!!! Holy cow that's a whole lot of testing!!! I thought they woke you up a lot on the bariatric floor...cardiac was an endless stream of people and 'bleeping' sounds everywhere! How are you feeling now?? Do you think it was all the stress you've been under? I hope you're catching up on your sleep now! What great news!! Both of you have interviews!!! Sounds like things are finally turning back around! And 'Trend Teacher' you've got that hands down! Have a great weekend and celebrate all the good news; heart's OK, both have interviews, you lost five pounds! Life is good again! Oh, and I highly recommend the long sleeve shirt (yes, I know it's FL, but maybe something gauzy-with embroidery?), and some foundation and small bandaids where needed, or they'll think you're a junkie. Well, that's my plan for tomorrow anyway...I'll let you know if it works. If I can fool 2 nurses and a Dr. (parents) then you'll be golden! Feel better! -BG

Susan I found this info on the mexican bandsters group: Dory Ferraro,M.S.,C.S.,ANP (Long Island Bariatric Center) , (516) 454-0960 , $250.00 without flouroscope , $450 with. Then there is Dr Kurian and Dr Ren, but I don't see any contact info available. Hope this info is valid. Btw, I think you should also tell them you have a midband, they might not fill for a midband.

Jennet - so true. My insurance will cover it; however after consulting with a couple of bariatric surgeons, due to my clotting history, the "vast" amount of weight I have to lose, etc. - they all recommended a sleeve. Also, a lot of follow up appts would be very stressful with my work schedule so that is not ideal. I need to lose roughly 175 to 180 lbs..so that is quite a bit and due to bone grinding on bone in my one knee, etc. the amount of time to get to where I need to be is not as achievable as the other alternatives.

