Ask Dr. Curry?

Hello Dr. Curry!

I was banded in November 2006. I had a maximum loss of 85 lbs. November 2007 I had a fill and was determined to go as long as I could without another because I felt I was relying on the band too much and not eating right or exercising as I should. I was trying to get back into the mentality of using the band as only a tool and not the miracle cure we sometimes wi**** was. 

May 08 I start having problems, I would wake in the middle of the night vomiting clear liquids. I couldnt sleep through the night. My PCP prescribed various antibiotics & then later allergy meds as well as a combo of both & the issue never resolved. The thought was that the clear liquid was post nasal drip, although I wasnt stuffy. This went on for months. I asked if the issue could be band related but I wasnt having any unusual or new problems eating and was losing weight fine so the consesus was that it was not. I went through 2 allergists, an ENT, had a CT scan, and went to have an endoscopy when at last the gastroenterologist finally suggested it was due to the band. I was too tight. So in Novmeber & December I had some fill removed. In January, I went back and some replaced since I had no restriction. Since then however I still dont really have any restriction and am having sinus issues. I am stuffy all the time and get heartburn a lot more frequently. Also I have regained about 25 lbs. My PCP thinks its allergies. Its springtime but according to the tests I had done just last year, I have no allergies. I never have. The allergists I spoke to said that gastro issues can sometimes manifest themselves as allergy symptoms, which is what happened last year.

So to my question, is it possible that the band is too tight again and thats why I am always stuffy? I would like to be able to breathe out of both nostrils once again. Also, if the band is too tight but Im not really feeling any restriction, does that mean I have stretched my pouch? Is it possible for both things to happen at once, tightness with a stretched pouch? I havent gone back to my surgeon because employer changed insurance and they no longer cover anything bariatric related. I really cant afford to go without knowing exactly what needs to be completed so everything can be resolved in one visit to minimize costs.

Any information you can provide will be helpful and appreciated.

Thanks
Michelle

I would be worried that you may have a slip or some pouch dilation that enables you to eat too much, but then things don't move through well thus causing the backup.  I would recommend an upper GI, but it has to be read by a band surgeon as your PCP or a gastroenterologist, or even a radiologist, will probably not interpret it correctly. 

I don't think being to tight would be related to nasal congestion, but it definitely is related to bringing up stuff at night.

Dr. Curry,
I met with you and your staff a little over a month ago.
I am still jumping through hoops for my insurance company and looks like only another month to go.

When I met with Erin S. she said that I would need to go on 4-6 weeks of Medifast before surgery.

Rebecca told me to start a diet plan now.  Well I am having trouble with that. 

My question to you is, could I start the Medifast now? and  that may put me on it for 2-3 months, is that too long?


Thanks so much
and Congrats to you on your band.

Steph

Steph,
You sure could start now, we usually put folks on a 5-and-1 plan, which means 5 Medifast or Healthwise products during the day and a lean green meal at night.  I have done it, it's really not that bad.  If you want to give it a try just call Rebecca at Fast Track and she can help you.

Greetings,
I was banded on Dec 18, 2008.  I have not seen the scale change to the degrees i was expecting....averaging....sigh .5lbs a week.  I follow eatting and excersize to the best I can, (excersize limited due to knee surgerys both prior and following the band)  That however is not the primary reason for my addressing you; see when my band was put in I was told they had put in 3cc fluid (ok I can accept that) when i went for my first fill they pulled out 5.5 cc of fluid and when I questioned it I was told well sometimes the charting isnt done quite right (ok I have issue with that but no other choice but to accept it.  they give me 1cc.  I go for my second fill and they pull all the fluid and say ok we took out 5cc with the one we add that brings you to 6cc.....(ok wait a minute....5.5 plus 1 comes to 6.5 so if we are adding one that brings us to 7.5.....(math wiz i might be....)  well the numbers arnt adding up that way  we were only able to pull out 5 cc so by adding the cc that makes 6cc.  I asked about it and again was told dont worry sometimes the numbers dont match up....


This is where i became concerned.....we are putting more and more fluid (granted harmless fluid) into my body and we are unable to recall it all from a supposidly contained unit.....hmmm

I go for my third fill yesterday, I tell them how for a while I was feelign some retention but the past week not so much however it was close to that LOVELY time for a woman and perhaps the increased appitite was due to that....dr says well we are only giving you .5cc this time because u already have so much fluid in the band we dont want issues....( wasnt happy about this and asked for more...but in the end I did something I dont generally do...i backed down and agreed to the .5cc and the dr agreed to see me in 2 weeks to give me more if i still felt i needed.....

The fill began and I hear gurgle gurgle....  I look at the needle the dr is using in my port and I see big air bubbles coming out of me andinto the needle....ummmm  no I think.    Uh, the dr said, you have air in your band.  but he wasnt overly concerned about it, well he didnt ask me to go have it checked or something....

Understand I am sooo not a dr and I am one of those people that think WAY to much.....BUT....if air is coming out of my band it has to also begoing into my band...if it had already been there the band would have been at a greater fill level then what they thought because air infact must take up space....   SOOO......   that means one of two things.....  there is a leak and somehow the air and fluid are changing spaces which would explain the flexing in restriction from some to zero...

Or, the air was in the band from at least the last fill and by removing it this fill the .5cc they introduce to the band has little or no baring since the space taht the air was filling is not being filled now that the air has been removed...

either answer means i am now at lower fill level even after having fluid put in my band....correct?

Dr. Curry - I just can't seem to find a good sweet spot.  Before I got banded, I never had a problem with acid reflux.  Since my port revision, I have been too tight and we are trying to "adjust down" until I reach my sweet spot.  In the meantime, I have horrible acid reflux, especially at night while trying to sleep, and it's frightening.  Needless to say, I have a job and other responsibilities which means I can't be running to my doctor's office every other day trying to get filled/unfilled to an acceptable level.

So until my sweet spot is reached, is treating my acid reflux with Nexium once a day enough?  At night, I wake up every 20 minutes coughing and choking feeling like I am drowning.  Trying to sleep sitting up doesn't help and is a misery in and of itself.  Thanks, Dr. C.

Nexium will not help with your symptoms, only an unfill will help. 

It's hard to say...perhaps it wasn't adequately primed at surgery and some air was left in.  I've also seen air get in if the needle is not tight on the syringe.  There's no way to know the source of any of these problems, I think you'll just have to see how much restriction you have and adjust accordingly.  I've never seen air get into the band from inside the stomach, even on an erosion.

What happens when your band has some erision,i had a upper scope today MY DR,Rantis,SAID I have a lot white stuff around my esophagus,he also said I HAVE SOME ERISON OF MY BAND,HE HAS TO DO BIOPSY OF WHITE STUFF ON ESOPAGUS ( WHAT COULD THIS B )HELP ME HAS THIS HAPPEN TO ANY ONE ELSE

It's hard to say, I wasn't there to see it obviously.  If it's an erosion, it will likely have to come out.