NoWorry

Antogonism was genuinely not my intent. I respect your opinions and experiences and am glad that you've shared them.

Let me put it another way. It is my understanding that the "regular" smaller band takes longer to place in patients with a higher BMI because it can, and usually does, involve the removal of fat deposits around the stoma area and requires a certain degree of time-consuming finesse by the surgeon. I know a patient - male, 5' 9" with a BMI of 44 - who was given a regular band at a local US hospital in May. The surgery took approximately 15 minutes longer than average for the reasons stated above. I don't believe that my conclusions based on that information are unreasonable, but I definitely welcome Dr. O's comments. Not coincidentally, IMO, my friend was restricted immediately upon release, has received only a single fill of .8 cc and has seen a weight loss of 65 lbs in three months. Perhaps you could also get Dr. O to comment on the average number of fills necessary to optimize a patient with a VG band, which is the bigger question here. I'm certain that many patients in this group would greatly appreciate an informed response. I definitely will.

First, congratulations on accomplishing your goal, Roger. It's stories like yours that keep me motivated. We are in complete agreement. However, my reference to the lies was the failure to update information as it has become available. A website is a dynamic tool and the absence of current information on it is a lie of omission, IMO. And it's dirty because the omission directly benefits the source of the inaccurate/outdated information. I'm also not convinced that I needed a VG band in the first place. I'm not disputing it, because I don't have enough information to do so. However, I am using the following information as a basis for my inference: many patients with my BMI have been given the regular band; the VG band takes far less time to install; I have heard from a very reliable source that Ortiz desires to increase his clinic's ability to process 10 patients a day instead of the current 5 or 6. I do not believe that it's a big jump in logic to assume that the VG will become the default band of choice, if that is not already the case. Ortiz alludes to it in the Q&A section of his book, while not quite clarifying whether OCC itself has taken that position. I think those two statements are interdependent. Since each person's perceptions and expectations are usually generated by the information received, the poor communication itself is the likely cause of most incorrect perceptions and expectations. And since I lack Pammie's apparent ability to conclude from Inamed's brochure that multiple fills are needed in the months following surgery ('may' and 'more than one' are vague and highly misleading, IMO), I don't believe I had the information to develop accurate expectations. Since I have that information now, it's clearly incumbent on me to adjust my expectations accordingly. And I believe I'm doing that. But I sure don't have to like it! And if I care for my fellow and future bandsters, I think it obligates me to share and proliferate the knowledge. Yes, thank you. That's my thinking exactly. I have no feedback on my local doctor, and while many bandsters have reported poor results from their local fill doctors, a significant number have also reported satisfaction. And it's not like I'm burning any bridges. If the local guy is not satisfactory, I can always trot down to OCC again. Question for you, Roger. I have the clear impression that you set definable goals for your weight loss journey. Did you also set timelines for your goals? Could you quantify the steps you took that lead to your success?

Actually, having dealt with both Romero and Acosta, I prefer Acosta. I find him honest, direct, communicative, enthusiastic, interactive and willing to accommodate individual needs. While Romero is extremely efficient, I find him methodical, close-lipped and mostly really just going through the motions. I vastly prefer the feedback I get from Acosta because it gives me something to work with, whereas Romero has been there, done that and figures the best bet is to not say too much. There is an argument to be made that Acosta could be more diplomatic, but diplomacy is just another word for spinning information and I prefer my information direct and un-spun. Quite frankly, if I require to do something more to accomplish my weight loss, I want to hear it, as unpleasant as it might be to hear. Give me the facts and let me decide how to use them. In my opinion, honest and direct information is a very rare commodity at OCC. And I believe that many, if not most, patients prefer it that way. (Yeah, so I guess I just agreed that Acosta is going to have to shut up pretty soon. ) And please don't take this as being nitpicky, since that is not my objective, but your statement is not an opinion, it's a desire. We all desire the band to do all the work. In fact, if we could, I think we would desire a magic wand instead. But if that desire is not going to be met, and I think we all now know that it's not, then it's important to know what other action is necessary to fulfill our goal. This assumes that you would not have opted for another, perhaps more efficient, weight loss option instead. I won't name them, because your comments have already started to draw the rah-rah sisters like sharks to chum and I can live without their single-minded derision of anything remotely perceived to be anti-band or anti-OCC. Excellent distinction. Certainly the weight of the money invested has to play a very significant role in the Return On Investment expected. In my case, I did not pay for my surgery myself. Yet, although I did not make a financial investment, I have made an enormous emotional investment and I expect a matching payback. Nothing less than reaching my target weight is even remotely an option. And I want to do it as quickly and as efficiently as possible. I don't know. The world is a big place and there are many places to visit. Three trips to San Diego/TJ are more than enough for me. Okay, for this one I'll risk incurring the wrath of the rah-rah sisters. There are literally thousands of studies that show that the longer an endeavor takes, the more the chances of success are reduced. Humans seem able to sustain their drive towards accomplishing goals for only limited periods of time. Yes, there are many exceptions, but at the end of the day, the vast majority simply allow most time-consuming goals to gradually slip away. Most people will get their first fill promptly, dawdle a little over the second fill, lose their enthusiasm for the third fill and by the fourth of fifth fill simply lose interest. And the long term statistical results of lap-band surgery do bear this out. The patients who lose the most initiallly relative to their target weight show much better results in the long term than those who struggle to lose weight during the first months. While it sounds good to say this is a long journey, the length of the journey does, in fact, have a substantial impact on the outcome. SHIELDS UP!

