Lap-Band Problems - and solutions

I think most would agree that this is a place designed exactly for those who are pursuing WLS, living with a band, or have experience living with a band/WLS to post comments and discussion.

Are you going to evade every question that is put to you ? I'll make sure that I return the favor.

I wonder if you could help me to tell me what you think my problem is?

 It seems I can not get a straight answer to find out my problem.  These postings of people who are not giving you a chance to share your information does not seem to me to be fair.  I don't believe you would be wasting your time on these postings if you didn't care about people.  After you give your opinion for peoples problems after surgery, it is up to the individual to decide to listen to you or go elsewhere for information to help them.

 At any rate....I have a major problem and it has been going on for almost as long as I had my surgery.  My lapband was put in 1 1/2 years ago.  Within the first 2 months I lost about 20 pounds because of the kind of diet I was on (basically liquids and soft foods) and then gradually about 5 pounds more.  Then that was IT!  Not only did I not lose any more weight but I have begun gaining weight.  I got my procedure done in NJ...I kept going when it was time to get adjustments.  I had no restriction AT PARTICULAR TIMES OF THE DAY!  I capitalized those words to realize the importance of that sentence.  In the morning if I even ate 1 or 2 bites of an egg,(for example) I might get a feeling that I can only describe as a hurting (kind of a pressure) in my chest to my throat.  It wasn't painful but very very uncomfortable....to the point that I would have to force myself to gag up and what would come up was unbelievable thick flem/mucus.  When it all came up, I was able to eat absolutely anything I wanted and as much as I wanted.  Because after I brought the mucus up I was able to eat anything and everything, I kept getting filled.  In NJ I was up to 11 1/2 (believe it or not!)  I was told that by law you should never even go more then 11 as the absolute top when getting filled but my doctor kept filling me because I was having no restriction in the EVENING meals.  At lunch often I would have to gag up the horrible flem most of the time but again, once I did that I was able to come back and eat entire salad or whatever.  In the evening I rarely had the problems of gagging and could eat basically whatever I wanted and as much as I wanted.  The doctors only told me they thought I had reflux and gave me prevacid to take every day which really didn't help a whole lot.  

I moved after about a year to Florida and am now an hour away from the Cleveland Clinic in Weston, Florida.  I thought maybe my doctors in NJ just couldn't figure out exactly what was wrong with me and why I keep having this development of mucus that I must get rid of.  The horrible feeling in my chest/throat is just overwhelming when it happens.  I can hardly even talk.  After I get rid of the flem I feel PERFECT and can sit down to an entire meal ****ep repeating the same thing because I need you to understand exactly what is going on with me)  When I went to the Cleveland Clinic they decided to take ALL the fluid out of the lapband so they could give me a laposcopy because they did not like the syptoms I was having and wanted to make sure EVERYTHING about the lapband was the way it should be from the inside out.   I had the procedure, they saw everything was fine...they told me that for 3 months they did not want me to have a fill and to give my body a chance to totally heal.  I had NO problems whatsoever after they took all the fluid out.  After 3 months I went back and they began filling slowly but surely based on the fact that I was feeling ok and not having symptoms as before.  I went 3 times and am now filled to 8 1/2.  I am having the same problems as before.  EXACTLY the same!  This has been going on for about 4 months now.  I don't want to get any fluid taken out because I am afraid I will have NO restriction but at the same time I don't want this horrible hurting of which is there because of the development of this thick mucus that needs to be gagged up.  If I ALWAYS had the same problem every single time I sat down to eat, it would all make much more sense to me but that is not the case so it is driving me crazy.  The doctor also said I have a "lazy esophogus" and that in the morning the esophogus doesn't work as well when you first wake up and then afternoon a little better and then by evening it is working to full capacity.  This could be the problem but what can I do? And WHY am I developing all this mucus that has to come up before I can feel better? Obviously when the doctors see the band in the xray after giving me the solution to drink up, they would not over fill me if they saw I was having any problem with the thick drink going down.  So what is the problem and what can I do about it.  Also wondering if ANYONE out there is having this same problem!  If I was suffering through this and was losing weight I would probably still try to figure this out because it hurts so much and who wants to keep excusing yourself from the table all the time to try to feel better and then eat an entire meal when they come back, IF you can't even lose weight!  I am tired of suffering and tired of not only not losing weight but now beginning to GAIN weight.  Please help me to understand and give me a suggestion of what is going on with me.  Have you ever heard of this with any of your other patients?

the lap band is not about restriction - and it does not work well that way. The band is about appetite suppression. 

