WLS Tips for those researching the LAGB.

This is going to be a very long reply

I know this must feel overwhelming to you right about now, but the good thing is...that this is not a race and you can take all the time you need to research all the different WLS that are out there. I'd like to offer you a few helpful tips in organizing your research if I may.

1. At the top of this page, close to your user name, you will see a link named "Bookmarks" every time you come across information that you want to save for future reference, all you have to do is click on that link and it will bookmark the page you are currently reading. You can also change the title of that page and have it reference the key information contained within the bookmarked page.

2. Spend as much time as humanly possible researching your options and remember that it's okay to change your mind over and over again.

More tips toward the bottom...

"All weight loss is a result of the lifestyle change."

This is true, however there is a lot more information about the band that you need to weigh here. I'm going to give you some links for you to follow and I am inviting you to click on the link in my siggy. That link will take you to a private message board here on OH which has over 300 members ( not all are failed bands ) but many are and some are there because they have a relative or friend who has had one.


This link is a link that is provided to surgeons by the manufacturer of the Lap Band. What you are seeing here in the graph below is the EWL ( estimated weight loss ) per # of patients at 6 through 35 months. This is the expected outcome of EWL with the Lap Band per the manufacturer.
www.allergan.com/assets/pdf/HM0670_94800-16_lapband_dfu.pdf

Mean %EWL by Visit
Visit               N                             %EWL
6 months        233                             26.5
12 months      233                             34.5
18 months      190                             36.4
24 months      189                             37.8
30 months      148                             37.9
36 month        178                             36.2
N = Number of Patients

There is something very concerning about the graph above to me. I live in California and we are being fed a constant and steady diet of Lap Band ads here. You cannot go an entire day without hearing, seeing or reading a Lap Band ad, unless you hole up in your bedroom with the all electronics turned off.
The average weight lost per the most recently updated information I have heard is 50 %. Some say it is 55%. I will use my WLS stats as an example here to demonstrate the graph above for you.

Starting weight was 256
Normal  BMI weight for my height is 145
Weight at 6 years out for me was same at 36 months is 184
72 lbs lost

My EWL per manufacture at 50 %

256 - 145 = 111 pounds excess weight

256 - 184 =  72 pounds lost

72 / 111 = 0.648...  = 65%

It is very important to tell you that I am not the norm. I am one of the few.

I have lost 65% of my excess weight. I am a huge success according to the manufacture of the Lap bands chart right ?

Here's the truth, At 184 LBS I would still have a BMI of 31.5. This indicates that I am still Obese. 
According to the National Institutes of Health, being overweight or obese have known risk factors for the following: ( update... Today I weigh 162, and I am STILL at risk for the following obesity related conditions. 6/5/12 )

• diabetes
• coronary heart disease
• high blood cholesterol
• stroke
• hypertension
• gallbladder disease
• osteoarthritis (degeneration of cartilage and bone of joints)
• sleep apnea and other breathing problems
• some forms of cancer (breast, colorectal, endometrial, and kidney)

Obesity is also associated with:

• complications of pregnancy
• menstrual irregularities
• hirsutism (presence of excess body and facial hair)
• stress incontinence (urine leakage caused by weak pelvic floor muscles)
• psychological disorders, such as depression
• increased surgical risk
• increased mortality

So if your intention for losing weight is not purely for vanity and you think you would not be happy at 184 pounds and still be at risk for the above mentioned obesity related risks. Then I would urge you to consider other options. I am not a big fan of the RNY, but if the Lap Band & the RNY were the only choices available to me...If I had this to do over again today, I would choose the RNY over the Lap Band.

If " Less Invasive & Easily Removed " means this to you: 

"It means I am too afraid and/or unsure to commit to bariatric surgery and I probably won't die on the table if I get a Lap-Band."

Then you have more research to do and that's not a bad thing to think it just won't get you where you want to be.

Now onto more tips.

