Re: Please help - Banded in 2005-long post

[Guest guest]

Hi, Jenn - welcome!

Estrogen is stored in fat, and when we lose, the estrogen is

released, increasing fertility a lot. we have to be extremly careful

with birth control, if we would prefer to delay prgnancy until we are

at a good wight. the surgeons should be very clear abut our needing

excellent birth control, beginning at least a minth before banding.

But congrats on the baby! I bet you'e busy with a little one! do you

have other kidlets too?

do think about reliable BC now, though.. :-)

There is no need to to unfill automatically with a pregnancy. We only

need to unfill if we are having symptoms requiring it - a lo o nausea

or vomiting, or if the fetus is growing too slowly. you did great and

gained only what is recommended for a healthy pregnancy anyway! ther

is NO need to gsain the 50-100# some women do.

I'm sorry you have a leak. You should request a simple dye test to be

sure, so you kow what you are dealing with. too much does not make

sense here, to me!

if there is a leak, it is ABSURD for your doc to " want to fill you

more often " instead of FIX the leak!! It is hard enough to get to a

good, fairly consistent level of restriction, without the up and down

of a leak! He will be tempted to overfill you, since the fill will

be leaking out, and this is very unsafe. You will have no chance of

getting much help from the band, as it is.

You have EVERY right to insist on a fix. It dos not require a whole

new band. All it requires in a port replacement. almost all leaks are

in the 1-2 inches right next to the port, and a port replacement

(with the 2-3 inches of attached tubing) fixes it.

this is a simple, 30-min out-patient procedure under a local

anesthetic and is not a big deal.

If the leak is elsewhere (higher up) a whole new band will be needed.

but the good news is that the new Inamed AP bands came out a year

ago, and are thought to be far superior - so you should be sure to

get one of these. almost all Us docs use only these bands now, bu the

MX docs cannot get them and are forced to use only the old-style

bands.

For this reason alone,

I would not be banded (again) in Mexico at this time.

Plus, your insuracne will pay for a new band - but you must have only

a highly-expeienced band surgeon place it.

The fluid barely tricking thru, yet your being able to eat almost

normally - PLUS the fluoro showing no dilation, etc all makes NO

sense.

I'm going to have to urge that you consult another more experienced

band surgeon. the military is very new to banding, and my suspicion

is that you need a doc much more exprienced, especially with Band

glitches.

Is it psosible for you to go see the surgeon who originally placed

the band? or another local skiled one?

In the meantime, all you can do is re-committ to good band eating,

food choices, improve your exercise and fluids, and pay attention to

getting the nutrients needed.

I'd suggest you review the basic band documents in the file here, for

more. There are several new things in the last year or two you may

not be aware of.

1. band guide

2. Vitamin document

3. Water doc.

4. exercise doc.

5. suggested reading

6. Protein, fiber, etc documents.

Please keep in touch and let us know what you find out. Glad you

found us!

sandy r, BSN, MN

band educator

at goal 4.9 yrs

-- In , " jennsntexas "

<jennsntexas@...> wrote:

>

> I had the 4cc band put in back in March of 2005. I started at a

> weight of 285 (at 5'10) and lost 85 lbs. In 2006 I became

pregnant

> and didnt have any fluid removed mostly because I had moved and

lost

> my job/ insurance that covered the lapband maintanence. The Dr.s

> followed me closely and I only gained 19 lbs during my pregnancy

and

> had a healthy 8.5 lb baby boy. Two weeks after the birth, I was

down

> to 5 lbs below my pre pregnancy weight. I will say I picked up a

> few bad habits during my pregnancy like drinking with my meals,

> etc. I have worked hard to break those habits, but despite my

> effort, I have gained 19 pounds back. I now weigh what I did when

I

> was 9 months pregnant!! ahhh

> The military insurance in the meantime has started covering the

> lapband and I have been able to get some fills. The first time I

> went to get a fill after my pregnancy, I had lost 2 of the 3 cc's I

> had before I was pregnant. The Dr. filled me up to 2.5 and wanted

> to see what that would do. Well, it didn't seem to do much, so a

> few months later I went back to see if he would fill me up to 3.