Your band is too tight now- you need to find a place where it doesn't feel restricted-

What you want is to eat a small amount of food- and two hours later not be hungry

More information see this link'

http://drsimpson.net/fills/Lap-band-surgery-support-science/notes-from-Dr-Terry-Simpson/lap-band-decreases-appetite/lap-band-decreases-appetite.html

Hmmm looks like IDB's post and our replies got pulled?  I thought it was quite eye-opening. 

Probably because whoever that is published stuff that was (a****rue (b) greatly exaggerated (c) stuff that no one would know which makes me wonder who the person is (d) all while remaining under cover of anonymous  .  

There certainly was a lot of detail in that post.  If those things were not based in fact why do you suppose someone would fabricate a story with that level of detail, and examples?  What would be the potential gain for that individual?  I really don't see one other than an effort to warn others if those statements are true.  You still have not provided any data to substantiate your statement that the "stomach re-grows", speaking of stuff that isn't true.  

The level of detail was astonishing - and wrong. For example: in our electronic medical record we went through to see the patient who had that first name described: we got them all, contacted them - none of them has had a band removed. One patient with that name had a band elsewhere- came to us once, and we had a long note - she was not our patient, and she never came back to us- had her band elsewhere. 

Who would talk to "all patients" and come up with those conclusions? *****ally no one - should raise suspicion.

There were other details that were flat out fabricated and some that had a grain of truth but greatly exaggerated. 

So - you might ask- who might this be? Someone who takes such a great interest in me and my practice, yet is not a patient? A former employee - an ex-girlfriend?  The gain is not to "warn" but the gain is to ruin my reputation. I can think of one person- and their motives. But yes- that is the question. 

Stomach re-grows is what we have observed in band over sleeve or band over DS (which is sleeve). When failure rate is looked at long-term that is what we suspect - stomach stretching. It does happen - you can hold more now than you did when we first got the sleeve.  So call it "regrowth" or stretching- but it happens - and sometimes we have to stretch it- if the sleeve is made too tight (few surgeons use 32 Fr to guide the band - most of use larger because of the data shown).  So what do you wish- my operative reports of band over sleeve? X-rays of them? Or that there are failures and not complete weight loss make sense?

In terms of the person who wishes to say bad things about me - take it for what it is worth. Imagine my position, if you would- should I do a point by point response? This post isn't about that, and there is a rule- don't get in a ******g contest with a snake, especially when they won't come up and be open as to who they are and what they know

"Stomach re-grows is what we have observed in band over sleeve or band over DS (which is sleeve). When failure rate is looked at long-term that is what we suspect - stomach stretching. It does happen - you can hold more now than you did when we first got the sleeve.  So call it "regrowth" or stretching- but it happens - "

So doc..what is it...REGROWTH or STRETCHING? These are 2 different things....and lends alot to you NON credibility.

Semantics but stretching is the vernacular. When you look at most websites about the sleeve or DS they talk about long term "stretching" but here is what does not happen:

The stomach does stretch, but it is not like a balloon that stretches- the cells cannot go beyond their small space and the elastic tissue that makes up some of the interstitial space can only go so far. If you look inside the stomach of a sleeve patient one two and three years out they are larger- but the inner layer, or mucosa is all there. This means the lining of the stomach - with all its function, is there. So it has re-grown.  

The best pathology of this is seen in patients who have had partial gastrectomies for cancer, (partial removal of the stomach, or a lot of it) for cancer. Then we have to re operate on some for recurrent cance. Wen those are put under the microscope, you see all layers of the stomach - so it does re-grow. The mechanism is  debated - but there is no doubt that there is new stomach tissue, in the mucosa, submucosa, muscular, and serosal layers. All new tissue - new cells not "stretched."

But, we call it stretched - 

There is your answer.

My personal observations in patients who have had sleeves or DS and were banded - the stomach size is the same size as it was originally- or close to it. Some surgeons use to say that was because the original surgery wasn't tight enough - meaning instead of using a 32 Fr guide a larger one was used.  But Gagner came out with a paper a few years ago where there was no difference at five years between those who had a 38Fr sleeve or a 60 Fr sleeve.  Recenly a paper came out saying that less than 40Fr led to more leaks than 40Fr or more. 

We think re-stretch of the sleeve happens by challenging the stomach with larger and larger volumes.  There is abosolutly no data for this- it is all speculation. Some people who have had regrowth of stomach had their original operations on video- and when reviewed by independent surgeons there was no technical reason they could see for any regrowth. We don't know why that happens- we don't know if there is anything that can be done to prevent it, or if some people will simply get it and some not.