Who are we fooling here?

Ok, I will start my post by saying that no one deserves to suffer complications from the band whether they are caused by frequent vomiting, being too tight, surgeons error of installing the band wrong, some people had bands that were too small for their stomachs with no fill and had to get the band removed, some had tubing issues, hiatal hernias, infections in the body or body rejecting the band, etc.

That being said, when I first signed on to Obesity Help over 8 years ago, I was very confused, MOST of the posts were about Pbing, (Productive Burbing) something that is forbidden with the band, yet 90 percent of the posts ON THIS BOARD were people either bragging about how many times of the day that they (threw up) or wanting to know if was dangerous with the band. I aways had some burning issues with my old band from day one from the hospital, I don't belive my first surgeon repaired a hiatal hernia that I had, they were not routinely repairing hernia's when I got my band back in 2005, but my burning was managed by taking Prevacid or stronger PPis.

I had no idea what productive burping was, until someone mentioned it was a "Bandsters Barf", so I was intrigued and I asked my surgeon is it "normal" to throw up about 10-20 times per day with the band, does PBing mean that you've achieved the correct amount of saline/restriction in the band? I asked my surgeon, he looked at me wide eyes and said in a soft voice, "you are never suppose to vomit with the band, (it will damage the band if done frequently) and if you get nauseous and sick with the flu I will give you Phenergan to help prevent any vomiting.

Posts about PBing horrified me, I remember a post where a lady mentioned that her band was to tight that she rode on the back of a motorcycle with her husband and she PB'd and the protein drink froze in mid air, and I wondered do I have the same band everyone else had? I had gone almost 8 months and lost about 80 pounds and still I had yet to PB, I had formed enemies on this board because I had not PB'd yet, I was not in the "in-crowd of PB'ers, they called me "hollier than thou"back then and the flames and taunts began.

I was still very intrigued about this PBing thing, I had lost a lot of weight by walking about 2 miles every day and eating tuna, chicken, eggs and praying, I just wanted a board among my peers where I could cheer them on, and they cheer me on, and I lose my weight -- THAT IS ALL I WANTED FROM THIS BOARD, I did not want fame, to make money off of people, I just wanted an outlet where I could vent, share my struggles, my journey, whether good or bad to keep me going.

So my weight began to slow, I still needed to lose about 50 pounds to get near goal weight back in 2006, so I asked my surgeon to further tighten my band, then a few more fills and all of a sudden, I learned what PBing was, I threw up ....NOW I said to myself, my band works! YAY! It is now working like everyone else on the board, I had my first slime and PBing episode, now I felt like I was an official member of the Lap band board.

This was the first time that my band was TIGHT, I wondered to myself, should I be this tight, I started to feel the band tight around my stomach, liquids were barely going down, but I was able to eat a few teaspoons of soft/purred foods. Then I started to feel burning in my stomach, I had discomfort in my throat and it hurt to eat, so I did not eat much, so that finally went away, I started sipping liquid tylenol, and apply heat pads to my chest and this helped with most most of the discomfort, but I started getting dehydrated because I could not finish an 8oz bottle of water in 1 day, I knew this was not right, but HEY I was finally TIGHT according to my fellow lap banders on Obesity Help, and the scales started to move RAPIDLY, I lost about 10 pounds in two weeks (mainly from dehydration).

I took a long trip to Florida about 2 weeks after my very tight fill, drove from Virginia to Atlanta and back home to Virginia, by the time I got home, my band got tighter and tighter and tighter to the point where I was foaming at the mouth, I was feeling sick, weak, could not get down any solids without vomiting, I said to myself, have I messed up my band? So I made an appointment to see my surgeon and told him my symptoms, I was feeling really sick, he gave me a script for the burning and took some saline out of my band and sent me home.

Even though I had some saline removed, I was still having issues, my band no longer worked properly, I was still feeling like I wanted to PB, and I was still having burning and stomach issues, so I went back to my surgeon and then he ordered an Upper GI and found that my band had a mild slippage, concentric pouch dilation and he took all the saline out of my band, and when he took all the saline out, this is when all hell broke lose, the burning got REALLY bad when my surgeon emptied my band, it felt like something was broken inside my stomach like an fire torch lit inside my stomach it WAS THAT BAD, the acid from the dilated pouch was REALLY bad, he put me on strong medications and meds to help with the burning, I suffered for at least 4-6 weeks, and finally the issues got better after I'd been unfilled for awhile, he slowly filled my band again, it took almost 1 year before I reached restriction again, BUT -- MY OLD band would NEVER WORK the same again, I had the old 4cc/10cm band that is no longer used in the US.

I tried and tried to reach the restriction level that I had previously with my old band, I never could get that sweet spot that I had intitally, I was actually at my sweet spot prior to getting too tight, I lost the bulk of my weight with no complications by working the band and eating about 4 oz of solid food every 5 hours each day and walking, I was doing things right without realizing it.