> When he removed my fill, I had lost .5 cc's. I guess I have a slow

> leak. He said we will monitor it because they would rather fill me

> more often that have a revision surgery for a slow leak. I, on the

> other hand, would rather get a new band put in and start over.

> Here is my delima....

> I am able to eat so much more than I have ever been able to. When

> we do the fills under flouro, he fills me to the point that the

> fluid barely trickles through (all of the fills are done before 9

am

> in his office) He says my pouch isn't dialated, but I don't

> understand how I am able to eat so much more with no pb's or any

> discomfort??? Not too long ago, I ate 3 pieces of pizza with no

> problems. (I don't normally EVER eat that much. Even though I

> could, I stop myself. I was just having a really bad night and let

> my emotions get the best of me.) I can eat anything with out

> complications or discomfort. On the rare occasion I ever start to

> get a twinge of discomfort, I just take a deep breath and it goes

> away.

> What do I do?? The Dr. says he can't fill me more cause the fluid

> is barely trickling through on the flouro, but after the fill, I

can

> almost eat what I did prebanded. What in the heck is going on?? I

> want to feel what I did a couple years ago. I had problems with

> even taking medication! I want to feel that way again!!

>

> Any advise would be appreciated!

>

[Guest guest]

Thank you for taking the time to write me back to that extent. I am

sooo puzzled too. I have really been paying attention to what

happens when I eat and basically, I can take a drink of really cold

water and feel it sit there for a bit. Then all of the sudden it's

like someone pulled the stopper out and it feels like it all goes

through at once. Kind of the same way with the food. When I eat a

few bites, (bigger bites than if I were restricted correctly) I will

start to feel the full feeling, but then it is like out of

nowhere,the bottom of my pouch opens up and dumps it all out. It

literally feels that way especially if I take a deeper than normal

breath. So strange. Unfortunately, I cannot go to another Dr.

This is the only one the insurance will cover here and I cannot

afford the 1,200 start up fees to see a private Dr. I don't know

what to do. I have an appt. set up for next Wednesday. I too feel

that maybe they aren't as experienced as I would like for them to

be, but they are my only choice. I can't blame him too much though

because I can see on the flouro the barium just sitting there when I

take a drink after the fill. I can see why he thinks I am filled as

far as I need to be, but it is impossible since I could eat at least

3/4 as much as I could preband if I chose to.

> >

> > I had the 4cc band put in back in March of 2005. I started at a

> > weight of 285 (at 5'10) and lost 85 lbs. In 2006 I became

> pregnant

> > and didnt have any fluid removed mostly because I had moved and

> lost

> > my job/ insurance that covered the lapband maintanence. The

Dr.s

> > followed me closely and I only gained 19 lbs during my pregnancy

> and

> > had a healthy 8.5 lb baby boy. Two weeks after the birth, I was

> down

> > to 5 lbs below my pre pregnancy weight. I will say I picked up

a

> > few bad habits during my pregnancy like drinking with my meals,

> > etc. I have worked hard to break those habits, but despite my

> > effort, I have gained 19 pounds back. I now weigh what I did

when

> I

> > was 9 months pregnant!! ahhh

> > The military insurance in the meantime has started covering the

> > lapband and I have been able to get some fills. The first time

I

> > went to get a fill after my pregnancy, I had lost 2 of the 3

cc's I

> > had before I was pregnant. The Dr. filled me up to 2.5 and

wanted

> > to see what that would do. Well, it didn't seem to do much, so

a

> > few months later I went back to see if he would fill me up to

3.

> > When he removed my fill, I had lost .5 cc's. I guess I have a

slow

> > leak. He said we will monitor it because they would rather fill

me

> > more often that have a revision surgery for a slow leak. I, on

the

> > other hand, would rather get a new band put in and start over.

> > Here is my delima....

