Lap band erosion

[WASaBubbleButt 41]

There are certainly some surgeons that agree with you. For me personally, I don't like the thought of having most of my stomach in the waste bucket forever. I like leaving the GI anatomy the way we were born - the band being on the outside and completely adjustable and reversible. If the sleeve is too small - you have to just deal with it. If the sleeve is too big - you have to just deal with it. There is talk of banding sleeves that stretch out over time and my thought is why not just band in the first place and have something easily adjustable for the rest of your life. We have hundreds and hundreds of band patients doing perfectly and I do think they don't post on message boards as much for some reason so one can get a false sense that all band patients have problems.

Some surgeons love the sleeve. Not for me.

Understand these are my opinions.

When surgeons have bariatric surgery they overwhelmingly choose the band and there are many reasons for this. I tend to steer away from operations that surgeons would never choose for themselves.

For the most part I agree with you regarding leaving the GI anatomy as it was when we were born but along that thinking the band is really no different. We weren't born with a band wrapped around a stomach. Bypass is the procedure I don't get, I just can't wrap my brain around anything logical with bypass, MGB or DS for a majority of patients.

I look at my stomach as an annoying part of my body that malfunctions. :huggie: Something is wrong between my brain and my stomach and just like any other part of the body that is causing problems such as an appendix, if it isn't working then get rid of it. I have no use for an entire stomach, it has done nothing but hold too much food. It just hasn't been a good friend to me.

I don't like the idea of 80% of my stomach in the garbage either but I'm not sure a band is much better. It is still invasive with a great number of complications. I'm not suggesting sleeves are less risk vs. banding at the time of surgery but wouldn't you agree that after 6 months or so the complications with sleeves are fewer in number vs. banding? I don't know, maybe I'm wrong.

And lets face it, doctors don't make things easy for us either. I was banded in Mexico and trying to get a fill in the US is very difficult. And you know what? I had my choice narrowed down to one US doc and one Mexican doc. I chose the Mexican doc because I couldn't stand the AZ guy's staff. And it's not just Mexican banded people, folks banded in the US who move to another state are in for a real challenge when trying to find a fill doc. There are docs out there that charge $1100 for a single fill and it's not even under fluoro! I know fills are not a huge money maker and docs are running a business, I get that. But $1100 is taking advantage of people who are desperate enough to do bloody anything to lose weight.

I know the history behind the fill issue, I know what Inamed does during certification classes, I know the politics, I know that Inamed hires a lawyer to come to the certification classes to warn docs about filling patients they didn't do surgery on... it's all politics and not a great deal of truth. I don't think Inamed realizes how much liability they are facing by attempting to stop people from getting medical care. But that's for another day. Point being, you guys (general you, not specific you) make life very difficult to obtain fills and don't you dare ever die because who will your patients go to for fill? With a sleeve there is no hassle, no problems with follow up care, nothing.

I still can't figure out why I was so set on having a band because I could reverse it. I can't think of a single reason why I would ever want to be MO again.

I have to admit something here. I've been reading so many boards and talked to so many people that lost their bands to slips or erosion. I am really beginning to question if this band is going to be doable 30 years from now. I know full well that people with problems are more likely to post on boards vs. people that met their goal and are out there doing their thing. I understand that. But there are just so many issues with a band.

I can't get rid of a strong feeling that I am one that won't have a band forever. I have felt this way since before I even had the surgery and I can't shake that feeling. When I was banded I was desperate and I would have done anything to lose weight.

So all in all, I am pretty sure if I had it to do over again I'd choose a sleeve.

[mbz 0]

"I have no use for an entire stomach, it has done nothing but hold too much food. It just hasn't been a good friend to me."

<br><br>

MY THOUGHTS EXACTLY!!!!!!!!:clap2:

[DrWatkins 5]

For the most part I agree with you regarding leaving the GI anatomy as it was when we were born but along that thinking the band is really no different. We weren't born with a band wrapped around a stomach. Bypass is the procedure I don't get, I just can't wrap my brain around anything logical with bypass, MGB or DS for a majority of patients.

I look at my stomach as an annoying part of my body that malfunctions. Something is wrong between my brain and my stomach and just like any other part of the body that is causing problems such as an appendix, if it isn't working then get rid of it. I have no use for an entire stomach, it has done nothing but hold too much food. It just hasn't been a good friend to me.

I don't like the idea of 80% of my stomach in the garbage either but I'm not sure a band is much better. It is still invasive with a great number of complications. I'm not suggesting sleeves are less risk vs. banding at the time of surgery but wouldn't you agree that after 6 months or so the complications with sleeves are fewer in number vs. banding? I don't know, maybe I'm wrong.