Hello... I thought I would post this must read article by the surgeon who invented the "Green Zone" and how the band should "ideally work".... http://bariatrictime...1/#comment-2133 Gastric Banding and the Fine Art of Eating BT Online Editor | September 22, 2011 by Paul O’Brien, MD Dr. O’Brien is from the Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Australia. Bariatric Times. 2011;8(9):18–21 Funding: No funding was received for the preparation of this article. Financial Disclosure: Dr. Paul O’Brien is the Emeritus Director of the Centre for Obesity Research and Education (CORE) at Monash University, which receives a grant from Allergan for research support. The grant is not tied to any specified research projects and Allergan has no control of the protocol, analysis and reporting of any studies. CORE also receives a grant from Applied Medical toward educational programs. Dr. O’Brien has written a patient information book entitled The Lap-Band Solution: A Partnership for Weight Loss, which is given to patients without charge, but some are sold to surgeons and others for which he receives a royalty. Dr. O’Brien is employed as the National Medical Director for the American Institute of Gastric Banding, a multicenter facility, based in Dallas, Texas, that treats obesity predominantly by gastric banding. Abstract The author reviews the physiology of eating and what the adjustable gastric band does to the function of the distal esophagus and upper stomach of the patient. The author also provides the “Eight Golden Rules” on proper eating habits for patients of laparoscopic adjustable gastric banding, including what, when, and how they should eat, in order to achieve optimal weight loss results. Introduction Laparoscopic adjustable gastric banding (LAGB) has been shown to enable patients with obesity to achieve substantial, durable, and safe weight loss,[1,2] which can help reduce or resolve multiple diseases,[3] improve quality of life, and prolong survival in patients with obesity.[4] LAGB is a weight loss surgical procedure performed solely for the purpose of affecting a key physiological function in weight loss, appetite control. In 2005, we conducted a randomized, blinded, crossover trial that showed that the LAGB controls the appetite.[5] However, if the LAGB is not placed properly or if the patient does not eat properly, it will not perform at an optimal level. For example, if the band is placed too loosely, then it will not provide the proper level of reduced satiety and appetite, and likely will have little effect on the patient’s weight and health. If the band is placed too tightly or if patient eats too fast or takes large bites of food, slips and enlargements can occur, leading to reflux, heartburn, vomiting, and sometimes the need for revision. Optimally, the band should be adjusted so that it squeezes the stomach at just the right pressure. If the patient eats correctly and the band is placed correctly, the LAGB should adequately control the patient’s appetite, resulting in optimal weight loss. The Physiology of LAGB Dr. Paul Burton, a bariatric surgeon at the Centre for Obesity Research and Education, Melbourne Australia, has studied the physiology and the pathophysiology of the LAGB closely. He used high-resolution video manometry, isotope transit studies, endoscopy, and contrast imaging to understand what happens during eating in normal controls, eating in patients who are doing well after LAGB, and eating in patients who have symptoms of reflux, heartburn, and/or vomiting after LAGB.[7–15] In Burton’s series of articles, he concluded that in LAGB, it is not the band that fails, but rather the patients who receive the band and, more importantly, the doctors who care for them. Many years ago at the Centre for Obesity Research and Education (CORE), my colleagues and I developed the Green Zone chart, a conceptual way of identifying the optimal level of band restriction (Figure 1). When a patient is in the yellow zone, it is an indication that the band is too loose. When in the yellow zone, a patient may be eating too easily, feeling hungry, and not losing weight. When a patient is in the green zone, he or she does not feel hungry, is satisfied with small amounts of food, and is achieving weight loss or maintaining a satisfactory level of reduced weight. When a patient is in the the red zone, it is an indication that the band is too tight. The patient experiences reflux, heartburn, and vomiting. The range of food the patient in the red zone can eat after undergoing LAGB is limited and he or she may start to eat abnormally (so-called maladaptive eating), favoring softer, smoother foods like ice cream and chocolate. While in the red zone, patients will not lose weight as effectively and they may even gain weight. Burton measured the pressure within the upper stomach beneath the band in numerous patients when they were in the green zone. He found the optimal pressure was typically 25 to 30mmHg. The art of adjustment is to find the level of Fluid in the band that achieves that pressure range. That level of pressure generates a background sense of satiety that persists throughout the day. The patient, when correctly adjusted, normally will not feel hungry upon waking in the morning, and throughout the day should feel much less hungry than he or she did before band placement. In my experience, it is common for LAGB patients to have no feeling of hunger in the morning. Then, during the day, a modest level of hunger will develop, which a small meal should satisfy. One of the key lessons learned from Burton’s studies was that each bite of food should pass across the band completely before another bite is swallowed. There is no pouch or small stomach above the band and there should never be food sitting there waiting. The esophagus is a powerful muscular organ that typically generates pressures of 100 to 150mmHg, but it is capable of generating pressures above 200mmHg. Esophageal peristalsis squeezes the bite of food down toward the band and then progressively squeezes that bite across the band. Each bite must be squeezed across the band before the next bite starts to arrive. Figure 2 shows a bite in transit across the band. A single bite of food, chewed well until it is mush, will move down the esophagus by peristalsis. At the level of the band, the esophageal peristalsis will squeeze that bolus of food across the band. It takes multiple squeezes (usually 2–6 squeezes or peristaltic waves) to get that bite of food across in a patient with a well-adjusted band (Figure 2). Those squeezes generate a feeling of not being hungry and stimulate a message that passes to the hypothalamus to indicate that no more food is needed. If a single bite of food is able to generate between two and six waves of signal, a meal of 20 bites may generate 100 or more signals. This is enough to satisfy a person and is enough to signal him or her to stop eating. We recognize two terms for appetite control, satiety and satiation. Satiety refers to the background control of hunger that is present throughout the day regardless of eating. In the LAGB patient, satiety is generated by the band exerting a constant compression on the cardia. Satiation is the early control of hunger that comes with eating. In the LAGB patient, satiation is generated by the squeezing of the bolus of food across the band during a meal. Each squeeze adds to the satiation signal. There are sensors in the cardia of the stomach that detect this squeezing. The exact nature of these sensors is still to be confirmed but they must be either hormonal or neural. We know that satiety and satiation are not mediated by one of the hormones currently known to arise from the upper stomach.