My old 4cc band had been "damaged for good" but I had still lost over 130 pounds with it, so I kept my band loose for the next 5-6 years and this was enough to keep my weight down, but during my 7th year, an undiagnosed hiatal hernia got inflamed probably from all those MANY fills I had trying to chase the sweet spot after I'd damaged the band in the first year from being too tight, and the chest/back pains had gotten unbearable, so I found another surgeon. I wanted to keep my old band, but my new surgeon told me that the older bands don't unbuckle properly without destroying the lap band system, so he repaired my hernia, removed the old band and gave me the new AP band system.

It was clear back then that if you WORKED your band the CORRECT WAY, you were not wanted here on this board, and if you did work the band 'correctly' you'd better keep your voice and opinions to yourself.  I remember a nurse who use to post years ago mentioned that her surgeon advised her not to participate on Obesity Help because 90 percent of the people abused their bands, since 90 percent of the posts were about vomiting/reflux and could not get food down.

This board was very busy back then, in fact, the Lap band board had more activety than all the boards.

If you dared 'challenged" someone about the "tightness" of their bands you'd better prepare yourself for a flame war, many would not let go of saline unless they were in the ER from dehydration and had no other choice, or about to lose their bands, many people would NOT let go of a too tight band. Many use to say they did not CARE if their bands were too tight as long as the scales were moving and they were losing weight by any means necessary which meant losing their bands to get to goal.

Posts about Pbing was the "norm" from 2005-2009, then all of a sudden the posts about PBing stopped, people never talked about it anymore "publicly" on the message board, then a new trend began, it was "Band Bashing".

No one no longer talked about their struggles and demons with the band, being too tight, bad aftercare/having difficulty find a surgeon to unfill/ or fill their bands, the new trend was the band sucks and if anyone gets one is stupid and, their life will be filled with misery and they will utimately have to get it removed.

Then the trend started from those who had poor aftercare that got bands in Mexico who lost their bands to slippage started getting Sleeves and one Lap bander who still post here under various troll accounts, who works for Mexican surgeons, started chasing those away who wanted bands and made it her full time job to get those with failed slipped bands revised to Sleeves and if anyone mentioned getting a lap band was chased away from Obesity Help. So if you DID THINGS RIGHT, you'd better post here quietly and not be outspoken if you worked your band the RIGHT WAY, because NO ONE wanted to hear it, especailly the band bashers.

Many of those who thought PBing was trendy and "stylish" lost their bands, I saw post after post after post of band removal, until I got numb, it was no longer shocking, it became more of the "norm" to get the band removed than to get the band installed.

And Sadly here we are today....with a dead forum because those who chose to work their bands differently from the band manufacturers recommendation became the majority.

I am glad you read your post because I am doing the band the right way. I just had surgery on 4/15/13. I have lost about 25 pounds. I am walking and trying my best to...to do want is best for me. Thanks again.

Your welcome, and I am wishing you a long successful journey with your band

I actually do remember this.  I agree people didn't want to loosen their band unless it was a dire emergency.  People back then did not keep their bands on the lose side (why that's crazy).  It was a keep it as tight as you can possibly stand it culture.  I mean I had a friend that could only eat a couple tiny little bites of food at a meal (maybe... 1/2  oz).  Thank god I didn't get my band till there was a wave of people that started to preach that you should keep your bands tight enough to feel full after a balanced responsible meal.  I listened to them.  I still have my band and I count myself blessed.        

This is what I don't understand, those who got their bands after 2007 really should not have that many problems IF it was installed properly and their bodies did not have any type of rejections. Because many got the safer bigger (AP bands), and surgeons had "Supposedly" more clinical experience.

When I got my band back in 2005, there was not much long term data on the consequences of being too tight (in the USA), there was only speculation and bad data from those who had went to Mexico (hence poor aftercare, and a high complication rate due to not having a surgeon to fill/unfill them locally). They only had data from those who had bands in Europe/Austrailia and that data was still not good because they had the old technique not the PARS Flaccida....so there was still no consistent long term data on the band.

Also, surgeons found out that the older model bands were very easy to slip and dilate and was harder on the body due to its harder surface, I had the old 4cc/10cm band which is no longer used, many still have the older model bands with no problems though. 

We did not know -- HOW TIGHT WAS TOO TIGHT, but I knew vomiting was not a good sign and it was dangerous to the longevity of the band if done frequently. I learned from some other vets who got their bands placed in 2002-2003, it was not that many of them back then, but we were all learning, even the surgeons.

It does not take long for BAND DAMAGE to occur, time is of essence when dealing with a too tight band and removing saline, my pouch got dilated from only 4 weeks of being too tight.

But I guess the Band Bashing started especially from 2009-2010 when PEOPLE KNEW BETTER about being too tight, but did not want to come clean about abusing their bands.

Also, many surgeons did not have "time" or patience with filling the band properly, nor did many peopld want to "deal" with going back for needed adjustments whether they were fills or unfills. Many people used to get angry with paying for fills/unfills, so this was a recipe for disaster. So surgeons who did not have the time for the band...well they started to pushing people to Sleeves without really knowing the long term consequences.

PBing isn't a desired response, and there were a lot of people who thought it was ok. It isn't. 