And lets face it, doctors don't make things easy for us either. I was banded in Mexico and trying to get a fill in the US is very difficult. And you know what? I had my choice narrowed down to one US doc and one Mexican doc. I chose the Mexican doc because I couldn't stand the AZ guy's staff. And it's not just Mexican banded people, folks banded in the US who move to another state are in for a real challenge when trying to find a fill doc. There are docs out there that charge $1100 for a single fill and it's not even under fluoro! I know fills are not a huge money maker and docs are running a business, I get that. But $1100 is taking advantage of people who are desperate enough to do bloody anything to lose weight.

I know the history behind the fill issue, I know what Inamed does during certification classes, I know the politics, I know that Inamed hires a lawyer to come to the certification classes to warn docs about filling patients they didn't do surgery on... it's all politics and not a great deal of truth. I don't think Inamed realizes how much liability they are facing by attempting to stop people from getting medical care. But that's for another day. Point being, you guys (general you, not specific you) make life very difficult to obtain fills and don't you dare ever die because who will your patients go to for fill? With a sleeve there is no hassle, no problems with follow up care, nothing.

I still can't figure out why I was so set on having a band because I could reverse it. I can't think of a single reason why I would ever want to be MO again.

I have to admit something here. I've been reading so many boards and talked to so many people that lost their bands to slips or erosion. I am really beginning to question if this band is going to be doable 30 years from now. I know full well that people with problems are more likely to post on boards vs. people that met their goal and are out there doing their thing. I understand that. But there are just so many issues with a band.

I can't get rid of a strong feeling that I am one that won't have a band forever. I have felt this way since before I even had the surgery and I can't shake that feeling. When I was banded I was desperate and I would have done anything to lose weight.

So all in all, I am pretty sure if I had it to do over again I'd choose a sleeve.

Certainly, choice of procedure is a very individual one and I respect that when patients are well-informed about the true differences.

Certainly band complications are no doubt much less severe than the "gut altering" procedures. For example, I would much rather have a port issue fixed with local anesthesia than peritonitis due to a leaking staple line which can be disastrous.

The topic of "surgery outside the U.S." is a delicate one. At the risk of controversy I would like to provide some insight perhaps on the way U.S. surgeons view this:

Please know that as far as technical ability in the operating room goes, there are many excellent band surgeons outside the U.S. That is not the problem.

You also have to know that plastic is more expensive in the U.S. Many surgeons outside the U.S. purchase the band for a third of the cost American surgeons have to pay. (About $1,000 vs $3,200). Part of this difference is that manufacturing companies are far less likely to be sued outside the U.S.

Liability insurance for bariatric surgeons in the U.S. is beyond outrageous. This insurance in other countries is cheap and most surgeons don't even buy it. If something really bad happened during or after surgery it would be very difficult to sue a surgeon in another country and it would be very difficult to find a lawyer to take a case like that.

The majority of band patients that travel out of the U.S. to have surgery never return to the foreign practice for their follow-up care or support group. Most patients in the U.S. return to their surgical practice for adjustments and support group and this requires hiring adequate staff.

American doctors that take a patient into their care after having surgery out of the U.S. are taking on a major liability that most doctors feel is simply not worth the risk.

So, if I could buy the band at a third of the cost and didn't have to buy expensive liability insurance and most of my patients never returned for their fills and adjustments and support gruop, I could offer the surgery for a very low price.

My desire, however, is to help patients lose as much weight as we possibly can together as a team. I always tell new patients that this is not surgery; it's a weight loss program. For patients not covered by insurance who are paying out of pocket we've always lumped the aftercare into the price because if you make patients pay for fills after the operation they don't come in as often because you have financially disincentivized their aftercare. We in essence require patients to purchase the aftercare with the operation as they are both equally important to the ultimate outcome - success!

Hope that helps

brad

[WASaBubbleButt 41]

Certainly, choice of procedure is a very individual one and I respect that when patients are well-informed about the true differences.

Certainly band complications are no doubt much less severe than the "gut altering" procedures. For example, I would much rather have a port issue fixed with local anesthesia than peritonitis due to a leaking staple line which can be disastrous.

If that was the only complication of a sleeve or band, I'd be more likely to agree with you but those are not the typical complications for either.

The topic of "surgery outside the U.S." is a delicate one. At the risk of controversy I would like to provide some insight perhaps on the way U.S. surgeons view this:

Please know that as far as technical ability in the operating room goes, there are many excellent band surgeons outside the U.S. That is not the problem.

You also have to know that plastic is more expensive in the U.S. Many surgeons outside the U.S. purchase the band for a third of the cost American surgeons have to pay. (About $1,000 vs $3,200). Part of this difference is that manufacturing companies are far less likely to be sued outside the U.S.