3. COE's

Q.  What is a "Bariatric Center for Excellence?


A. It is a hospital where the insurance companies have conspired with certain hospitals and surgeons to consolidate bariatric surgeries, for the sake of "efficiency."  Now one aspect is true - the learning curve DOES favor hospitals where a lot of surgeries are done - the doctors are more experienced; the staff knows how to work as a team; they have better equipment.  But as for the rest - in exchange for being the SOLE provider of bariatric services for the insurance companies, the hospital and surgeon make a deal with the devil - they agree to accept low rent prices from the insurance company.  And to work with the insurance company to keep costs low - often at the expense of the patient.

So, basically, "Bariatric Center of Excellence" = SURGERY MILL.



4. You are going to come across many posters (such as myself ) who you may perceive to be angry or overly emotional regarding your WLS choices.  The best gift you can give to yourself is to put aside your emotions while researching your choices and to really hear what the message is within all these tangled emotions.

Try to understand that ( I'll use myself as an example here ) when I'm sharing with you my opinion regarding the lap band....please keep in mind that it is not you personally whom I am against, it's the lap band I am against.

5. This is probably the most important tip I can pass on to you.   Your choice of WLS should not be a decision that is decided on between you and your surgeon...and here's why,

I'm going to use the Duodenal Switch WLS as an example..... The DS surgery is one out of the four main WLS being offered today, but that doesn't mean it's for everyone ( you can ask a DS'er why over on the DS forum ). If you consult with a surgeon who does not perform the DS surgery...that surgeon will most likely steer you away from the DS and toward a surgery he performs because he does not want to lose you and more importantly your money.$$$$$

Surgeons did not go through the time and expense of medical school to not make money...This is their livelihood and they have to provide for their families too.This is purely a business decision on their part and there is absolutely nothing wrong with that...to a degree.

Out of the 4 main WLS being performed today....the lap band surgery is the money making surgery for WLS surgeons...why you ask...well let me tell you why...

1. It is a quick surgery and lap band surgeons can perform many of them in a single day $$$$$

2. Lap Bands seem to have the highest re-operation rate of all the WLS, therefore pretty much guaranteeing your surgeon a second surgery with you and your money $$$$$

3. Lap Band adjustments guarantee your surgeon more of your money $$$$$

We have a special name for lap band surgeons who perform multiple lap band surgeries almost everyday and they are....Conveyor Belt Surgeons. These CBS are not only performing 3 or 4 lap band surgeries in a day, they are performing 6 and 7 of these money making surgeries a day and this is exactly how Allergan the manufacturer of the Lap Band markets their product, The Lap Band to these surgeons at weight loss surgery conventions every year. These surgeons tend to only work in their offices 1 or 2 days a week. One of those days is set aside for new surgical consults $$$$$ and the other day is set aside for lap band adjustments. That means that it can take a very long time to be seen by your surgeon once you've already been banded.

If your band is too tight and you need to quickly get it unfilled, you will need to make an appointment and it can take up to a month before you can be fit into their schedule. My surgeon was so busy that he would have me come into the ER  between his surgeries so he could unfill my band $$$$$.

If your band is too loose and if you have chosen a CBS, then you could be waiting for an entire month or more just to get in and see your surgeon for that fill. My surgeon was a busy busy man, but he was very caring and he was able to squeeze me in whenever I needed an appointment. He even gave me his cell phone number so I could call him directly if I ever needed anything. He was a rare breed of doctor.

I sincerely adored my band surgeon, but it was the band itself that caused me and many others like me to suffer permanent damage. For this reason...please choose your surgery first and then choose a qualified surgeon.

For the above stated reasons... do not allow a surgeon to guide you in your choice of WLS. Surgeons are sales people too, they will tell you whatever they want to in order for them to close the deal and if that means lying and/or scaring the living **** out of regarding other WLS then that is exactly what they will do.

" Free " Weight Loss Seminars ( They're all free ) are another tool surgeons use for selling you the WLS they perform. Lately we are starting to see more CBS advertise that they perform all  the WLS, but once they get you there...they or their staff will talk you out of any surgery that they do not perform by scaring the crap out of you or flattering you and telling you that you don't need the bypass or DS surgeries because they are too extreme and you don't have that much too lose.$$$$$

If you still want the Lap Band, then here is my # 1 tip for eating with your Lap Band. This may or may not help keep you safe, but it's worth noting.

