Banded and gaining

[LAN2k 18]

Thanks so much for your response! I have a few questions still. My online research refers to "dumping," hair loss, acid reflux and throwing up. Any long lasting issues with those side effects? I read that the 10 year study on the band shows almost 50% failure rate. If they had told me about the 30 carb per day limit, I never would have done it. I was never "full," but often "blocked" which resulted in vomiting several times a day. I learned to eat around the band. My typical lunch salad while at work would take about 3 hours to eat so I could keep it down. They wanted me to eat in 15 minutes. No way! I saw on u-tube that some sleevers actually have to make themselves eat because they are not hungry, and they divide their day into 6 small meals. What about when you get old? Will you still eat or will you just dry up from malnutrition? I've made a terrible mistake with the Lap Band but it is reversible. The sleeve is not. I want to know everything I can from real sleevers before I commit. Please help!

You are to be commended in doing much research and asking many questions. Hair loss is expected. I personally lost at least a third of my hair. Although it came out in handfuls during a wash etc. Oddly enough the hair lost was evenly distributed around my head. I am 7.5 months out of surgery and the hair loss is about ended. I am hoping that my hair will thicken once again. I have not encountered "dumping". I do not fully enjoy eating however and must eat slowly not to feel too full to eat enough. It seems that many others have little problem enjoying food. Your question about eating later on in life and the potential for malnutrition makes sense to me. As you must already know the gastric "sleeve" per se' has not been around as a weight loss procedure for that many years. You would perhaps benefit by researching the stomach gastrectomy which has been done for decades, performed for health reasons other than weight loss.

[Tiffykins 673]

Thanks so much for your response! I have a few questions still. My online research refers to "dumping," hair loss, acid reflux and throwing up. Any long lasting issues with those side effects? I read that the 10 year study on the band shows almost 50% failure rate. If they had told me about the 30 carb per day limit, I never would have done it. I was never "full," but often "blocked" which resulted in vomiting several times a day. I learned to eat around the band. My typical lunch salad while at work would take about 3 hours to eat so I could keep it down. They wanted me to eat in 15 minutes. No way! I saw on u-tube that some sleevers actually have to make themselves eat because they are not hungry, and they divide their day into 6 small meals. What about when you get old? Will you still eat or will you just dry up from malnutrition? I've made a terrible mistake with the Lap Band but it is reversible. The sleeve is not. I want to know everything I can from real sleevers before I commit. Please help!

I'll apologize ahead of time for this lengthy post. You asked for a bunch of information so I'll just try to give a glimpse of what I've done with my sleeve, and my experiences so far.

The Hair loss is very temporary, and if you take some extra measures, you can actually help the regrowth in most cases. I chose to use Folicure extra care Shampoo instead of taking Biotin or another type of hair/nail/skin supplement. I lost hair for 3 months starting around 3.5 months post-op and it ended around 6.5 months post-op. I had new growth coming in before the shedding actually stopped.

As for the nausea, I only experienced nausea when on other meds like antibiotics. I also experienced it when I would try a new food that maybe my body wasn't ready for at that time. I stayed on mushy and soft solid food longer than prescribed because it was easier to eat, and I was able to get in my required Protein for the day.

As for getting old, you can do some independent research on gastrectomies for other conditions such as stomach cancer and ulcer patients. There are plenty of personal stories out there that show men and women in their late 50's. 60's and 70's that had gastrectomies many decades before and they are not malnourished or withering away. There are even people that thrive when they go through a complete gastrectomy, or complete removal of the entire stomach and a new stomach is made out of remnant intestinal tissue. It's truly amazing how the human body can adjust and thrive even in the most difficult situations.

Acid reflux can occur with any of the surgeries. I have several friends in real life with RNY that have acid reflux. But, I take 1/20 mg Prilosec daily and have zero issues with acid.

I have zero dumping episodes and eat all kinds of stuff including ice cream, chocolate candies such as Snickers, Heath and Reese's miniatures. I had cheesecake with strawberry topping with zero issues as well. Obviously, I did NOT eat these things while losing. It's only a possible side effect with VSG, and I've only read a couple people talk about it. It doesn't seem to be something that happens chronically with VSG patients.