Actually, in Mexico it is $1,850-$2,000. While they pay less for the band they also helped to perfect the band and the procedure. While US docs have a huge help from Inamed in advertising, Mexican docs get nothing. They aren't even supposed to use the Inamed logo on their websites. Those TV commercials on at midnight with one doc and Inamed patients and band? Paid for mostly by Inamed. Mexico gets nothing like that. So really, the cost of the band does tend to even out.

Liability insurance for bariatric surgeons in the U.S. is beyond outrageous. This insurance in other countries is cheap and most surgeons don't even buy it. If something really bad happened during or after surgery it would be very difficult to sue a surgeon in another country and it would be very difficult to find a lawyer to take a case like that.

True, while the better Mexican docs do have medical malpractice people are not nearly as sue happy in Mexico as they are the US. In the US it is considered free money. Not the wisest of attitudes but nonetheless, our attitude. We have created a horrible situation in the US for docs and medical malpractice insurance. (Hubby is a physician, I write out that check and cringe each time I do)

The majority of band patients that travel out of the U.S. to have surgery never return to the foreign practice for their follow-up care or support group. Most patients in the U.S. return to their surgical practice for adjustments and support group and this requires hiring adequate staff.

Agreed.

American doctors that take a patient into their care after having surgery out of the U.S. are taking on a major liability that most doctors feel is simply not worth the risk.

We disagree.

People have surgery all the time and follow up with another doctor. If I have a total knee replacement done by Dr. ABC, I know if I move to another state Dr. DEF will still do my follow up. Not true in the US when it comes to banding. Inamed started that and there are many political games involved, probably too much to go into here. But mark my words, someday the sue-happy banded American is going to be unable to obtain emergency medical care and I assure you, that person is going to go after Inamed and I will support them 100%. As anti-lawsuit as I am, I HOPE someone goes after Inamed. THEY are the reason we can't get medical care in the US if we are banded.

Do you agree with a doctor charging $1100 for a non-fluoro fill on a Mexican banded patient? Or a patient banded by another US doc?

My desire, however, is to help patients lose as much weight as we possibly can together as a team. I always tell new patients that this is not surgery; it's a weight loss program. For patients not covered by insurance who are paying out of pocket we've always lumped the aftercare into the price because if you make patients pay for fills after the operation they don't come in as often because you have financially disincentivized their aftercare. We in essence require patients to purchase the aftercare with the operation as they are both equally important to the ultimate outcome - success!

Don't you think there is a difference in contractual agreements between insurance co's and docs/hospitals vs. what private pay patients fork over? Don't most docs make more from a private pay patient vs. what Medicare pays, for example?

Please don't get me wrong, of the docs that post here on LBT, without a doubt you are my favorite. You are easy going, approachable, willing to answer questions, you aren't stuffy, arrogant, or overall a pain in the butt. You are really a very kind man. I don't want to make it sound like you are the anti-doctor or anything similar. But I know both sides of the coin as well and quite frankly, it's not the docs I have a problem with, it's Inamed.

Just wanted to make that point clear.

[NM Sunshine 1]

DrWatson

Thanks for the information on erosion. A lot of questions I had were answered. Also, I agree with you about throwing half of the stomach away. That grosses me.

I have not had any of the problems; GERD, slippage and erosion. The forum is a wonderful resouce. I find answers to my questions, how to handle living with the band, what symptoms to watch out for and just plain ol good support.

I return to Tiajuana Mexico for fills and figure I can fly there quickly if I need. I drive about 200 miles to the airport. Then spend 3 hours or so in air and changing planes. The MD's (he's part of the surgical team) wife picks me up at San Diego airport and takes me back. I get the fills for free for rest of my life.

When WASA said sometimes 1100 in USA for fills, I was shocked:faint:

BTW I can get those planes tickets for as low as $98 and can fly there and back in a day.

[WASaBubbleButt 41]

When WASA said sometimes 1100 in USA for fills, I was shocked

It is shocking, it's a huge rip off as well.

I can understand charging more to patients that the doc didn't band. I get that and I agree with it. Fills are not much of a money maker in an MD office. But $1100 is a bit silly.

There are two docs (in practice together) near me that charge the same BUT if they do your fills you have to join their entire program. The nut, psychologist, monthly meetings, etc. That is a lot of overhead and I can totally understand their fee schedule. But the other guy, just a blind fill and it's $1100.00.

I don't know, maybe I take it personally since I am banded but to me that just sounds like it is taking advantage of people desperate to lose weight.

My doc is the same, fills for life for free (although the hospital charges for the radiology equipment, etc,) and I'm very lucky because I can quickly drive to Mexico whenever I want. I do feel for people that have to fly.