[16] Ghrelin is a hormone that stimulates appetite. A number of hormones that can be derived from the cardia of the stomach are known to reduce appetite. None of these hormones are found to be raised in the basal state after gastric banding and none can be shown to rise significantly after each meal.[16] Vagal afferents are plentiful in the cardia, and one group of afferents has a particular structure that lends itself to recognizing the compression of the gastric wall associated with squeezing of the bite of food across the band. In my opinion, the intraganglionic laminar endings, better known as IGLEs, are the most likely candidate as mediator of the background of satiety throughout the day and the early satiation after a meal. The IGLEs lie attached to the sheath of the myenteric ganglia and are known to detect tension within the wall of the stomach. They are low-threshold and slowly adapting sensors and therefore are optimal for detecting continued compression of cardia of the stomach over a 24-hour period. The several squeezes that go with the transit of each bite stimulate the IGLEs further. The signal passes to the arcuate nucleus of the hypothalamus and the drive to eat is reduced. The lower esophageal contractile segment. Burton developed the concept of the lower esophageal contractile segment (LECS). It is made up of four parts: the esophagus, the lower esophageal sphincter, the proximal stomach (including the 1cm or so above the band and the 2cm of stomach behind the band), and the band itself (Figure 3). As the esophagus squeezes the bolus of food down toward the band, the lower esophageal sphincter relaxes as this peristaltic wave approaches. It then generates an after-contraction, which can maintain some of the pressure of the peristaltic wave as a part of the food bolus is squeezed into that small segment of upper stomach. The upper stomach, including the area under the band, is sensitive to these pressures. It generates signals to the hypothalamus. These signals may be hormonal but are more likely to be neural. A correctly adjusted band will generate a basal intraluminal pressure of 25 to 30mmHg, providing a resistance to flow. The segment of the bolus that is squeezed through generates more signals from that area. Keeping the LECS intact is a key requirement for success with the gastric band. Bad eating habits (e.g., insufficient chewing, eating too quickly, taking bites that are too large) hurt the LECS. If those bad habits go on for long enough, stretching occurs and the power of peristalsis is lost, leading to the return of hunger (Figure 4).[11,12] The Fine Art of Eating A quality aftercare program is essential to successful weight loss in patients after LAGB. Before making the decision to proceed with LAGB in patients, I promise my patients three things: 1) to place the band in the optimal position safely and securely, 2) that they will have permanent access to a skilled aftercare program, and 3) that I will give them the information they need to obtain the best possible weight loss from the band. In return, I ask for three commitments from my patients: 1) that they follow the rules regarding eating after undergoing the procedure, 2) that they follow the rules regarding exercise and activity, and 3) that they always come back for follow up no matter how many years have passed.[6] The “Eight Golden Rules.” At my facility, we summarized guidelines for eating after LAGB into what we call the “Eight Golden Rules” (Table 1). These rules are included in a book and DVD given to every patient who undergoes LAGB at the facility.[6] The rules are also posted on www.lapbandaustralia.com.au and are reinforced at most aftercare visits. These eight golden rules must become part of each patient’s life. The effect of the LAGB procedure on hunger facilitates a patient’s adherence to the rules, making it more likely that he or she will follow them. However, achieving positive results with LAGB requires a working partnership between the physician and patient. Adhering to these rules is the patient’s part of the partnership, and he or she ultimately is responsible for the success or failure of weight loss following LAGB. What to eat. After undergoing LAGB, patients should eat small amounts of “good food,” meaning food that is Protein rich, of high quality, and in solid form. Each meal should consist of 125mL or 125g (i.e., about half of a cup of food). This measure of “half a cup” is a concept rather than a real measure of food, as some foods, such as vegetables and fruit, are composed largely of Water and this has to be allowed for in some way. Thus, I allow exceeding the “half a cup” limit a little for vegetables and fruit. We instruct patients to put each meal on a small plate and to use a small fork or spoon. The patient should not expect to finish all of the food on the plate, but rather he or she should plan to stop when he or she is no longer hungry. Any food left on the plate should be discarded. Protein-rich foods. Protein is the most important macronutrient in the food a LAGB patient eats. At our clinic, we recommend that our patients consume approximately 50g of protein per day. We have measured protein intake of our patients (Table 2) and have monitored their blood levels. We have not seen any protein malnutrition after LAGB, indicating that a daily intake of about 50g a day is sufficient. Table 2 shows the energy and macronutrient intake of 129 consecutive patients measured before and at one year after LAGB. Note the mean energy intake is reduced by approximately 1500kcals.[17] The best source of protein is meat; however, red meats, such as beef and lamb, tend to be difficult to break up with chewing in order to be sufficiently turned into mush. It is much easier to break up fish with chewing, and many fish are high in protein, including shellfish. chicken, duck, quail, and other birds can also be cooked to be easily chewed to mush before being swallowed. eggs and dairy, including cheese and yogurt, are also excellent protein sources. For nonanimal sources of protein, a patient should consider lentils, chickpeas, and Beans. Half of the “half a cup” allotment per meal should comprise protein-rich food. The other half should be made up of vegetables and/or fruits. I recommend to my patients that they eat more vegetables than fruit because vegetables have less sugar. Any space left in the “half a cup” can be used for the starches, (e.g., bread, Pasta, rice, cereals, potatoes), though I recommend to my patients that they eat a minimal amount from this group of foods as they tend to provide no important nutritional benefit. High-quality foods. High-quality food are foods that are minimally processed, natural, and whole. We encourage our patients to look for quality over quantity—for example, they might try sashimi-grade