Currently at 11 months out, I can only eat 4-5oz of dense Protein with a few bites of veggies per meal. I can eat about a cup of mushy consistency food such as yogurt, chili, mashed potatoes, etc. Because of where I'm at, below goal, I do eat 6-8 times a day. 4 meals at a minimum with 3-4 Snacks. I did not snack during my losing stage. I did not consume more than 30grams of carbs during my losing stage. Others do not watch their carbs and not everyone decides to do the same exact things as the next person. I wanted to maximize my honeymoon phase. I wanted to get to goal quickly. I know it's not a sprint, but I'm not good at endurance races. I ate 4 meals a day during my losing stage, and that was it.

I don't throw up. I only vomited early out and it was not often. In my opinion, those of us that had the band first, kind of have the learning curve of the sleeve beat. It was not difficult for me to listen to my body, and not overeat. I found eating with the sleeve much easier than with the band. Of course, the post-op diet and swelling is a quite a bit different, but for me, I found it easier. I literally have zero food intolerances. I eat salad weekly. I eat super crunchy salad not just super soft lettuce. I do eat Pasta, potatoes, rice without any issue as these foods are now slider foods for me. Same goes for chips, crackers, pretzels, so I still have to make the "best choice" when it comes to eating. If I eat all the "bad" stuff, I'll gain weight. None of the surgeries will change that. You can cheat the sleeve just like you can the band, RNY or even the DS. So, making the conscious effort to choose the best options for your meals is essential to success. I eat anywhere between 1500-1800 calories a day with an average of 100grams of carbs, and 100grams of protein. Some days my carbs are higher because I eat more fruits. Some days I only get in 60 grams of protein. I'm trying to maintain at this point so it's quite different than when I was losing.

Truly, I do not miss my big stretchy stomach, and the large quantities of food I used to consume. Tonight, I made a fabulous mexican dinner. chicken quesadillas with homemade mexican rice. I ate 1 wedge of a quesadilla (made on the George Foreman grill, with 2-10" tortillas, chicken, onions, green & red peppers, and loads of cheese), and I ate a 1/2 cup of the rice (made with white rice, corn, red/green peppers, black Beans, green chiles & tons of spices). I was completely satisfied. I will probably eat again in about an hour, and have another wedge of a quesadilla and a little more rice. I also added plain non-fat Greek yogurt in place of sour cream. So as you can see, I do not miss anything in my meals.

For lunch today, I had 1/2 of a bagel thin sandwich with cream cheese and thin sliced turkey with 10 cheesy poofs. I ate about 1/4 of a large pancake with butter and Syrup for Breakfast, had 1/2 granola bar and a 1oz sharp cheddar cheese wedge for a snack, and enjoyed 1/2 apple with some homemade cream cheese fruit dip. I also had 3 miniature Heath candy bars throughout the day when I was out running errands. I eat more junky type food on the weekends. Plus, I think I'm about to start my period, and I eat more junk the week before.

Hope this helps. If you have any specific questions, feel free to post here or shoot me a message and I'll help any possible way I can.

[jobigirl 2]

Congratulations on your success and thanks for your response. I need to hear more from people like you!

[brianMD 1]

I'll apologize ahead of time for this lengthy post. You asked for a bunch of information so I'll just try to give a glimpse of what I've done with my sleeve, and my experiences so far.

The hair loss is very temporary, and if you take some extra measures, you can actually help the regrowth in most cases. I chose to use Folicure extra care Shampoo instead of taking Biotin or another type of hair/nail/skin supplement. I lost hair for 3 months starting around 3.5 months post-op and it ended around 6.5 months post-op. I had new growth coming in before the shedding actually stopped.

As for the nausea, I only experienced nausea when on other meds like antibiotics. I also experienced it when I would try a new food that maybe my body wasn't ready for at that time. I stayed on mushy and soft solid food longer than prescribed because it was easier to eat, and I was able to get in my required Protein for the day.

As for getting old, you can do some independent research on gastrectomies for other conditions such as stomach cancer and ulcer patients. There are plenty of personal stories out there that show men and women in their late 50's. 60's and 70's that had gastrectomies many decades before and they are not malnourished or withering away. There are even people that thrive when they go through a complete gastrectomy, or complete removal of the entire stomach and a new stomach is made out of remnant intestinal tissue. It's truly amazing how the human body can adjust and thrive even in the most difficult situations.

Acid reflux can occur with any of the surgeries. I have several friends in real life with RNY that have acid reflux. But, I take 1/20 mg Prilosec daily and have zero issues with acid.