[NM Sunshine 1]

WASA

I also pay hospital charges for radiology equipment.

There is a support group in our little town. It's held at a doctors office, after hours, open to anyone and free. I go to it.

As for the medical lawsuit insurance, we need some boundaries on it so we can elimanate the nuts who sue over a stubbed

toe.

Actually I can only see lawsuits only for when the harm was intentual. In the USA we, the clients, need to take more responsibility. That might effect insurance prices.

I never sued in my life except for a lawyer who delibertly screwed my up badly by lying to a judge and getting through the other lawyers interpretation of settlement. I wasn't even told the hearing was taking place. A 37 year marriage to an abuser and that settlement took every thing away from me and left me poverty stricken on SSI disability and Medicaid. The ex. has some wealth.

A top lawyer in Albuquerque took on my case for free. He knew we wouldn't get anything out of the sewer rat lawyer, because he's been sued quite a few times before and doesn't carry malpractice insurance. YES, New Mexico allows lawyers to practice without malpractice insurance. I recently won 105,000 on the lawsuit. But, the man has all his assets covererd so I can't get any of the money I won.

Sorry to go on so long.....just think we should let the doctors off the hook some and put all lawyers on the hook.

[DrWatkins 5]

If that was the only complication of a sleeve or band, I'd be more likely to agree with you but those are not the typical complications for either.

Actually, in Mexico it is $1,850-$2,000. While they pay less for the band they also helped to perfect the band and the procedure. While US docs have a huge help from Inamed in advertising, Mexican docs get nothing. They aren't even supposed to use the Inamed logo on their websites. Those TV commercials on at midnight with one doc and Inamed patients and band? Paid for mostly by Inamed. Mexico gets nothing like that. So really, the cost of the band does tend to even out.

True, while the better Mexican docs do have medical malpractice people are not nearly as sue happy in Mexico as they are the US. In the US it is considered free money. Not the wisest of attitudes but nonetheless, our attitude. We have created a horrible situation in the US for docs and medical malpractice insurance. (Hubby is a physician, I write out that check and cringe each time I do)

Agreed.

We disagree.

People have surgery all the time and follow up with another doctor. If I have a total knee replacement done by Dr. ABC, I know if I move to another state Dr. DEF will still do my follow up. Not true in the US when it comes to banding. Inamed started that and there are many political games involved, probably too much to go into here. But mark my words, someday the sue-happy banded American is going to be unable to obtain emergency medical care and I assure you, that person is going to go after Inamed and I will support them 100%. As anti-lawsuit as I am, I HOPE someone goes after Inamed. THEY are the reason we can't get medical care in the US if we are banded.

Do you agree with a doctor charging $1100 for a non-fluoro fill on a Mexican banded patient? Or a patient banded by another US doc?

Don't you think there is a difference in contractual agreements between insurance co's and docs/hospitals vs. what private pay patients fork over? Don't most docs make more from a private pay patient vs. what Medicare pays, for example?

Please don't get me wrong, of the docs that post here on LBT, without a doubt you are my favorite. You are easy going, approachable, willing to answer questions, you aren't stuffy, arrogant, or overall a pain in the butt. You are really a very kind man. I don't want to make it sound like you are the anti-doctor or anything similar. :confused: But I know both sides of the coin as well and quite frankly, it's not the docs I have a problem with, it's Inamed.

Just wanted to make that point clear.

This is a great discussion to have because it is very informative to everyone on these boards. It's necessary information.

I'll speak to the Inamed advertising - we paid half the ad costs and I think one patient came to our clinic as a result of their ads. The ads referred patients to a call center that was a turnoff to patients. The ads (and the campaign) were so ineffective they pulled it. Allergan now does ads on their own to raise general awareness.

Certainly American patients having surgery by American doctors easily transfer their care without much fuss. American doctors do accept a lot of risk when they accept the care of a patient who had surgery out of the country. I agree that $1100 is way too much. To me that basically says that they don't really want to do it, but if you pay the outrageous fee then okay sure.

What is happening now is that more insurance companies are paying for the band and soon it will be commoditized like gallbladder and hernia surgery and the aftercare will be fairly ubiquitous. Gastric banding is at an awkward state in the evolution of a new technology where you have early adopters having trouble getting care in their neighborhood. This will change over time.

Medicare rates are truly at all time lows. Most of their reimbursement is below what it costs to provide the service (at a high level of quality and customer experience). Most physicians accepting Medicare are paying their light bills by other means.