tuna, smoked salmon, duck breast, lobster, or even a simple poached egg. It is also important to remind your patients that there is no limit to the amount of herbs and spices that can be used to enhance the flavors of their foods. Solid foods. The patient should choose solid foods over liquids whenever possible. Liquids pass too quickly across the palate and, more importantly, too quickly across the band. There is no need for the esophagus to squeeze liquid, and without the squeeze, there is no stimulation of the IGLEs and no induction of satiety; therefore, eating calorie-containing liquids may negatively impact a patient’s weight loss. When to eat. After undergoing LAGB, a patient should eat three or less times per day. If the patient is in the green zone, meaning that the band is adjusted correctly, there should be no need for him or her to eat between meals. In fact, even three meals a day may be more than needed for satiety. In my experience, patients have little interest in eating in the morning. By late morning or early afternoon, patients may start to notice some hunger, which indicates that it is time to have a first small meal. In the evening, patients may have another meal. Most importantly, patients should be instructed that a meal missed is not to be replaced later on. The typical human body is satisfied with a maximum of three meals per day but often is happy to accept two or even one meal per day. Patients should be reminded that there should be no snacking between meals. If a patient finds that he or she is hungry by late afternoon, encourage him or her to eat something small and of high quality, such as a piece of fruit or some vegetables, just to tide him or her over until the evening meal. The patient should then visit the clinic to check whether or not he or she is in the Green Zone. It is important that the patient adhere to the aftercare program to monitor whether or not he or she is in the green zone. If not in the green zone, the patient will need to have fluid in the band increased or decreased. How to eat. Take a small bite and chew well. The “half a cup” of food should be placed on a small plate. The patient should use a small fork or a small spoon to eat. A single bite of food should be chewed carefully for 20 seconds. This provides the opportunity to reduce that bite of food to mush. It also provides the important opportunity for the patient to actually enjoy the taste, the texture, and the flavor of the food. Encourage your patients to enjoy eating more than they ever have. After chewing the food until it is mush, the patient should swallow that bite. Swallow, then wait a minute. The patient must wait for that bite to go completely across the band before swallowing another bite. Normally, it will take between two and six peristaltic waves passing down the esophagus, which can take up to one minute. This is probably the biggest challenge of educating the patient who has undergone LAGB. You must instruct the patient to eat slowly—chew well, swallow, and then wait one minute. A meal should not go on for more than 20 minutes. At one bite per minute, that is just 20 small bites. The patient probably will not finish the “half a cup” of food in this time. In this case, the patient should throw away the rest of the food. After undergoing LAGB, the patient should always expect to throw away food and to never eat everything on the plate. If it takes between two and six squeezes to get a single bite of food across the band and each squeeze generates satiety signals, then 20 bites should be generating 40 to 120 signals. The actual number will depend on the consistency of the food, the tightness of the band, and the power of the esophagus. With good eating practices and optimal band adjustments, the patient should not be hungry after 20 bites or less. As soon as the patient is no longer hungry, he or she should stop eating. After undergoing LAGB, the patient should never expect to feel full. Feeling full means stasis of food above the band and distension of that important part of the LECS above the band. This destroys the LECS, the mechanism that enables optimal eating behavior and appetite control. A patient should always keep this process in mind. If the patient finds that after eating the “half a cup” of food he or she is still hungry, he or she should review his or her eating practices, correct the errors, and consider the need for further adjustment of the band. If this is occurring, it is usually an indication that the patient is not in the green zone. Eat a small amount of good food slowly. These eight words are the key to success. Small amount refers to small bites, the small fork (e.g., oyster fork), and a total meal size of half a cup. Good food refers to protein-rich, high-quality, and solid food. Slowly refers to chewing well, swallowing, and waiting a minute. Try to repeat these eight words to every patient every time you see them. Get them to repeat it at every meal. The failure of the gastric band can almost always be traced to failure of this process. Addressing the Challenges The two principal challenges after LAGB are weight loss failure and the need for revisional surgery due to proximal enlargements above the band. Weight loss failure will occur if the band is not placed or adjusted correctly or if the patient does not adhere to the guidelines of proper eating and exercise. When a patient is not achieving results after his or her LAGB operation, the doctor should check to ensure that the band is correctly and safely placed. The most common reason for weight loss failure is poor eating behavior, which leads to enlargement above the band. There are three common eating errors: 1. The patient is not chewing the food adequately. Food must be reduced to mush before swallowing. If it cannot be reduced to mush, it is better for the patient to spit it out (discreetly) than to swallow it. 2. The patient is eating too quickly. Each bite of food should be completely squeezed across the band before the second bite arrives. 3. The patient is taking bites that are too big to pass through the band. Each of these errors leads to a build up of food above the band where there is no existing space to accommodate it (Figure 4). Space is then created by enlargement of the small section of stomach or by enlargement of the distal esophagus, both of which can compromise the elegant structure of the LECS. If the LECS is stretched, it cannot squeeze. Without the squeezing, satiation is not induced. When satiation is not induced, hunger persists, more eating occurs, and stretching continues. If our patient continues this each day for a year, it is inevitable that chronic enlargement will occur, the physiological basis for satiety and satiation is harmed, and stasis, reflux, heartburn, and vomiting supervene. The doctor should continually review the Eight Golden Rules for proper eating and exercise with each patient. For optimal weight loss following LAGB, the patient should have access to a comprehensive long-term aftercare program for clinical support and optimal band adjustments and he or she must follow the guidelines regarding eating and exercising for the rest of his or her life. “Eat a small amount of good food slowly” is the key to optimizing the gastric band.