I have zero dumping episodes and eat all kinds of stuff including ice cream, chocolate candies such as Snickers, Heath and Reese's miniatures. I had cheesecake with strawberry topping with zero issues as well. Obviously, I did NOT eat these things while losing. It's only a possible side effect with VSG, and I've only read a couple people talk about it. It doesn't seem to be something that happens chronically with VSG patients.

Currently at 11 months out, I can only eat 4-5oz of dense Protein with a few bites of veggies per meal. I can eat about a cup of mushy consistency food such as yogurt, chili, mashed potatoes, etc. Because of where I'm at, below goal, I do eat 6-8 times a day. 4 meals at a minimum with 3-4 Snacks. I did not snack during my losing stage. I did not consume more than 30grams of carbs during my losing stage. Others do not watch their carbs and not everyone decides to do the same exact things as the next person. I wanted to maximize my honeymoon phase. I wanted to get to goal quickly. I know it's not a sprint, but I'm not good at endurance races. I ate 4 meals a day during my losing stage, and that was it.

I don't throw up. I only vomited early out and it was not often. In my opinion, those of us that had the band first, kind of have the learning curve of the sleeve beat. It was not difficult for me to listen to my body, and not overeat. I found eating with the sleeve much easier than with the band. Of course, the post-op diet and swelling is a quite a bit different, but for me, I found it easier. I literally have zero food intolerances. I eat salad weekly. I eat super crunchy salad not just super soft lettuce. I do eat Pasta, potatoes, rice without any issue as these foods are now slider foods for me. Same goes for chips, crackers, pretzels, so I still have to make the "best choice" when it comes to eating. If I eat all the "bad" stuff, I'll gain weight. None of the surgeries will change that. You can cheat the sleeve just like you can the band, RNY or even the DS. So, making the conscious effort to choose the best options for your meals is essential to success. I eat anywhere between 1500-1800 calories a day with an average of 100grams of carbs, and 100grams of protein. Some days my carbs are higher because I eat more fruits. Some days I only get in 60 grams of protein. I'm trying to maintain at this point so it's quite different than when I was losing.

Truly, I do not miss my big stretchy stomach, and the large quantities of food I used to consume. Tonight, I made a fabulous mexican dinner. chicken quesadillas with homemade mexican rice. I ate 1 wedge of a quesadilla (made on the George Foreman grill, with 2-10" tortillas, chicken, onions, green & red peppers, and loads of cheese), and I ate a 1/2 cup of the rice (made with white rice, corn, red/green peppers, black Beans, green chiles & tons of spices). I was completely satisfied. I will probably eat again in about an hour, and have another wedge of a quesadilla and a little more rice. I also added plain non-fat Greek yogurt in place of sour cream. So as you can see, I do not miss anything in my meals.

For lunch today, I had 1/2 of a bagel thin sandwich with cream cheese and thin sliced turkey with 10 cheesy poofs. I ate about 1/4 of a large pancake with butter and Syrup for Breakfast, had 1/2 granola bar and a 1oz sharp cheddar cheese wedge for a snack, and enjoyed 1/2 apple with some homemade cream cheese fruit dip. I also had 3 miniature Heath candy bars throughout the day when I was out running errands. I eat more junky type food on the weekends. Plus, I think I'm about to start my period, and I eat more junk the week before.

Hope this helps. If you have any specific questions, feel free to post here or shoot me a message and I'll help any possible way I can.

I have decided to get either a band or a sleeve done.

The more I read the sleeve sounds better.

What are the best reasons to get a sleeve over a band?

Thanks!

[Tiffykins 673]

I have decided to get either a band or a sleeve done.

The more I read the sleeve sounds better.

What are the best reasons to get a sleeve over a band?

Thanks!

Hi Brian,

Here is some information on the band from the band manufacturer.

1 in 4 band patients will need another surgery due to complications such as a slip, erosion, or mechanical failure.

The band has the slowest and lowest weight loss.

You will not have restriction until you get enough fills to hit the "sweet spot" which is sometimes never hit. Many fills and unfills are typically needed to give you restriction and to ensure you are not too tight which causes an entire slew of other problems by being too tight.

The band has a lot of food restrictions.