The main thing to recognize is that the informed patient will undertand that when you leave the country for low cost surgery, you are only buying the operation. Success = operation + post-op support. I'm always impressed by people that leave the U.S. every time they need a fill and get their aftercare out of the country. Most people don't (can't) do this. The other thing that makes my eye twitch is that I've known many examples of people who purchased the operation only -very cheaply- and over the next year spent more money in total getting their aftercare than if they had just stayed in our practice and received their care by an amazing team right in their neighborhood. (Cheap surgery can be expensive). We've also seen patients that come back from "cheap surgery" with a disaster and end up paying two and three times what we charge simply fixing complications. That scenario gives me heartburn. It just shouldn't happen.

I've heard of several patients that came back with just a port and no band inserted. I've heard of several patients where a non-traditional band was inserted - some of these look like they were made in someone's garage. I've heard of nurses stealing the narcotic pain medications and injecting patients with saline and patients being in pain with the "pain medication" not working. We've had to remove several bad band infections in patients that went outside the U.S. Many places outside the U.S. will re-use disposable instruments by soaking them in anti-septic solution (i.e. not sterile) because it's cheaper than sterilizing reusable surgical instruments. If you don't use sterile instruments your infection rate is going to be higher.

To prevent infections, U.S. operating rooms are required (and regularly inspected) to have laminar flow whereby the ventilation system is in the ceiling in the center of the room and the air flows down and out away from the operating table. This air flow prevents contaminated air from other parts of the room circulating around the open wounds. In other words, you don't want air flowing from shoes and floor up onto the surgical wounds. Also, U.S. operating rooms are required to have positive pressure. You can test this yourself by putting a Kleenex on the floor beneath the door of the operating room. The Kleenex should be blown away from the door. If the Kleenex doesn't move or even worse, gets sucked under the door into the room, that operating room doesn't have positive pressure and the infection rate will be much higher (the air is flowing from contaminated areas into the operating room). You want this to flow the other way. Air should flow from sterile areas into contaminated areas - not the other way around. If an operating room doesn't have laminar flow and positive pressure, you shouldn't have a surgical implant placed. The infection rate will be too high. You can tell if an operating room has laminar flow if the ceiling around the operating room lights has a square area with metal grids with fine holes in them and the return air ducts are in the corner of the room. You can also do the Kleenex test to see if the room has positive pressure. If the operating room doesn't have laminar flow or positive pressure, RUN!

Anyway, I like you too, WASaBubbleButt. You make me think.

brad

[WASaBubbleButt 41]

This is a great discussion to have because it is very informative to everyone on these boards. It's necessary information.

I'll speak to the Inamed advertising - we paid half the ad costs and I think one patient came to our clinic as a result of their ads. The ads referred patients to a call center that was a turnoff to patients. The ads (and the campaign) were so ineffective they pulled it. Allergan now does ads on their own to raise general awareness.

The cost for an Inamed band is cheaper in Mexico for several reasons and advertising is just one of them. Another is that Inamed will pay attorney fees to fight insurance companies to force them to pay for banding *in* the US. They give US docs first shot at the new band. I believe Inamed's latest band still isn't available to Mexican doctors. Website advertising, US docs can use Inamed's logo, Inamed's videos, Inamed's everything. Mexican docs are not permitted to do the same. In AZ the Inamed advertising I see is geared to the doc of the night. :confused: If Dr. ABC gets his turn on Monday then Dr. XYZ gets his turn on Tuesday and they are not giving out call center numbers but the doc's direct office number. I'm wondering if it varies by location? Or the number of bands a doctor has placed?

Even OH (sponsored by Inamed) advertising is much different. All docs pay the same for advertising but in order to search for Mexican docs you have to have a name. You can't just click on Mexico and see all the docs in that area. US docs are divided by state, if you put your mouse over the state on the photo of the map it will list all the bariatric docs (that pay for advertising) in that state. Yet everyone pays the same for advertising.

The way I understand it, there is a contractual agreement between Inamed and Mexican docs. It has to do with the work the Mexican docs did on the band to perfect the band and procedure. They really did do quite a bit of work and much of the real time research so that is another reason they get the bands for less money.

Another issue, US docs ALWAYS have access to Inamed bands. When Inamed is running low on stock Mexico is the last place to receive shipments. They went for about two months with no bands at all recently and Inamed claimed that was because of customs. Well, come to find out that isn't true. But that one kind of backfired on Inamed because many docs switched over to the J&J band. However, many of the better docs had at least a month supply of bands for just these times. The docs that are not as busy and well known don't really have the $$ to keep that kind of an inventory available. So sure, there is a cost difference between Mexico and the US for bands but there are many reasons for that too. It seems to me that it all averages out in the end.

Certainly American patients having surgery by American doctors easily transfer their care without much fuss. American doctors do accept a lot of risk when they accept the care of a patient who had surgery out of the country. I agree that $1100 is way too much. To me that basically says that they don't really want to do it, but if you pay the outrageous fee then okay sure.