Tia, The thing with Aetna seems to be to make sure that you do everything they require. Duh! You need to take a look at their Clinical Policy Bulletin #0157. It spells out pretty clearly the "Selection Criteria" (i.e., the hoops you have to jump through) for bariatric surgery. I read it and figured out what I needed to do to qualify in the shortest possible time. Unless you have 6 months of physician supervised diet in the last 2 years (I did not), I don't see how you can qualify in less than 3 month.

The doctor that I saw that put in the referral for my psych cons. as well as my nutrition cons. has not put in the bariatric consult. I have called and left message after message to let her know that I have completed both the referrals that she sent me for. I get nothing back. I understand docs at the MTF are busy...but geez....its been 3 weeks now. Im just so frustrated!

@@bellabloom Breakfast : eggs with green pepper and sweet onion. On days I need to get out the door breakfast of jimmy dean turkey sausage Yogurt is also a favorite.( mmmm caramel apple pie dannon light n fit) Lunch: At work I eat a bento box filled with chopped chicken, snap peas, red grapes and cheese. It all finger food. I'm on the run I graze it. its visually appealing, great for portions, so many options to fill it with. https://www.pinterest.com/eggface/bento-licious/ Dinner: many things to try. http://insidekarenskitchen.com/bariatric-friendly-recipes/

All of the above is great advice. I also made a list of things I wanted to do, a kind of bucket list of things after weightloss, that were not possible/ fun at my highest weight. Even only 8 weeks out, I have already managed some and it is very motivating. I collected recipes that I knew would be bariatric friendly, too. I made a binder for them so they would be ready to go when I was. My family has since implemented a "new recipe" night every Saturday where we cook and test one out together. (Makes a great replacement for eating out.) Check out the Food Before and After thread link below for lots of pics of yummy healthy food people eat post op for some great inspiration. Food before/after Hang in there, you can make this time count for sure!

I personally prefer Bariatric Advantage Orange Cream. Great taste, no after taste. I use skim milk instead of water.

OK so I had RNY 3 weeks ago and I'm doing just fine. I am wanting to get a new PCP now that I've had the surgery. I'm wanting someone that is familiar with bariatric surgery and what all I will be going through. I don't feel my current PCP is a good fit for me now that I've had RNY. My question is, what kind of PCP should I go to now? Is family practice ok or should I see general medicine, or internalist... I have no clue what kind of PCP would be the best choice... My surgeon gave me a few names of doctors he recommends but I'm not sure if they will be a good fit for me as most of them are older and I feel I won't be able to relate with them or connect with them... HELP PLEASE?? :-)

I still would like some more info on Dr A and going through Bariatric Pal. Where do I even start?