Band info from lapband manufacturer

http://www.lapband.com/en/learn_about_lapband/safety_informa tion/

Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. In the United States clinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events, ranging from mild, moderate, to severe. Nausea and vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet blockage) (14%) were the most common post-operative complications. In the study, 25% of the patients had their band systems removed, two-thirds of which were following adverse events. Esophageal dilatation or dysmotility (poor esophageal function) occurred in 11% of patients, the long-term effects of which are currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing) occurred in 9% of the patients. In 9% of the patients, a second surgery was needed to fix a problem with the band or initial surgery. In 9% of the patients, there was an additional procedure to fix a leaking or twisted access port. The access port design has been improved. Four out of 299 patients (1.3%) had their bands erode into their stomachs. These bands needed to be removed in a second operation. Surgical techniques have evolved to reduce slippage. Surgeons with more laparoscopic experience and more experience with these procedures report fewer complications.

Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above the diaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, prickly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection. Be sure to ask your surgeon about these possible complications and any of these medical terms that you dont understand.

Back to Top What are the specific risks and possible complications?

Talk to your doctor about all of the following risks and complications:

• Ulceration
  
• Gastritis (irritated stomach tissue)
  
• Gastroesophageal reflux (regurgitation)
  
• Heartburn
  
• Gas bloat
  
• Dysphagia (difficulty swallowing)
  
• Dehydration
  
• Constipation
  
• Weight regain
  
• Death
  

Laparoscopic surgery has its own set of possible problems. They include:

• Spleen or liver damage (sometimes requiring spleen removal)
  
• Damage to major blood vessels
  
• Lung problems
  
• Thrombosis (blood clots)
  
• Rupture of the wound
  
• Perforation of the stomach or esophagus during surgery
  

Laparoscopic surgery is not always possible. The surgeon may need to switch to an "open" method due to some of the reasons mentioned here. This happened in about 5% of the cases in the U.S. Clinical Study.

There are also problems that can occur that are directly related to the LAP-BAND? System:

• The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing that connects them.
  
• The band can slip
  
• There can be stomach slippage
  
• The stomach pouch can enlarge
  
• The stoma (stomach outlet) can be blocked
  
• The band can erode into the stomach
  

Obstruction of the stomach can be caused by:

• Food
  
• Swelling
  
• Improper placement of the band
  
• The band being over-inflated
  
• Band or stomach slippage
  
• Stomach pouch twisting
  
• Stomach pouch enlargement
  

There have been some reports that the esophagus has stretched or dilated in some patients. This could be caused by:

• Improper placement of the band
  
• The band being tightened too much
  
• Stoma obstruction
  
• Binge eating
  
• Excessive vomiting
  

Patients with a weaker esophagus may be more likely to have this problem. A weaker esophagus is one that is not good at pushing food through to your stomach. Tell your surgeon if you have difficulty swallowing. Then your surgeon can evaluate this.

Weight loss with the LAP-BAND? System is typically slower and more gradual than with some other weight loss surgeries. Tightening the band too fast or too much to try to speed up weight loss should be avoided. The stomach pouch and/or esophagus can become enlarged as a result. You need to learn how to use your band as a tool that can help you reduce the amount you eat.

Infection is possible. Also, the band can erode into the stomach. This can happen right after surgery or years later, although this rarely happens.

Complications can cause reduced weight loss. They can also cause weight gain. Other complications can result that require more surgery to remove, reposition, or replace the band.

Some patients have more nausea and vomiting than others. You should see your physician at once if vomiting persists.

Rapid weight loss may lead to symptoms of:

• Malnutrition
  
• Anemia
  
• Related complications
  

It is possible you may not lose much weight or any weight at all. You could also have complications related to obesity.

If any complications occur, you may need to stay in the hospital longer. You may also need to return to the hospital later. A number of less serious complications can also occur. These may have little effect on how long it takes you to recover from surgery.

If you have existing problems, such as diabetes, a large hiatal hernia (part of the stomach in the chest cavity), Barretts esophagus (severe, chronic inflammation of the lower esophagus), or emotional or psychological problems, you may have more complications. Your surgeon will consider how bad your symptoms are, and if you are a good candidate for the LAP-BAND? System surgery. You also have more risk of complications if you've had a surgery before in the same area. If the procedure is not done laparoscopically by an experienced surgeon, you may have more risk of complications.

