Ask Dr. Curry!

Hello,
I am having real difficulty following the "band rule" of no drinking with meals.
My weight loss has been slow (I was banded in November with the Realize Band)
but I am still losing weight.

Have you had patients continue to drink with meals and lose weight with the band?
Also, exactly what harm would/could diet soda do...I haven't totally given that up either.
Lastly, how common is it for someone to "stretch their pouch" and how would one know?
I have 7.8cc's in my band and feel very little restriction.  Being that the band holds 9cc's...I feel like I should have more restriction than I do.

Thanks for answering!

I think that no drinking with meals is important as it will make you stay full for much longer after you eat.  When you do drink while eating, it flushes your pouch out and makes it empty sooner, therefore you are hungry again.

Some think that carbonation can lead to pouch stretching, I don't know of any actual research on this.

The last 1.2cc in your band will make a huge difference in the amount of restriction you have more than likely. 

Dr. Curry,

I am trying to get the VSG approved, but insurance did not approve CPT 43843. I have talked to customer service and they imply they cover the VSG but of course do not offer another code. May I ask what  code  you use for the sleeve if different than above?

If I can't get the VSG approved, then I will probably go with the band. Which band do you think is best overall (if it were you, which would you have..and to go one better, if you were having weight loss surgery, which procedure would you have and why)?

 Are the bands designed to last a lifetime? What is the rate of corrosion or failure of the device? Over time, do they damage the stomach and cause other medical problems? Once the "sweet spot" is found, do you ever need another fill?

I appreciate any information you can give me and thank you for taking the time to answer questions for all of us on this forum!!

43843 is not the right code for a sleeve, unfortunately many surgeons are trying to use this code because the sleeve doesn't yet have its own code.   You have to use 43659 which is a generic code for "unlisted laparoscopic procedure on the stomach."

As far as which band is best, there is no clear answer at this point.  Both bands offer some good options and are designed to last a long long time.  If I were having a weight loss procedure, it would either be a band or sleeve.  Failure rates vary from study to study so that's a hard one to answer, I would ask your surgeon about the failure rate of his particular practice.

Most patients will need an occasional fill every year or two to maintain their sweet spot, as bands are a little bit permeable so may lose tiny amounts of saline over time.

Dear Dr. Curry,

I tried posting this earlier, so hopefully you're not getting this for the second time. I had my surgery last Monday, October 13, 2008 at Cedars Sinai Medical Center in Los Angeles by Dr. Scott Cunneen. I didn't have much pain; I have a lot of discomfort, especially when trying to sleep. When will I be able to sleep on my stomach again? I naturally roll onto my stomach after falling asleep, but I can't now. When, if ever, will the constant thinking about food and the sometimes nagging hunger go away? Are there any liquid alternatives to protein drinks, diet Snapple, water and Crystal Light that are somewhat satisfying?

More importantly, I have a question about the Realize Band and getting adjustments. I have epilepsy and take 3 different medications. I was able to get one of them in liquid form and one in chewable form. The other is a capsule and there is no alternative form. The first 2 meds I started taking in the new form about a week before the surgery, with no side effects. The third medication does not mix well with liquids or Jello. The medication is so bitter out of the capsule that I gagged and almost vomited when taking it. About 3 days ago I started taking the capsules in their original form again; I now put them in my mouth, wait until they almost dissolve, then swallow them. Afterward, when I try to go to sleep, I get an acid reflux sensation but nothing actually comes up. Is there a chance they can block my opening? What do patients normally do when they take other meds? I'm especially concerned about what will happen when I get adjustments. I am trying to get my neurologist to work with my Realize band doctor's office, but I'm having so many problems with the neurologist's office that I had to go to the ombudsman. I don't think that doctor is in favor of this surgery at all; he told his office assistant to ask my pharmacist about any alternatives.

This situation is incredibly frustrating to me, because I cannot stop taking or modify any of my anti-seizure medications without undergoing extensive testing, which would entail taking another week off of work. It also seemingly has affected the way that I sleep.

Thanks for any help you can give me.

Probably the pain when you sleep on your stomach is related to your port and should go away, although have Dr. Cunneen check it if it persists.

As far as the pills that's a tougher one - but I find that if patients avoid taking pills in the morning they tolerate them much better.  The stoma is usually wider and a little more relaxed as the day goes on.  Other than that I'm afraid I don't have any magic tricks.

Dr. Curry,

I am having a very difficult time getting restriction.  I had surgery on June 13, 2008 and have had 5 fills and am up to 8 cc's in my Realize Band.  The problem is that I have no restriction.....I mean I guess not.  I have no idea what I am looking for at all.  I feel like I don't even have a band.  I know its there bc my dr. sent me for an x-ray a couple of weeks ago and he seems to think the position is good.  I feel like I can eat anything in any amount as fast as I want and take as big of bites as my heart desires.  I have never got "stuck", pb, or slimed.  I am at the end of my rope.  I have dieted off 26 pounds and am struggling to keep it off.....I was never a good long-term dieter and that is why I had surgery.  I struggle daily with hunger and feelings of guilt over eating portions I know are not a "banders" size.  My surgeon says that the makers of the Realize Band do not suggest filling it over 8 cc's.   I am afraid to even go back into the office bc I almost feel like he thinks I am not doing my part but I am and I just want my tool to help me.  Is this a common problem?  What will happen if I can't get any more fills.  Does it sound like there is something wrong with my band??   Please give me some advice.  Thank you!

Ethicon does not recommend filling the band over 9cc, there is no recommendation against over 8cc.  I would recommend another fill, if you still don't have restriction at 9cc then a scope is probably in order to make sure there is no erosion.

Hi tommiejean,

I had surgery four days after you and am in the same dilemna. I have gotten so frustrated with this site which is supposed to be support oriented because everyone acts like they never had a weight problem!! I am down about 25 pounds and went under floro for my last fill and even though I feel more restricted, I can still eat more than I should. I just need to feel like I will eventually get there. This is really depressing... I have 7.8 in my band and get a fill again tomorrow. I am sure that there are others in this situation but it goes on ignored on the boards! Keep on trying I know we will get there eventually!!!!

cfoxc,

I will not lie and say that things are great and wonderful and easy.  I can only share my experience as of date.  I continued to struggle after I posted this and did not have restriction up until May, 2009!!  You got it, it took 11 months to reach restriction!!!  I am at 9.9 cc's in my Realize Band and finally losing weight.....slowly.  It is amazing the difference .2 cc's made in my band.  I went from pretty much no restriciton to great restriction when I went from 9.7 to 9.9 cc's!!!  I have only lost 50 pounds in 13 months but 15 of that was in the past 2 months.  I started walking as well and have worked my way to 3 miles a day.  I know that everyone says to "hang in there"  (I know EXACTLY the disgust and frustration that your feeling) but give it a little more time and fills!!!  Let me know how tomorrow goes for you!!  Good luck!!  :)

~tommiejean