I would have to disagree with this. If a patient has surgery in CA and later moves to NY, trying to find a doc that will do follow up care is very difficult. Ask around, read the posts. People that are looking for a fill doc are not just Mexican banded patients, they are US banded patients.

I talked to Bart Bandy a few months ago. For those who may not be familiar with Bart Bandy (and yes, that's really his name <G>) he used to be the owner of Inamed. When he sold Inamed to Allergan he became the Sr. VP of Allergan.

I spoke with him a couple of months ago about some issues in the US. Namely, patients trying to obtain follow up care regardless of where they were banded. I'll even give you an example, and this is the example I gave Bart as well.

I had only been banded a couple of months or so and I went to a Nurse practitioner in AZ for a fill. I happen to have weird band problems and I don't tolerate fills well at all. I didn't know this at that time. I point that out because I don't want to make it appear she did anything wrong, she did not. But due to swelling I couldn't even keep my own saliva down. I was barfing about every 20 minutes for almost a full day and it got to the point that I was barfing blood and blood clots. It was 3AM and I was exhausted, getting dehydrated, and quite ill. No ER in the Phoenix area had a doc with a clue about bands and ports. All I needed was an unfill. The NP that filled me was out of town, she left the evening she did the fill and I was SOL.

What was I supposed to do? No US doc that I knew of at that time would see me, (I've since found three that will in a similar situation) no ER knew what to do with the port, my NP was out of town, and my surgeon was in Mexico. Not having many choices at the time I finally did an unfill myself.

Now, I'm a nurse and I know sterile technique, I understand the port, I know how it works. What if I didn't have that knowledge? What is someone to do if they don't have the supplies and know sterile technique? It's not exactly a matter of alcohol and a clean needle.

When I spoke to Bart Bandy he explained that he hires a lawyer to come to the certification classes and warn doctors that if they fill a patient they did not band, they now own the surgery. That's just a load. The board of medicine in AZ does not agree with this, medical malpractice insurance co's don't agree with this thinking, this is all from Inamed. They are frightening doctors into believing all kinds of things that are quite frankly, untrue.

My personal opinion is that Inamed started doing this to keep people in the US for surgery. Let's face it, if they sell the band to you they make more money than they do if they sell the band to my Mexican surgeon. It pays Inamed to keep people in the US for surgery. I don't think they banked on the fact that docs won't even fill a band placed by a surgeon in the US. What they have essentially done is to be proactive in preventing US patients from getting medical care. Just as I asked Bart, how stupid is that? That's just ignorant to put themselves in a position where they are responsible for that kind of liability.

Since when does a doc take ownership of the surgery for doing follow up care on another doc's patient? People have surgery every single day and they have no problem finding a doctor to do follow up care. What if I had a total knee replacement and let's say I had it done in Mexico. I wouldn't have any problem getting follow up care if I were to move, or if my doc were to die. It wouldn't be an issue. This is Inamed that has done this and I feel quite certain they are going to pay for this one someday. I think their greed is going to get the better of them. Someone is going to start a class action lawsuit against Inamed and I'll be behind them 100%.

I'll respond to the rest of your post in a bit.

[WASaBubbleButt 41]

What is happening now is that more insurance companies are paying for the band and soon it will be commoditized like gallbladder and hernia surgery and the aftercare will be fairly ubiquitous. Gastric banding is at an awkward state in the evolution of a new technology where you have early adopters having trouble getting care in their neighborhood. This will change over time.

I think the fact that J&J is in the picture now things will be changing. Historically Inamed pretty well got their own way since they didn't have any competition. Today they do, today they have J&J. It used to be that Inamed didn't give any deals on the band, something like buy 10 and get one free. Today they are reconsidering and thinking it might pay to give quantity discounts. That is only because of J&J IMHO.

I agree, insurance co's are doing a little better covering WLS but they still have a very long way to go. I have often wondered if the reason they don't like paying for WLS is because typically WLS is quite expensive and does not have a great deal of success. Look at the technique used 25 years ago for the sleeve procedure? What an ineffective horror. Look at the cost to follow a bypass patient. The labs, the complications, the strictures, everything. Then look at the number that eventually gain it all back again? What purpose did the surgery serve?

I can't help but to wonder if the band turns out to be effective 20 and 30 years from now, would insurance be pushing the procedure instead of making people jump through hoops to get it done? My own insurance covers banding but I went to Mexico anyway. Between the psych eval, nut eval, sleep studies, six month medically supervised diet, etc etc etc., I realized recently that had I used insurance vs. paying cash... by the time I would have been getting my first fill under insurance I was actually at goal by going to Mexico. The hoops they wanted me to jump through served them well, they didn't have to pay for my surgery because I was not willing to wait.