Anti-inflammatory drugs that may irritate the stomach, such as aspirin and NSAIDs, should be used with caution.

Some people need folate and Vitamin B12 supplements to maintain normal homocycteine levels. Elevated homocycteine levels can increase risks to your heart and the risk of spinal birth defects.

You can develop gallstones after a rapid weight loss. This can make it necessary to remove your gallbladder.

There have been no reports of autoimmune disease with the use of the LAP-BAND? System. Autoimmune diseases and connective tissue disorders, though, have been reported after long-term implantation of other silicone devices. These problems can include systemic lupus erythematosus and scleroderma. At this time, there is no conclusive clinical evidence that supports a relationship between connective-tissue disorders and silicone implants. Long-term studies to further evaluate this possibility are still being done. You should know, though, that if autoimmune symptoms develop after the band is in place, you may need treatment. The band may also need to be removed. Talk with your surgeon about this possibility. Also, if you have symptoms of autoimmune disease now, the LAP-BAND? System may not be right for you.

Back to Top Removing the LAP-BAND? System

If the LAP-BAND? System has been placed laparoscopically, it may be possible to remove it the same way. This is an advantage of the LAP-BAND? System. However, an "open" procedure may be necessary to remove a band. In the U.S. Clinical Study, 60% of the bands that were removed were done laparoscopically. Surgeons report that after the band is removed, the stomach returns to essentially a normal state.

At this time, there are no known reasons to suggest that the band should be replaced or removed at some point unless a complication occurs or you do not lose weight. It is difficult, though, to say whether the band will stay in place for the rest of your life. It may need to be removed or replaced at some point. Removing the device requires a surgical procedure. That procedure will have all the related risks and possible complications that come with surgery. The risk of some complications, such as erosions and infection, increase with any added procedure.

Here are some research links on the sleeve that you may find interesting

LapSf Study that I swiped from MacMadame's profile

LapSF Educational presentation to FACS - includes some 2 year results

LapSF Two Year Study

LapSF Five Year Study - abstract only

LapSF Five Year Study - presentation (requires Windows to play)

Literature review on the sleeve - requires $$ to get the full text unfortunately

Sleeve best for over 50 crowd

Video of a sleeve with lots of education discussion

Video of a sleeve that is more about the operation

Ghrelin levels after RnY and sleeve

Ghrelin levels after band and sleeve

Diabetes resolution in RnY vs. Sleeve

Comparison of band to sleeve - literature review

Updated statement from the ASMBS on the sleeve with some study results.

http://www.asmbs.org/Newsite07/resources/Updated_Position_Statement_on_Sleeve_Gastrectomy.pdf

Now onto why the sleeve is better than the sleeve:

No food or medication restriction

You retain a normal functioning stomach unlike the band that gives you a pouch.

The sleeve gives most patients removal of hunger by removing the large portion(fundus) of the stomach where the hunger hormone Ghrelin is produced. Now, Ghrelin is produced in the pancreas as well, but Ghrelin is greatly reduced by having the sleeve. I'm 11 months out and I still have never experience true hunger, or stomach growling. I still have to remember to eat.

No maintenance with the sleeve. No fills, or unfills. Immediate restriction.

The long term complications of the sleeve are pretty non-existent with the band as you can see from the above information can be pretty extensive.

The band is the "safest" operation for procedural purposes. But, the complications that are found with the band within the first few years outweigh it being the safest operation.

The highest risk with the sleeve is a staple line leak. An experienced surgeon, and your compliance with the post-op diet prescribed by your surgeon decreases your risk substantially.

Some people think having 75-85% of our stomachs removed is scary, or unthinkable. But, believe me, I don't miss that huge part of my stomach. I eat anything and everything I want, I enjoy a healthy, balanced diet, and do not feel like I'm dieting like I did with the band. The band did not reduce my hunger, yes I got full when I ate, then the food would slip through, and I'd be hungry again. Once the restriction was gone, I was hungry all the time again.

The band is not reversible in my opinion. It can be removed, replaced, or you can revise to another surgery. But, once that band is around your stomach, your anatomy is forever changed.

I hope this helps, and if you have any other specific questions, feel free to ask or shoot me a message.

[kalew 0]

Aetna does cover sleeves now. Google Aetna's Coverage Policy Bulletins, and look under obesity surgery. All of their criteria is listed. Good Luck!