Bands - as we know now, are best loose than tight. If they are tight too long scar tissue forms around the band that will constrict the stomach - and then no matter if the band is empty the scar tissue will be a nasty problem. Removing that scar tissue is easy- but it does require surgery. I suppose one could try to dilate it endoscopically, but that may not work well with the band over it. 

When people come and want the band tight, and say they lost weight before- it is difficult, because they had a positive weight loss with an overly tight band. So now we say that the best way to have the band is to keep it on the loose side - and that the band does not work when you eat, but two hours later. 

There has been a lot of good research by Dixon about this - showing that successful patients, long term - the food goes past the band quickly. People who have food above the band for too long end up with dilation of the pouch, leading to reflux, heartburn, and a slip. That constant pressure on the diaphragm increases the opening and is diagnosed as a hiatal hernia. 

We can unbuckle the old bands- it takes a bit of work, and sometimes the band is damaged when it happens, but it can be unbuckled.

What I wish is we had a band that would allow it to open if something got caught. 

What we know now is this: the band is not meant for restriction, but for appetite control. The more it is used for restriction, you can have success, but when it gets to a point it will no longer work, and people always chase that "sweet spot." 

When we gave patients who were five years out, and stable weight with BMI

Hi Dr Simpson,

First I would like to thank you for your needed professional insight on this board, I remember you and Dr C used to post here years ago, before the forum went downhill.

I've always read your helpful tips on your website as well. Yes back then when I got my band we were all learning, learning how to use it properly and how tight was too tight. But we all know the end results of a "too tight" band now which has contributed to very high rates of unnecessary lap band complications over the years.

I really wanted to keep my old band when my surgeon repaired my hernia 5 months ago, he mentioned that he tried to salvage my old band but he had some difficulties when he got in there -- trying to unbuckle the band and not destroying the lap band system, I had a lot of adhesions that were covering up a large hiatal hernia, so he had to dissect and cleanup a lot of scar tissue also. He mentioned that the AP bands are easier to unbuckle and fix slips and hernias than the older 4cc/10cm bands.

He also found my concentric pouch dilation to still be dilated after all those years when it occurred back in 2006, my original surgeon never fixed it surgically, but I was able to live with it with hardly no issues, the only issues I had was not finding the sweet spot again, but I was able find suitable restriction, but not ideal with my old band.

This is what my new surgeon says, the band is about satiety and not about restriction, but when I got my band 8 years ago, we were told that it was about satiety and restriction, very confusing.

Edited to Add:

Dr Simpson you mentioned:

Bands - as we know now, are best loose than tight. If they are tight too long scar tissue forms around the band that will constrict the stomach - and then no matter if the band is empty the scar tissue will be a nasty problem. Removing that scar tissue is easy- but it does require surgery. I suppose one could try to dilate it endoscopically, but that may not work well with the band over it. 

I have a question about his, many here on the boards have mentioned that their bands "tighten up" on their own without a recent fill that caused horrible reflux and vomiting and they still did not get any relief even when the band was emptied.

In the old days and documented studies, when a patient experienced sudden extreme restriction without a recent fill meant band slippage. I've always known that a very tight band can cause esophagus damage and dilation.

Do you think that keeping a too tight band for long periods of time caused this as you mentioned scar tissue formed and caused the stomach to constrict? Although when I had my old band, I only experienced being too tight briefly only about about 4 weeks and yet I got so irritated it caused pouch dilation, but I've never kept a too tight band longer than 1 month so I never experienced this  'scar tissue' damage that caused frequent vomiting/reflux on an empty band.

In my case, my LapBand was extremely loose.  I never had it too tight.  Not once.  I never PB'd or vomited until it had suddenly tightened from the Scar Tissue formation.  I had a 14ml band and had just over 4mls in it.  I had very few fills and each of my fills were less than 1 ml.  Some were as little as 0.2mls.  I really do not think being too tight has anything to do with scar tissue formation.  It didn't in my case and it didn't in a few others who have had their bands removed for the exact reason, I did.

I kept my band very loose for a reason and that was that I never wanted to have a complication.  I dieted most of my LapBand life, lived low carb and high protein.

I never had saline in my band, either. 

But people who are scared of the truth need to tell themselves that band complications only happen to people who "don't follow the rules." It's a denial reaction, I suppose. 

Nic,

I am not sure why you keep preaching about your issues, we've heard them a zillion times, we are all sorry you suffered complications....I had complications too...but mine were fixed and I moved on.....no one ever said that ALL band complications are the fault of the patient, not sure if you clearly understand this...WE DON'T KNOW if you never had saline in your band or not -- we just take your word for it...again you had the old band model that was more prone to issues, WE ALL understand this, SO DID I....

Not only you, but MANY people had bands that were too small for their anatomy during the time you got your band placed nearly 10 years ago....that was old technology including old band model type, surgeons started using bigger bands for this very reason to make sure patients had 'room' in their bands for adjustments where they would not be too tight empty....so you CAN'T compare your complications with someone who's band was place today...they are apples and oranges....