Medicare rates are truly at all time lows. Most of their reimbursement is below what it costs to provide the service (at a high level of quality and customer experience). Most physicians accepting Medicare are paying their light bills by other means.

I agree with you here. I suspect that people stuck it to Medicare for so many years that Medicare finally put their foot down and now they are doing a 180 here. Of course, I'm reminded of the gal on OH that had a band placed under Medicare and for whatever reason she thought she would have to pay $20 towards her fills and she wasn't willing to do that. She wanted a revision to bypass so she didn't have to pay the $20 out of pocket. How many times can Medicare play these games?

The main thing to recognize is that the informed patient will undertand that when you leave the country for low cost surgery, you are only buying the operation. Success = operation + post-op support. I'm always impressed by people that leave the U.S. every time they need a fill and get their aftercare out of the country. Most people don't (can't) do this.

Well, I live in AZ so my surgeon is only about three hours away from me. I can go there anytime I wish and it's not a big deal but that is not the case for many. There are quite a few people getting bypass vs. a band because they can't afford US rates for either a bypass or band and if they get a band they can't keep running to Mexico for fills. So they opt for bypass thinking there is no follow up care. Obviously, that isn't accurate.

I agree with you that it is ideal to have the support system in place but many who have surgery in the US don't have that. I drove three hours to Mexico for my surgery yet a person posting here who also lives in the Phoenix area drove 14 hours to Denver for her surgery last week. She's planning to go to Mexicali and see my surgeon for her follow up care because it's easier and cheaper. And if she were to have a complication or problem it is much easier to drive to Mexico vs. CO. So it really isn't just Mexican banded patients that experience the very issue you refer to, it is a good number of US banded folks as well. Look at the number of people posting here and on OH that drive hours and hours to see Dr. C for follow up care, same thing.

My doc is willing to do her follow up even though it really ends up costing him money but his explanation is that there are docs that do follow up for his patients, it's only fair to do follow up for other doc's patients. He charges $175 for fills on people he did not band. $100 goes to the Asst. surgeon for doing the fill, $75 goes to the hospital for radiology services, and my doc gets to pay for the supplies. :confused: But he's right, fair is fair. If US docs are going to follow up his patients he needs to return the favor.

The other thing that makes my eye twitch is that I've known many examples of people who purchased the operation only -very cheaply- and over the next year spent more money in total getting their aftercare than if they had just stayed in our practice and received their care by an amazing team right in their neighborhood. (Cheap surgery can be expensive). We've also seen patients that come back from "cheap surgery" with a disaster and end up paying two and three times what we charge simply fixing complications. That scenario gives me heartburn. It just shouldn't happen.

Sure, these things do happen. Just as in any country there are good docs and bad ones. If you'll notice the link in my sig it is how to research Mexican doctors. While there are jerks in Mexico there are also quite a few very good docs. If someone can't afford US prices they either leave the country or go without surgery. I think that is a shame.

While complications certainly happen in Mexico they happen in the US as well. Look at all the infections happening lately. I have not seen a single post from anyone that went to Mexico and had surgery in the last few months that came home with an infection. But there are plenty that are coming home with infections in the US. Did you know that according to the CDC US hospitals have higher infections stats than Mexican hospitals. Now, this could be that they do fewer elective procedures or a few other reasons. But the point is that Mexico does have a lower infection stat than the US. I don't know what it is about infections lately but my goodness, people are posting a great deal lately about infections. It's spooky.

I've heard of several patients that came back with just a port and no band inserted. I've heard of several patients where a non-traditional band was inserted - some of these look like they were made in someone's garage. I've heard of nurses stealing the narcotic pain medications and injecting patients with saline and patients being in pain with the "pain medication" not working. We've had to remove several bad band infections in patients that went outside the U.S. Many places outside the U.S. will re-use disposable instruments by soaking them in anti-septic solution (i.e. not sterile) because it's cheaper than sterilizing reusable surgical instruments. If you don't use sterile instruments your infection rate is going to be higher.

I know exactly what you are talking about. There was a Mexican doc (I believe he was in Monterrey) and he was actually making his own band. He referred to it as the "Mexican" band. He and his asst surgeon placed about 650 of these bands and a whopping 50% eroded. One would THINK that after removing the first 100 bands to erosion they would have a bit of a clue but nope, it took 650 bands and over 300 erosions before they quit using that band and began using Inamed. That surgeon was murdered and the bands are no longer being made or placed but sure, it happened.

