Video of Lap-Band Adjustment
Check out this quick video of Dr. Steven Fowler doing a gastric band adjustment or lap-band fill at his Aloha Surgery office in downtown Honolulu, Hawaii.
Nutritional Recommendations for Band Patients
Adjustable Gastric Band patients are still recommended to take vitamins. It is true, that the chance of a nutritional deficiency is uncommon if one is eating a healthy diet since there is no “malabsorption” of the food that is being consumed. But two main factors influence this recommendation. Of note, many patients come to surgery with a nutritional deficit and many of our lives are busy making it difficult to ensure a proper food balance on a daily basis. Standard multivitamin preparations located at grocery stores, vitamin shops, and Costco are probably fine. Make sure to clear your decision with our dietitians Mary and Allison. Calcium is the other recommended supplement. Most dietary professionals agree on 1200 mg per day of Calcium. This mineral is packaged in a variety of forms, from tablets, chews, powder, and shakes. My office carries the Bariatric Advantage product line for your convenience. Try to find a product that has Vitamin D incorporated into the supplement.
So all you Band patients, stay healthy and remember your multivitamin and Calcium!
FDA Approves the LapBand for BMI 30-35!
On a fairly surprising note, the FDA adjusted its criteria for LapBand surgery. The old FDA recommendations were for LapBand placement in adults with a BMI of greater than 40, or a BMI 35-40 with a serious medical condition related to obesity. The new criteria have dropped the BMI level to 30-35 with a serious medical condition. What’s a serious medical condition? This will include diabetes, obstructive sleep apnea, and heart disease. This is a big step in realizing surgical weight loss as the best tool in conjunction with a comprehensive weight loss program, to improve an individual’ health.
Even though the FDA now approves this lower BMI rating, I doubt the local insurances will rush to alter their surgical weight loss policy criteria. So, for now, if one falls within this category, they will most likely have to pursue surgery on a cash pay basis.
MoreHelp! My Band is too tight!
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.
MoreNew FDA Ruling on LapBand
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.
More