Depressed- no one will do lap to rny revision

David Lautz at Brigham & Women's in Boston is also doing my revision from lap band to RNY next month.  He seems to recogize patient dissatisfaction with weight loss to be a valid reason to do a revision. 

I just visited my surgeon yesterday and asked for a revision from LAP to RNY.  They said while there are alot that have been done, they did not think or expect my insurance to cover it.  I had 2 bands as the first one slipped so I went to a better more equipped hospital (Columbia in NYC) and they had to give me a new band - still no weight loss. I only lost 45 from the first band only to gain 20 back.  The problem is that my BMI is at 35 so they are thinking there is no way insurance will cover a revision.....boo hoo....all I do is vomit - I vomit on salad some days while other days I can eat a big salad with croutons....I vomit on granola and yogurt while other days I can eat an english muffin - this band is not worth all the work......Has anyone ever heard of insurance approving a BMI of 35? Donna New York 205/159/179

I've definitely heard of insurance companies covering revision for BMIs of 35 and even under when there's a problem with the band.  My surgeon, David Lautz, advocates endlessly for what his patients need when they're having problems.  He would definitely consider that a reason to convert (assuming fill tweaks have been tried).  Check into it and find a surgeon who will advocate for you.  If the band isn't working, get it revised, insurance should cover it.  I have a BMI of 37 with no co-morbidities and BCBS didn't blink an eye.  They covered it no questions asked.  My situation is exactly the same.  I get stuck everyday, but who knows what it will be on.  It's different everyday and what gives me trouble one day goes down beautifully the next.  Check into it, I bet you might be surprised.  You will need a doctor who's on your side and will advocate for you. 

Thanks for your response, I appreciate it.  Once my surgeon does the surgery, you then follow up with from that point on with the PA.  She does the fills, consults, etc.....She is the one who was so adminant about my insurance not covering it, was negative before even asking the question.  I have top of the line Oxford PPO and I would love to contact them myself but I am sure it has to come through her.  I will look into other surgeons if she tells me Oxford denied me.  I will also call Oxford to make sure it was denied.  She said it would take a couple of weeks.  With my first band, I was filled, unfilled, filled, little bit out, little bit in, back and forth.  I then also saw another doctor in between my first band doctor and the new doctor for fills, same thing, too tight, too loose, never could find the sweet spot.   Your response was encouraging and I appreciate it.  Will keep on plugging.....And what a relief to hear someone say exactly what I was feeling - how you get stuck everyday, but who knows what it will be on...its different everyday and what gives you trouble one day goes down beatifully the next.....Its my exact daily life.... Yesterday I had a salad, that would not go down - every bite came back to bite me......however the previous 2 nights had salads for dinner - go figure!!! Thanks, Donna

Kerry,

I was very successful with the band for many years before I had complications that forced me to have a revision. I revised several months ago to a gastric sleeve.

I read your original surgeons profile. She is young and has only been doing surgeries on her own for 2 years since 2006. Not holding this against her. She maybe a great surgeon, but not that great with fill/restriction protocol. It took me 5 fills in my first year before I got to good restriction, so for her not to be able to give you a solid answer as to why she wont do more (unless it is a compliance issue you are not telling us about that is being questioned) is ridiculous. You dont give us enough information about if you ever had restriction, never had restriction, whether you are compliant to fill protocol, so based on this limited information, it is hard to make recommendations other than you need to consider a new surgeon.

You dont need a revision. You need another surgeon to look at your band and do further testing to find out why your present band is not working for you. The band is purely restrictive and if your tool is not working properly or not filled adequately, you will not be successful. If it is compliance that is the problem and she doesnt want to fill your band based on this, then it really wont matter what doc you go to. However, it sounds like you simply dont have restriction which is a shame if you have a perfectly working band.

