For all the adjustable gastric band patients, I want to give you some information that hopefully will give you some piece of mind. You need to know, at some point, your band will be too tight. This isn’t necessarily based on you doing something ‘wrong’ or not following our recommendations. Think about it, you have an unforgivong foreign body wrapped around your stomach, which is a dynamic digesting muscle. There’s bound to be some issues one time or another. Following our recommendations will go a long way in preventing something getting stuck, but it isn’t a guarantee.
That being said, if your band is too tight, it doesn’t mean you have a slip. The vast majority of cases involve inflammation or swelling around the band causing persistent obstructive symptoms. This can be from eating something that didn’t pass, or stress, or even menstrual cycle. The first thing to do is call your surgeon, me. I will recommend for you to go back to clear liquid diet, possibly add an antacid, and see me the soonest available time. In the office, I will take some fluid out of your band to relieve your symptoms. Importantly, an exception to this pathway is if you have persistent pain. In which case, you have to go to the ER. After the band is adjusted, you will feel better. And after a couple weeks, we can place some fluid back into the band to get to the right level of tightness.
Having the adjustable gastric band is a learning process. It’s a great tool to help in imroving your health, but bumps along the way are to be expected.
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Have you guys heard about the buzz regarding multivitamins linked to increased death rates? This month in the Archives of Internal Medicine, researchers found a slightly increased death rate in individuals who consume multivitamins on a regular basis over a 19 year period. The study gets respect interms of the amount of patinets studied (about 40 thousand women), and the extended follow up period, but needs some serious perspective in stating its results:
-This sudy merely shows and association. It does not prove cause and effect… meaning it doesn’t show that the multivitamins increase your risk.
-It does not address nutritional needs of post surgical weight loss patients. It is clearly shown that bariatric patients need some type of nutritional supplement to prevent vitamin defficiencies.
-It fails to discuss the real issue of overall decreased nutrition of Americsns. Our generation eats greater amounts of simple sugars, modified fats, and highly processed foods with decreased nutritional content. A multivitamin can help offset this poor diet, and it’s certainly better than nothing…. but the real message should be centered on educating and supporting a society towards good nutritional food consumption.
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After submitting a formal request for HMSA to review their Vertical Sleeve Gastrectomy Criteria, once again I receive a denial. Bascially, there is growing evidence that the Sleeve procedure provides good weight loss with acceptable safety. How much evidence does an insurance company need before it adjusts their criteria? Well, we have 6 year prospective data in the US, 10 year data internationally, major insurance carriers United Healthcare and Aetna now cover the sleeve, some Blue Cross insurance companies in the US cover the sleeve, our own program has over one year data on HMSA members who have undergone the sleeve and are doing well… and yet they still will not budge!
The good news is that momentum is in our favor to accept the Sleeve as a viable option for surgical weight loss with criteria similar to the Band and Bypass. But, we are going to have to be patient and wait for HMSA to catch up. I still have a hard time rationalizing why we must argue to get our surgeries covered when we know they save lives, improve quality of life, and decrease overall medical costs.
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Everyone wants to know what the next big thing is, be it where to go, who’s doing what, of how it’s being done. In the field of laparoscopic surgery, it’s SINGLE INCISION surgery. There have been a few other hot topics, like robotic surgery and NOTES, but these don’t have the same potential to significantly transform how we do surgery across America.
SINGLE INCISION surgery is exactly what it states: the surgeon only makes one small cut to perform the operation. There are a lot of different names for this technique like SILS, LESS, and SPA, but they pretty much mean the same. Generally, the one cut is only about an inch long, and can often be hidden within the belly button fold. The technique is considerably more difficult that the traditional approach of making multiple small cuts. With new training and new instruments designed specifically for single incision surgery, the popularity of this method will grow.
Why would patients be interested in SINGLE INCISION surgery? Well, if the operation can be performed safely and efficiently, then why not have a surgery with a hidden scar? Weight loss surgeons currently can perform Bands and Sleeves via this technique. Don’t be shy to ask your surgeon if they do laparoscopic surgery, and if they do, can they perform SINGLE INCISION.
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On December 3rd, an FDA Advisory Panel ruled in favor of indicating the LapBand procedure for patients with a BMI of 35 and greater, and for patients with a BMI of 30-35 with a significant medical comorbidity. This is a significant step in allowing patients access to surgical weight loss who were excluded previously due to BMI limitations. Keep in mind this is only an Advisory Panel decision, and the FDA will make a final ruling in the next few months. In general, the FDA will follow the recommendations they receive from such panels.
How does this impact us? Well, assuming the FDA makes its final decision in favor, some insurance companies may adjust their coverage criteria to match the FDA guidelines. This would probably increase the number of LapBand procedures being performed in the US.
I am in favor of the current ruling because there are plenty of patients (who I have had to turn away) who would benefit form surgical weight loss and fall within the BMI 30-40 class.
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