Ask Dr. Curry?

I would like to ask you about what's been going on with me.  I was banded on June 30,2008.  I'm filled to 5ccs from 2 fills.  I was doing fine for a while but then I went through a period of about 3 weeks where everything I ate I vomited up.  The past couple of days I've been hungry and I could eat fine.  Now today I tried to eat scrambled egg for breakfast, but I could only take 3 bites.  I felt like it was sitting there.  I'm only down 55 lbs since June.  Nothing has come off for the last 2 months.  I'm exercising and trying to eat enough protein.  Can there be something wrong?  Or am I not doing this whole thing the right way?  I starting to get very fustrated.

Thank you for your time.

Christine

I think you probably need a barium swallow to assess your pouch size and band position.  As far as whether you're doing this right, that's something that you probably need to sit down with your surgeon and dietitian to figure out.  Best of luck to you though.

Hi Dr Curry!  Thanks for taking the time out to answer our questions.

I am getting conflicting information about how much a body can absorb protein at one time.  Some are telling me that we can only absorb 20grams at a time, and others are telling me more or less, or that it can be absorbed completely.

I want to make sure I am meeting my protein intakes, and do eat meats to meet that goal.  Once I used Fitday to determine the protein of a trimmed rib eye, and it said 64 g of protein.  Do we absorb all of that - or should I only consider that a portion is absorbed, and that I need to seek out additional protein as the day goes on?  The same is for the protein bullets - they have 50g of protein in them if you drink the whole thing, are you wasting it because you can only take in so much grams of protein?

We don't really know for sure, I've asked my dietitians this a number of times.  Personally I don't think you are wasting the protein, but I also don't think it's a good idea to try to get all your protein in at one time of day.  Your body doesn't really have good ways of storing protein in the short term, so a slow and steady supply is much better.

Thank you for your insight. 

Some history:  I was banded by Dr Ortiz 10-1-07, he also repaired a hiatal hernia.  Three fills at FCUsa (5 hours away).  Last fill 1-10-08.  Back to Mexico for a look at my band using fluoro on 10-18-08.  Great restriction, band looks good.  I have lost 95 pounds and I am very happy here.  My loss slowed down because I did.  Perhaps in the summer I'll get back to the gym to lose the last 10 pounds.  I do not eat anything for at least 3 hours before bed - I have never been a night time eater and I know it can cause problems.  I do take my four pills, one hour before bed.  The biggest is bupropeon.

The problem:  This has happened 4 times in the last 7 days.  After being in bed about 5 or 6 hours, I begin getting a foul tasting foaming back-up.  I swallow, or spit, and cough.  The only way to get it to stop is to get up.  I am able to eat as usual the rest of the day.  BTW - I get VERY crabby with only 6 hours of sleep.

Observation:  I HAVE been under quite a bit of stress the last month.  For the 5 years before banding I was taking ranitadine twice a day.  Should I go back to that?  I am my PCP's only band patient, I have no local surgeon to turn to.

This means most likely you are too tight.  Sometimes it can indicate a slip as well.  I would start with an unfill to see if that fixes the problem.

Dr Curry-have you ever heard of a band patient loosing a lot of bone mass when they are 1 yr post-op.  I am 51 yrs old and 9 yrs post-menopausal and my bone density showed significant bone loss.  But the scanner picked up my port in L-4 so that skewed the results.  My GYN wants me to start Boniva or Fosamax but I am unsure I should do that.  Any idea about bone density loss with lap band?  I have no family history of this and am 5:8" tall and caucasian-so I don't fit the usual profile of someone at high risk.  I've never been a smoker or drinker either and I work out 2 hrs a day 6 days a week.  I really thought my bone density would increase with the 60 lb weight loss and the increased exercise.  I'd appreciate your input on this.
Teanne

Dr. Curry, its always nice to see a familure face. I've been hanging around the boad since 2000 and I first want to thank you for you many replys and advise to all of us.
I was banded 10/2004 with the 4cc band. My weight has not changed bt by 5 lbs this last year, up and down. I've had a lot acid reflex the 6 months and just found out I have a dialated pouch. I wondering if its better to take the band off for a while or to replace it. My dr. has suggested replacing the same day of surgery. I want to do whats healthy and Im not sure what is the best thing to do. The last 45 days have been so challenging, i get an upset stomach so easy, I can throw up water, I have to sleep elevated to keep from choking when I wake up to fluids coming up. 

What do you think ?
Thanks, Gail

Gail,
Usually what we do is:

1.  Take the old band out
2.  Take down the previous gastric wrap completely
3.  Open up and repair the hiatal hernia that is usually present
4.  Replace with a new AP or Realize band that is lower pressure

It's a very complicated operation and takes a lot of experience to do it right, but we've had great success with this approach.  To be honest I feel that I have only been really good at this type of revision for about the last year, it took me that long to figure out how it really needed to be done.  We tried lots of other things that were simpler and less complicated, but didn't have the results that we wanted for our patients.

Hi dr. Curry,

I have been talkig to my surgeon and he is concerned that the band is causing acid reflux.  We are checking for everyting but if this turns out to be the case I will have to have it removed since the medication is not aleaviting the problem.

According to my surgeon I then have 2 choices
1.  simpley remove the band - and continue with dieting etc.  I did loose about 70 lbs wiht exercise, diet changes, and keeping up wiht accountability at the dr. office. I have also been working on personal issues that have changed my self image to the better.

2. Convert to gastric bypass at hte time of surgery.  He said I am aa good candidate, fewer health reisk now that in July when I was banded since I am down another 57 lbs and been exercising.

My questions is have you ever had to remove a band and if so what was the success of weight loss with both choices?  Trying to "get my head around this" (as my surgeon says) and wanting some informatin to help base my decision on.  I will tell you I have never been comfortable with the thought of by-pass; although we had not discussed it before my last appointment my surgeon was alreay aware that is scarres me.  I am seriously hoping it is the galbladder or something else but I get the feeling my surgeon is not convenced that is the case.

I guess I am mostly concerned with sustaining weight loss either way.

Thanks in advance for any assistance,  I know this is only one source and plan to use it as part of my decision.  I do trust my surgeon and will ultimately weigh his opinion very heavely.  He is very caring and only wants to do what is best for me all around.

Thank you again for any information,
Michele S.