> > I am able to eat so much more than I have ever been able to.

When

> > we do the fills under flouro, he fills me to the point that the

> > fluid barely trickles through (all of the fills are done before

9

> am

> > in his office) He says my pouch isn't dialated, but I don't

> > understand how I am able to eat so much more with no pb's or any

> > discomfort??? Not too long ago, I ate 3 pieces of pizza with no

> > problems. (I don't normally EVER eat that much. Even though I

> > could, I stop myself. I was just having a really bad night and

let

> > my emotions get the best of me.) I can eat anything with out

> > complications or discomfort. On the rare occasion I ever start

to

> > get a twinge of discomfort, I just take a deep breath and it

goes

> > away.

> > What do I do?? The Dr. says he can't fill me more cause the

fluid

> > is barely trickling through on the flouro, but after the fill, I

> can

> > almost eat what I did prebanded. What in the heck is going

on?? I

> > want to feel what I did a couple years ago. I had problems with

> > even taking medication! I want to feel that way again!!

> >

> > Any advise would be appreciated!

> >

>

[Guest guest]

If you are almost closed off, you need far less fill. you're flirting

with even more serious problems here, imo.

I'd suggest you ask for a referral to a GI doc for further tests,

including esophageal motility tests. What you are describing is

typical of E.M porblems ffrom a damaged esophagus fom too-tight ills.

With a bad fill, the esophagus can and often does suffer permanent

damage, and this can require the bandto be removed.

You ALWAYS have a choice in thr docs you go to ! You're just not so

willing to put the band first, here. sorry.

Consulting another doc is not $1200 and could well save your band.

It's always up to you to what degree you care about your band and

what you are willing to do to keep it.

A bit of " tough love " here becuase I'm very concerned about you.

Sandy

>

> Thank you for taking the time to write me back to that extent. I

am

> sooo puzzled too. I have really been paying attention to what

> happens when I eat and basically, I can take a drink of really cold

> water and feel it sit there for a bit. Then all of the sudden it's

> like someone pulled the stopper out and it feels like it all goes

> through at once. Kind of the same way with the food. When I eat a

> few bites, (bigger bites than if I were restricted correctly) I

will

> start to feel the full feeling, but then it is like out of

> nowhere,the bottom of my pouch opens up and dumps it all out. It

> literally feels that way especially if I take a deeper than normal

> breath. So strange. Unfortunately, I cannot go to another Dr.

> This is the only one the insurance will cover here and I cannot

> afford the 1,200 start up fees to see a private Dr. I don't know

> what to do. I have an appt. set up for next Wednesday. I too feel

> that maybe they aren't as experienced as I would like for them to

> be, but they are my only choice. I can't blame him too much though

> because I can see on the flouro the barium just sitting there when

I

> take a drink after the fill. I can see why he thinks I am filled

as

> far as I need to be, but it is impossible since I could eat at

least

> 3/4 as much as I could preband if I chose to.

>

[Guest guest]

Sandy,

I can take the tough love and appreciate it. I never thought it

could be an esophageal problem. Wouldn't there be other signs or

symptoms?? I never PB or feel stuck. I would guess I would notice

something, but I will def. get that checked out.

Back before the military covered the band, I did check into going to

a different Dr. but they did tell me it would be $1,200 because he

didn't band me. That is when I first found out I was pregnant. I

didn't end up going to him because I decided to " ride it out " for a

little bit and see if I needed an unfill and it turns out I didn't.

I was able to gain what the baby needed and had a happy healthy

pregnancy. During the time of my pregnancy, the military's

insurance decided to cover the band and I didn't go for my first

fill until about 4 months after he was born. That is when I noticed

I could eat much more than I had been before without the " full

signs " . Back in 2005 and 2006, I was filled to a 3 in a 4cc band

and that seemed to be my sweet spot. When I went in for a fill in

2007, I was down to 1cc. He took me up to a 2 to be on the cautious

side and that didn't seem to be enough. I went back 2 months later

and when he checked my fill level, I had lost .5cc. So, that is

what leads him to believe I have a slow leak. This last time, he

was only about to comfortably fill me to a 2.5 before he felt it

might be too tight. I too saw the barium sitting there and slowly

trickling and figured 2.5 would be perfect. Not so, I can still

eat too much if I were to let myself.