Babs

Thanks for your response and after arguing with someone on another board, I should maybe elaborate.  Number 1 is everyone who has had WLS has food issues, so Im NOT going to say I dont.  THAT BEING SAID.  The problem with the band has been on going since day ONE.  I couldnt swallow follwing surgery, thankfully that resolved, I was kept in the hospital extra amount of time.  After surgery I had restriction right away.  Some people have none, well *I* immediately went to eating FAR FAR less ( after liquid phase ofcourse)  I lost 20 lbs right off the bat and ofcourse i was ecstatic.  I went in for a fill.  1 CC in a 4CC.  It was a little more restriction and the actual filling SUCKED, i have a hard port to get into apparently, I needed to be done under flouro originally (which could also be seen as inexperience by my surgeon b/c she has since gotten much better at it).  So the 1 CC was ok.  A little throwing up, but the biggest complaint was pain when I ate.  I can NOT stand the feeling of the food sitting on my band b/c its painful!  No matter how much I chew.  Yes the food goes down but alot of times I have to run around the house performing the chicken dance for this to happen.  But I was committed to doing this.  I went in for a second fill another 1 CC which brought me up to 2CC.  Same problems.  Pain in the stomach and pain in the abdomen after really concentrating on my chewing.  So at this point, my surgeon was kinda starting to question me b/c I had only lost 5 lbs.  I explained to her truthfully that the food HURTS and yes, I have been somewhat turning to easier foods to eat (ie not protein based).  I even called her office and told her at one point....its painful and i find myself eating pasta's b/c it goes down easy and painless.  She actually told me to "just eat that then".  At this point I was disgusted.  I felt like this isnt going to work, the band isnt right, something is not right.  I didnt go back to see her at that point for almost a yr i believe.   when I finally did go back, I was still down about 10 lbs.  Still having problems.  Still complaining.  She scheduled me for a barium swallow which the radiologists actually told me my band had slipped.  My Dr contradicted the next day and said NO it actually didnt slip.  I was a little dissapointed honestly b/c I said OMG THAT IS THE PROBLEM!  Anyway after that my surgeon gave me a couple of options, one to try and talk about revision, another to UNFILL completely, or another to try a slight fill and just see.  I said Dr, I WANT this to work, so lets try a slight fill.  She checked and I still had 2CC in there and she filled it with .5, so that now makes 2.5 in a 4CC.  I went to the nutritionist that she asked me to visit and just go over some things again.  That went well.  My next visit, I was still the same weight (basically down 10lbs).  She said to me that at this point, with the pain and the complaints, that she didnt think another fill would help.  She was going to talk to another dr about a revision for me.  I said fine.  THAT dr doesnt do revisions, neither does she.  They referred me to UMASS hence my post.  I hope I explained well.   Kerry

Just wanted to say that I fully understand what you mean about pain with eating.  I'm not talking about getting stuck, I'm talking about pain with merely having one bite of chewed food in your pouch.  It's uncomfortable, you tend to focus on it. I hate my band.  TEN more days to a sleeve revision~

Kerry, I am so sorry and I truly feel your pain.  I have had much the same experience with my band from 4/24/06 until today.  I gave it one last go with a band expert and followed a strict post-fill protocol which basically consisted of room-temp clear liquids for six days following the fill.  I had to get unfilled before leaving his facility because he was too aggressive and water would not even stay down.  I had him back it out and just fill it .25,  the fill was very small and I am very sensitive to fills.  Cclear liquids after this fill prevented the usual night regurgitation I usually experience 4 to 6 days after a fill.  I lost weight during the clear liquid phase, but of course once back on full liquid and regular food (if you can call a lap band diet regular food, it is mostly liquid for me), my weight loss stalled again.  This band is a guessing game day to day, don't know if anything will go down or if everything will go down.  I could never eat salad, pasta, bread, all the food I avoid anyway, but have trouble with proteins too.  Moist chicken works one day and not the next; mornings are very tight.  Eggs are impossible.  I have tried unsuccessfully with it and have decided to revise to RNY scheduled for next month.  I think the band is OK for those who need to lose less than 100 lbs and are under 40, comitted to going to the gym daily.   Good luck, I am sure you will find someone to revise to RNY. Michele

Your story sounds so similar to mine.  I was tight from day one, stay in the hospital extra days.. etc.  I started thrwoing up all the time in January and had the band unfilled, instant relief. I also had an upper gi that showed my esophagus a little swollen.  Doc said to leave the fill out for a month and come back in for another fill.  I never went back in for the fill because I've been throwing up almost daily.  Some times it's on my morning coffee!  YES, coffee!  The next day I can eat an entire peice of grilled chicken, rice and corn.  I've started going back to my old bad habits, handfuls of candy, smoothies, crackers... things I don't puke on.  I was down 60 pounds from last summer to january but I've gained 20 back. I go to the doc tomorrow and depending on what he finds I'm going to bed for a revision to something different. Laurel

Hi Kerry, I would recommend my doctor, Dr. David Lautz at the Brigham & Women's Hospital.  He is doing my lapband to RNY revision on June 9th.  He did my lapband for me two years ago and I had trouble eating, getting stuck, etc.  It was a pretty miserable existence.  He suggested the revision to me in January of this year. My insurance approved it no problem.  He is in my opinion one of the best bariatric surgeons in Boston and takes on the difficult cases that many other doctors will not. He is very skilled and even did the RNY several years ago on a lady on OH with the DaVinci robot.  She did fine. Good Luck! Valerie