That's why patients need to research regardless of where they are having surgery. I don't care if it is the US, Mexico, India, or anywhere else. They have to do their research. It is surgeons like that, that give all Mexican docs a bad name. Yet if the same level of horror happens in the US people don't claim all medical care in the US is risky. There are posts right here regarding liver lacerations, stomach lacerations, infection, and everything else including death and these folks had surgery in the US. We tend to forgive those docs because they are US docs. But Mexican docs are a different story.

As for nurses taking the narcotics, that happens every single day in the US. I used to work for a hospital and part of my job was to catch these nurses. It was much easier than many think but due to the Pyxis system it made it almost simple to catch them. If you look at the board actions for nurses or docs in AZ, the greater majority of the board actions involve drug and alcohol abuse (Arizona Medical Board - Protecting the Public's Health). Nurses take patient's meds all the time. Orders might be to give 6mg IV morphine. Maybe the patient gets 3mg and the nurse keeps 3mg. Happens all the time. There was one nurse that was so used to popping drugs she didn't even think twice about it and one day I was at the Pyxis and she was at the other, about 2' away from me. She entered the patients name and info, removed a Vicodin, and popped it in her mouth right in front of me.

I have no doubt US docs have had to remove bands that were placed wrong, infected, etc. But Mexican docs do the same. My doc operated on a botched bypass patient. Patient had bypass in the US and the surgeon essentially butchered her. She couldn't find anyone to fix it. Either they didn't have the skill to undo the damage (according to the family her case was very tricky and quite complicated) or they didn't want to mess with their stats. Regardless, she couldn't get it taken care of in the US. She resorted going to Mexico and having the problems repaired there. So sure, there are some really bad docs in Mexico and they pretty well butcher their patients. But that is not the norm just like it isn't the norm in the US.

To prevent infections, U.S. operating rooms are required (and regularly inspected) to have laminar flow whereby the ventilation system is in the ceiling in the center of the room and the air flows down and out away from the operating table.

I am familiar with Laminar flow hoods and when I worked at mayo we had the same set up as you describe in OR. With all the precautions we take in the US we really shouldn't have any hospital caused infections such as MRSA but again, our stats are higher than Mexico for infection. And nursing homes? Holy crap, MRSA spreads faster than the staff can keep up with. It's usually lazy behavior on the part of the staff.

All in all I think the US and Mexico have very similar issues in many ways. Infections, bad doctors, lazy nurses who steal narcotics, botched surgeries, the works. That is why I push research, again... see my sig link. We are less forgiving of Mexican docs vs. US docs. What would really be ideal is to make the band more affordable to everyone, more accessible to people, and much fewer hoops to jump through to satisfy the insurance co's.

Anyway, I like you too, WASaBubbleButt. You make me think.

brad

Thank you. One person here often times says we should all meet in real time and discuss these kinds of issues over a bit of wine or imported beer. It would be kind of fun to get everyone on the boards together for some good discussion. One point I would like to clarify... in rereading this post I am writing it appears that I am anti-US and pro-Mexico. That is not my intent at all. My first choice for people is to stay in the US for surgery. But there are many people that simply can't afford US prices so they either leave the country or go without. That isn't right.

[Dibaby 0]

I'm wondering Dr. Watson, do you do fills for patients that have their bands placed by other surgeons? I have also have had issues with finding a fill doctor and think it's ridiculous that doctor's get away with turning patients down. It's like saying..sorry your knee replacement was done by such and such doctor..I can't look at it even though I'm qualified to do so.

[NM Sunshine 1]

After reading the posts by Dr.Watson and WASA, I am extra happy that I choose to pay more so that I could have my surgery done in Hospital Angeles. I also spent 2 &1/2 days there. The hospital is brand new and state of the art. It's right over the border from San Diego.< /p>

[urbrdfs 0]

What happens if you don't know it has eroded? Say you've had the band 3 years, no problems, only have a slight fill without plans to have another fill anytime soon (therefore since I am self-pay would not have the fluro done). Can it be lifee-threatening?

[WASaBubbleButt 41]

I'm wondering Dr. Watson, do you do fills for patients that have their bands placed by other surgeons? I have also have had issues with finding a fill doctor and think it's ridiculous that doctor's get away with turning patients down. It's like saying..sorry your knee replacement was done by such and such doctor..I can't look at it even though I'm qualified to do so.

Actually, it is more like saying, "Dr. ABC did your surgery and he got the big bucks for surgery. Follow up isn't much of a money maker so if I didn't get the surgery, I'm not doing the follow up."

[Dibaby 0]

Actually, it is more like saying, "Dr. ABC did your surgery and he got the big bucks for surgery. Follow up isn't much of a money maker so if I didn't get the surgery, I'm not doing the follow up."

Yeah I get what your saying..but come on..where is there any other surgery that doctors get away with that? Really it seems illegal.