I know I was at a 3 at one time and felt great there. But, I don't

understand why during the flouro, it is barely trickling. Could my

needs have adjusted that much, or I am wondering if maybe

the " stress " of the fill causes a lot of swelling and tightness that

shows I am tighter at the time than I will be a few hours later.

I dunno, but thanks for your advise and for " listening " . Hopefully

I can get this figured out next Wednesday.

> >

> > Thank you for taking the time to write me back to that extent.

I

> am

> > sooo puzzled too. I have really been paying attention to what

> > happens when I eat and basically, I can take a drink of really

cold

> > water and feel it sit there for a bit. Then all of the sudden

it's

> > like someone pulled the stopper out and it feels like it all

goes

> > through at once. Kind of the same way with the food. When I

eat a

> > few bites, (bigger bites than if I were restricted correctly) I

> will

> > start to feel the full feeling, but then it is like out of

> > nowhere,the bottom of my pouch opens up and dumps it all out.

It

> > literally feels that way especially if I take a deeper than

normal

> > breath. So strange. Unfortunately, I cannot go to another Dr.

> > This is the only one the insurance will cover here and I cannot

> > afford the 1,200 start up fees to see a private Dr. I don't

know

> > what to do. I have an appt. set up for next Wednesday. I too

feel

> > that maybe they aren't as experienced as I would like for them

to

> > be, but they are my only choice. I can't blame him too much

though

> > because I can see on the flouro the barium just sitting there

when

> I

> > take a drink after the fill. I can see why he thinks I am

filled

> as

> > far as I need to be, but it is impossible since I could eat at

> least

> > 3/4 as much as I could preband if I chose to.

> >

>

[Guest guest]

A great many things can change along the band journey. When we have a

lengthy unfill (more than about 2-3 weeks) or a pregnancy, or any of

a large number of things, all bets are off!

A fill of (for instance) 2 cc before that might have been great

before, has nothing at all to do with what a good fill level may be

now.

As an example, I had a small esophagus dilation about 15 months out,

and needed an unfill and rest period of 3 months. When I got

unfilled, I was at about 3.2 cc in a " 4 " cc band.

After I started re-fills later on, I could not get one drip above 2

cc without starting severe reflux. I've tried a few times in the last

3 yrs, and still cannot get even a tad above 2 cc.

What happened, we are pretty sure, is that scar tissue filled in when

the band was unfilled, and this is pretty common. It does not mean

we cannot get to another good fill level, it just means the NEW good

level is likely to be VERY different than the " old " good level. THis

is one of many reasons why we can never just jump right back to any

previous level after an unfill.

With esophageal problems, there can be no symptoms other than what

you describe - a sudden emptying of stuff in the pouch. Others may

have a great delay in emptying, a lot of reflux, or other things.

I believe a lot of people have mild esophageal problems even before

banding, and are never tested for them since they may have no or

unclear symptoms. Then the band can make them worse, especially if we

have a big fill or TOO much fill. I think much more pre-op testing

needs to be done.

This is a re-post of a study I posted here early in september, 2008:

" This is an important study, and confirms my belief that we need pre-

banding esophageal studies to evaluate possible motility problems

that might indicate banding is NOT wise. This is pretty clinical -

so go to the " conclusion " at the bottom for the most impt info.

Sandy r

Obes Surg. 2008 Jul 29. [Epub ahead of print] Links

Lap-Band Impact on the Function of the Esophagus.Gamagaris Z,

C, Schaye V, Francois F, Traube M, Fielding CJ, Fielding

GA, Youn AH, Weinshel EH.

Division of Gastroenterology, Department of Medicine, New York

University School of Medicine, Bellevue Hospital Center, 462 First

Avenue Room 10E1, New York, NY, 10016, USA, gamagz01@....