Thanks for the information but its a little too late for me. I used weightlossagents but as a nurse and having bariatric surgery before, I didn't ask any questions. I had revision surgery (lapband to sleeve) April 7, 2015 and had a great experience. ☺️

Sitting on the tarmac, that's a great analogy! My process has been long, for lack of a better word! I decided while visiting family July 4th weekend that it was time to pursue bariatric surgery, after considering it off and on for 20 years or so. Did some research, found a doctor that I felt looked super credible, asked my endocrinologist for a reference, and they referred me to the doctor I had already picked. Called the surgeons office to get the ball rolling and found out our insurance didnt cover the surgery. I went back and forth about just doing self pay and getting the surgery asap, but instead opted to change our insurance to a plan with bariatric coverage during the next insurance enrollment period, which thankfully was in August. New insurance started 10/1, and I called the surgeon that day and got the initial preauthorization and an appointment for the following week! My insurance requires 6 months of medically managed weightloss, and nutrition classes. At first I was bummed that I had to jump through all the hoops to finally get to the surgery but in retrospect Im so glad I've had to 'practice' eating healthier, moving more, etc. I've been to all of the nutrition appointments as of last week, and I've only got two more surgeon appointments left (net week, and March 17). I've already had cardiac clearance, and psych clearance, but need to get primary care physician clearance still (going to see him in March, for that, and prescription refills!) It just hit me last week that I'm almost done with all those 'hoops' and surgery is coming up faster than I realized! The past 4 months kind of sped by, probably because of all the holidays packed in there! I've had good luck with the change in diet. I basically just stopped eating fast food and chocolate, donuts, Cookies, brownies, ice cream, etc. i have a major sweet tooth, so I've substituted fruit for desert. I have apples/oranges/pineapple/bananas/etc after or with almost every meal Using the myfitnesspal ap helped out a ton when I first started too. I stopped using it religiously around Thanksgiving and have just been mindful of each meal being somewhere in the vicinity of 500 calories, as well as ensuring I am eating enough Protein and vegetables. I've managed to continue to lose weight regardless, but I need to get back on track with the ap in the coming weeks. I'm down 30lbs from my initial surgeon visit, insurance required I lose 25, surgeon wanted me to lose 33. So I have 3 more pounds to get off in the next 6 weeks. At the rate Im dropping weight I think I'll bypass that! I hope! This is probably waaaay more information than you were expecting! Fingers crossed for your appointment and a quick surgery date!

Bowel prep is one of the many things that varies from doctor to doctor and program to program. May the Bariatric Surgery Gods bless you with not having to go through THAT particular experience. The worst part for me? The first of two days of bowel prep was on my birthday. Crappy Birthday to me! Literally.