How to eat with a LAP BAND.

• A “half a cup" of food should be placed on a small plate.
• Take a small bite and chew well.
•  Use a small fork or a small spoon to eat.(an oyster fork or baby spoon)
  
• A single bite of food should be chewed carefully for 20 seconds. This provides the opportunity to reduce that bite of food to mush.
  
•  After chewing the food until it is mush, the patient should swallow that bite. 
• Swallow, then wait a minute. The patient must wait for that bite to go completely across the band before swallowing another bite. Normally, it will take between two and six peristaltic waves passing down the esophagus, which can take up to one minute.
• A meal should not go on for more than 20 minutes. At one bite per minute, that is just 20 small bites. The patient probably will not finish the “half a cup" of food in this time. The patient should throw away the rest of the food.
  
• It takes between two and six squeezes to get a single bite of food across the band
  
• The patient should not be hungry after 20 bites or less.
  
• After undergoing LAGB, the patient should never expect to feel full. Feeling full means stasis of food above the band and distension of that important part of the LECS above the band. This destroys the LECS, the mechanism that enables optimal eating behavior and appetite control. A patient should always keep this process in mind.
  
• If the patient finds that after eating the “half a cup" of food he or she is still hungry, he or she should review his or her eating practices, correct the errors, and consider the need for further adjustment of the band. If this is occurring, it is usually an indication that the patient is not in the green zone. 

There are three common eating errors:

1.The patient is not chewing the food adequately. Food must be reduced to mush before swallowing. If it cannot be reduced to mu**** is better for the patient to spit it out (discreetly) than to swallow it.

2. The patient is eating too quickly. Each bite of food should be completely squeezed across the band before the second bite arrives.

3.  The patient is taking bites that are too big to pass through the band.

Each of these errors leads to a build up of food above the band where there is no existing space to accommodate it.  Space is then created by enlargement of the small section of stomach or by enlargement of the distal esophagus, both of which can compromise the elegant structure of the LECS. If the LECS is stretched, it cannot squeeze. Without the squeezing, satiation is not  induced. When satiation is not induced, hunger persists, more eating occurs, and stretching continues. If our patient continues this each day for a year, it is inevitable that chronic enlargement will occur, the physiological basis for satiety and satiation is harmed, and stasis, reflux, heartburn, and vomiting supervene.

Esophagus

After food is chewed into a bolus, it is swallowed and moved through the esophagus. Smooth muscles contract behind the bolus to prevent it from being squeezed back into the mouth. Then rhythmic, unidirectional waves of contractions will work to rapidly force the food into the stomach. This process works in one direction only and its sole purpose is to move food from the mouth into the stomach.^[2]

In the esophagus, two types of peristalsis occur.

AA simcplified image showing peristalsis

• First, there is a primary peristaltic wave which occurs when the bolus enters the esophagus during swallowing. The primary peristaltic wave forces the bolus down the esophagus and into the stomach in a wave lasting about 8–9 seconds. The wave travels down to the stomach even if the bolus of food descends at a greater rate than the wave itself, and will continue even if for some reason the bolus gets stuck further up the esophagus.
• In the event that the bolus gets stuck or moves slower than the primary peristaltic wave (as can happen when it is poorly lubricated), stretch receptors in the esophageal lining are stimulated and a local reflex response causes a secondary peristaltic wave around the bolus, forcing it further down the esophagus, and these secondary waves will continue indefinitely until the bolus enters the stomach.

Esophageal peristalsis is typically assessed by performing an esophageal motility study.

Good Luck with your research and if there is anything I can help you with please feel free to ask me.

Lisa

 If this information had been available when I was researching, I might have made a different choice.  Great post!

You're very welcome Steph

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 I don't know what you do for your profession, but you seem like a very educated person who is very passionate about sharing your research.  Thank you for your detailled posts.  I know it takes a lot of time to read and reply to those of us who are trying to find answers, but I, for one, appreciate you and your willingness to educate us!

Thank you so much Sally, I really appreciate your thoughtful reply. Alot of what I share here and on other OH forums is a combined effort by many of us over in the FBG.