BACKGROUND: The laparoscopic adjustable gastric band (LAGB) has been

widely used to treat morbid obesity. There is conflicting data on its

long-term effect on esophageal function. Our aim was to assess the

long-term impact of the LAGB on esophageal motility and pH-metry in

patients who had LAGB who had normal and abnormal esophageal function

at baseline.

METHODS: Consecutive patients referred for bariatric surgery were

prospectively enrolled. A detailed medical history was obtained, and

esophageal manometric and 24-h pH evaluations were performed in

standard fashion preoperatively and 6 and 12 months postoperatively;

patients served as their own controls. RESULTS: Twenty-two patients

completed manometric evaluation. Ten patients had normal manometric

parameters at baseline; at 6 months, mean lower esophageal sphincter

(LES) residual pressure increased significantly from baseline (3.9 +/-

2 vs. 8.9 +/- 4 mmHg, p = 0.014). At 12 months, the mean peristaltic

wave duration increased from 3.6 +/- 1 at baseline to 6.8 +/- 2 s, p

= 0.025 and wave amplitude decreased during the same period (98.7 +/-

22 vs. 52.3 +/- 24, p = 0.013). LES pressure and percent peristalsis

did not differ significantly pre- and post-LAGB. Twelve patients had

one or more abnormal manometric findings at baseline; at 12 months,

LES pressure in these 12 patients decreased significantly (31.1 +/-

10 vs 23.6 +/- 7, p = 0.011) and wave amplitude was significantly

reduced (125.9 +/- 117 vs 103 +/- 107, p = 0.039). LES residual

pressure did not change significantly pre- and post-LAGB. Twenty-two

individuals were evaluated for impact of Lap-Band on esophageal acid

exposure. Sixteen of these patients had normal esophageal pH-metry

values at baseline and had no significant changes in 12 months in any

pH-metry measurement. Six patients had abnormal pH-metry values at

baseline. Among these patients, time with pH < 4.0 and

/DeMeester score did not change significantly during follow-

up. There was a significant decrease in the number of reflux episodes

from baseline to 6 months (159 +/- 48 vs. 81 +/- 61, p = 0.016).

**** CONCLUSIONS: Abnormal manometric findings are frequently

encountered post-LAGB. Increases in LES residual pressure and

peristaltic wave duration were the most significant changes. LAGB is

not associated with an increase in total esophageal acidification

time. Further evaluation of the clinical significance of manometric

abnormalities is warranted.

PMID: 18663546 [PubMed - as supplied by publisher]

> > >

> > > Thank you for taking the time to write me back to that extent.

> I

> > am

> > > sooo puzzled too. I have really been paying attention to what

> > > happens when I eat and basically, I can take a drink of really

> cold

> > > water and feel it sit there for a bit. Then all of the sudden

> it's

> > > like someone pulled the stopper out and it feels like it all

> goes

> > > through at once. Kind of the same way with the food. When I

> eat a

> > > few bites, (bigger bites than if I were restricted correctly) I

> > will

> > > start to feel the full feeling, but then it is like out of

> > > nowhere,the bottom of my pouch opens up and dumps it all out.

> It

> > > literally feels that way especially if I take a deeper than

> normal

> > > breath. So strange. Unfortunately, I cannot go to another

Dr.

> > > This is the only one the insurance will cover here and I cannot

> > > afford the 1,200 start up fees to see a private Dr. I don't

> know

> > > what to do. I have an appt. set up for next Wednesday. I too

> feel

> > > that maybe they aren't as experienced as I would like for them

> to

> > > be, but they are my only choice. I can't blame him too much

> though

> > > because I can see on the flouro the barium just sitting there

> when

> > I

> > > take a drink after the fill. I can see why he thinks I am

> filled

> > as

> > > far as I need to be, but it is impossible since I could eat at

> > least

> > > 3/4 as much as I could preband if I chose to.

> > >

> >

>