Jan. 18, 2013 -- More than 200,000 weight loss surgeries are performed each year in the U.S. Several recent studies have questioned the effectiveness and safety of one type, gastric banding, which has led to a decline in its use as patients choose other surgical options. But the largest and longest study yet of the procedure found that patients followed for up to 15 years maintained significant weight loss -- an average of about 60 pounds. Study: Banding Effective for Weight Loss About half the patients in the study needed additional surgeries to adjust the bands or deal with other complications, but only about 1 in 20 patients opted to have the bands removed. Researcher Paul O’Brien, MD, of Melbourne, Australia’s Monash University, was a pioneer of the Lap-Band procedure, and his latest study was supported by Allergan Inc., which markets the gastric band system. He says gastric banding offers an effective, reversible, long-term solution for weight loss as long as patients get good follow-up care and are willing to carefully control the way they eat. The study is published in the January issue of the Annals of Surgery. “Placing the band is just the first step in the process,” he says. “Compliance and follow-up are critically important. There are plenty of people out there doing this surgery without a follow-up program for their patients, and they are setting them up for failure.” Banding, Bypass, and Sleeve Gastrectomy The Lap-Band procedure is one of several weight loss surgeries performed in the U.S. and the only one that is easily reversible. The band is an inflatable silicone ring that is wrapped around the upper part of thestomach to create a pouch the size of a golf ball, which limits the amount of food that can be eaten. The band can be tightened or loosened to increase or decrease the size of the opening to the lower stomach. The most commonly performed type of gastric bypass surgery also reduces the size of the stomach to that of a golf ball. The surgery also bypasses a section of the small intestine, which limits calorie absorption. The gastric sleeve procedure involves the surgical removal of a portion of the stomach to create a "sleeve" that connects to the small intestine. Just a few years ago, gastric banding was widely seen as less risky, less costly, and less invasive than either of the other surgical options, and about half of weight loss procedures in the U.S. involved banding. But that has changed as the long-term data comparing weight loss surgeries has come in, says Ronald H. Clements, MD, who directs the bariatric surgery program at Vanderbilt University Medical Center in Nashville. Fewer Lap-Band Surgeries Performed Clements says just five of the 360 weight loss surgeries performed at Vanderbilt last year were Lap-Band procedures. “We have essentially stopped doing this operation,” he says. “The sleeve and the bypass are just better for helping people lose weight and keep it off. That’s what we are seeing in our patients and that’s what the data are telling us.” A 2011 study from Belgium found that the bands eroded in 1 in 3 patients, while 60% required additional surgeries. And a study published last year that compared banding to bypass surgery found that bypass patients lost more weight and kept it off over six years and had fewer complications. Four years ago, as many as 40% of weight loss surgeries performed at Lenox Hill Hospital in New York involved gastric banding, says Mitchell Roslin, MD, who is chief of obesity surgery. Today, the figure is closer to 3%. “Last year we took out 80 bands and converted them to other procedures,” he says. “Patients do well in the short term, but they tend to have problems later on.” Banding Good Option for Some American Society for Metabolic & Bariatric Surgery President Jaime Ponce, MD, confirms that fewer Lap-Band surgeries are being performed in the U.S. Allergan’s sales related to its Lap-Band system reportedly fell from close to $300 million in 2011 to about half that figure last year, and last fall the company announced that it was looking to sell its weight loss surgery division. But Ponce says the surgery is still a good option for some patients. “The band is a device that requires a lot of maintenance and multiple adjustments, and one problem is that our insurance system is not set up to pay for this,” he says. He says gastric banding is much more popular and widely performed than gastric bypass in Australia. “In Australia, aftercare is covered by national insurance, so patients don’t have to worry about paying for adjustments,” Ponce says. And there are plenty of gastric banding success stories here in America, including New York Jets head coach Rex Ryan, who lost more than 100 pounds after having the procedure in March of 2010. Ponce says patients who understand that gastric banding will require careful compliance and frequent follow-up visits to their doctor can achieve good results with the gastric banding surgery. “Patients need to be followed, preferably every month or so,” he says. “If your surgeon doesn’t offer this kind of follow up, you need to go somewhere else.” http://www.webmd.com/diet/weight-loss-surgery/news/20130117/lap-band-shown-effective-long-term-weight-loss?page=2

This might be late information to this thread, but hopefully it will help someone in the future. If you're from Ontario, Canada you can check out all the information at http://www.ontariobariatricnetwork.ca Just have to get your doctor to refer you into the registry, then you'll get a letter in the mail about 1-2months later telling you when your orientation date is... from there you're on your journey! There are bariatric centres in Hamilton, Toronto, Guelph, and Ottawa that you can have the surgery at. The bypass & sleeve surgeries are both covered by OHIP!! So rejoice!! I sure am!! :purplebananna: :not_ripe: There's a and shares some of the out of pocket expenses she had, so this might help you as well when saving money for this surgery. Hope this helps my fellow Ontarians! :cornut:

I was looking into different sites that offer high protien Snacks and such that would be good for the whole family. I was wondering if anyone from Canada has ordered from these sites and had any problems with shipping through customs? Thanks for any information that you can share!

The DS as a virgin procedure is more challenging to perform than a VSG or RNY, which is why relatively few bariatric surgeons offer it, despite its' demonstrably better performance (the RNY is "good enough" for most patients...) That's your first challenge - finding a reliable DS surgeon. Converting a VSG to a DS is straightforward for any DS surgeon, as the DS uses the VSG as its basis, so it's mainly a matter of adding the "switch" part - the malabsorptive part - to the VSG. Revising an RNY to a DS is another, much more complicated matter, and surgeons who can do that are few and far between. It used to be, a few years ago, that there was maybe a half dozen surgeons in the US that reliably did them, and I have seen references to a few more have joined the ranks in recent years. Rabkin and Keshishian in CA have both done them for many years, as has Roslin in NYC. I've heard that someone in Salt Lake has done some, along with some docs at Duke University in NC, possibly Kemmeter in MI. Some surgeons who don't do the DS will offer to revise to a distal RNY instead - that is a "long limb" RNY that has malabsorption more akin to the DS. However, it does not have a great reputation, and is usually not approved by US insurance as a primary procedure (but often will as a revision under the right circumstances.) My take on why it seems to be more problematic than the DS is that it is rarely done, and the surgeons and their practices aren't all that in tune with its' long term requirements. A DS, and by association the distal RNY, has a quite different nutritional and supplement requirement to the standard proximal RNY, which is well known to those in the DS world, but not all that well appreciated by those in the RNY world. Like with the RNY, and much more important with the DS, is to commit to having annual labs and follow ups for life - with the altered absorption and nutrition/supplement requirements, things can go askew in sometimes if you don't stay on top of them. Those who do stay on top of things typically have minimal long term problems. I would not go to MX for a procedure like this, as you really don't know what you will end up with. Historically, there has only been one reliable DS surgeon in MX - Gilberto Ungston - who, if not retired, is heading that way. He has trained a couple of others to do the DS, but I haven't heard of him doing the RNY to DS revision. There are, of course, the various horror stories of MX surgeries gone wrong, and in particular of those seeking a DS and getting "something else" (who knows what.) There are great, reputable surgeons down there for the VSG and RNY, but I wouldn't go there for something more complicated like a DS, unless it was someone well vetted in that procedure (such as Ungston,) - the differing legal systems leave one with no recourse is something doesn't go right (and the chances of that happening with something as complex and an RNY/DS revision are high there.) Good luck - it is a long search for what you need, and be prepared to travel. Being in CA myself, and my wife is a Rabkin DS, we have seen several successful revisions like this from both Rabkin and Keshishian, so it is viable when done by someone experienced with it. It, also, is not a simple outpatient procedure, and Rabkin's standard practice for travelling patients is to remain in town until at least the 10 day post op follow up. Most everything else can be done remotely (and they are set up for doing so.) Keshishian is similar in this regard.

Glad to hear that your recovery is going well! That sharp pain near your sternum could have been from repair to a hiatal hernia which is pretty common for surgeons to fix while performing bariatric surgery. You might ask your surgeon if there was a hernia repair during your procedure. In any case, glad to hear the pain has subsided. I hear you loud and clear on the Protein shakes. No matter how many flavors I had, I dreaded the next shake!! I did find some water-based Protein drinks that really helped as they had different flavors and textures than the shakes. About Time Prohydrate and Isopure were 2 that really helped offer a variety. Also, adding Protein powder to Soup broth was a good alternative. Glad to hear things are going well and welcome to the "other side"!!

My post-op programme didn't limit anything - no calorie goals, no protein goals, no fluid goals even! I learnt all that by being on this forum. I was told just eat as you feel. Seems just basic common bariatric sense to me now to get my protein in first, veg second, fruit third and then other carbs after that. Even now at almost exactly a year out I don't reach 50g carbs or anything like it most days. Other than weekends, when I *choose* to drink some alcohol. So many ways to skin a rabbit, LOL.

Yeah, I recently injured a knee and it is not healing. No issue with the joint, but the meniscus is torn. I'm normally a reasonably active person, but now I can't do most of the things I like to do in terms of physical activity. Which is only strengthening my resolve about surgery. Thank you very much for the reassurance! I also have a torn meniscus, which has halted my favorite activities: African Dance, jazzercise and hiking. I started physical therapy and my therapist taught me all sorts of fun stuff I can do in the pool. I jog laps with various kinds of "weights" made from styrofoam and plastic, walk forwards, backwards and sidewise, kick with a kickboard, lunge walk, and do squats and heel lifts. I suspended my jazzercise membership and as soon as my PT period ends, will join the hospital gym and pool, and go after work. I am also in the process of completing my pre-requisites for bariatric surgery...I am just completing a horrid round of anti-biotics to get rid of an ulcer caused by painkillers for the knee, and will be issued my CPAP next week. I hope to have the surgery in October or November. My plan is to see if weight loss relieves the joint pain. If not, then I will look at knee surgery in the spring. Oh yeah, I'm 56.