Thanks for your response, Judy. I admire your ability to not weigh yourself and go by the fit of your clothes. I have read that this is a desirable way of approaching weight loss, but I have not been able to stay away from the scales. While I think that fills at OCC are more reliable, accurate and efficient, I get the impression that you believe that they should also give better results. I don't believe that this naturally follows. Their primary concern is safety and this generally means passive fills. In fact, if I had not insisted on top ups on both my fill trips, I would not have had any restriction at all following both my fills. Their concern for safety, though, is comforting to me.

No, I haven't. If you've stopped obsessing, it would appear to me that you have made a psychological shift. While you're clearly attributing that to the band, I'm not convinced that the two are connected. I applaud you for being satisfied with a 10 lb loss. By my math that works out to a cost of $850+ per pound lost. I don't think you could sell this procedure successfully at that price. However, the important thing is that you're happy with your results.

What an excellent point. I had never even considered that, but it makes perfect sense. Why would you buy a car if you had to run alongside it? The idea is that it should simply take you wherever you want to go. Worse yet would be the car that you have to push around! And that's a lot like the band. It not only doesn't carry it's own weight, but you have to work extra hard to make it work. But then, of course, you wouldn't buy a treadmill and not expect to actually use it. It really comes down to the bill of goods you've been sold. I expected to work with the band, but I didn't expect to have to do almost all the work as it's turning out to be. You took the bait in my questions perfectly! If you agree that part of why you're sticking with it is that there's no reasonable way to back out, then clearly if backing out was an option you might have considered it. And if you would consider backing out, then you have to consider that the friend whom you recommend the procedure to might also wish to back out at a later date. So I'm not sure that you would be doing your friend any favors by recommending the procedure. For me, it's strictly wait and see. There are a few close friends who have been using me as a guinea pig and I've told them that the jury is still out and they are patiently waiting. Eventually, the jury will come in and it will probably effect the decisions of many, many more people and I have to be impeccably convinced that I'm giving the best information possible. But if someone put a gun to my head and said I had to make a decision right now, I would tell them not to do it. Three months after my surgery my weight is exactly the same as when I started. However, the jury is almost in on the question of the the sweet spot. And the verdict is that it's a myth. Definitions first: my understanding is that the sweet spot is a level of fill that keeps the patient at an optimized level of restriction for an extended period of time while the weight simply rolls off. My new understanding is that this is a contradiction in terms. The sweeter the spot, the faster the weight comes off, and the faster you leave the sweet spot. The sweet spot can really only exist if you don't lose any more weight (i.e. there are no more physiological changes to your body) and we know that no one wants that! When I spoke with Romero on this visit and asked him why my first fill stopped restricting, he asked me if I had lost any weight. I had. He asked if I had lost any inches. I had. It's as simple as that. You lose weight, you lose inches, you lose restriction. As I was leaving, the last thing he said to me was "See in you 6 weeks." Put that on a banner on the OCC homepage: Lap-Band Surgery Requires A Fill EVERY SIX WEEKS After Surgery and see how many people sign up! You may have heard the old story about the frog: Drop a frog in boiling water and it will immediately jump out. Turn up the heat gradually and the frog will sit there until it boils to death. Yes, we are the frogs. So the myth of the sweet spot lives on. Because without it, many of us would have jumped out. Personally, I'm more practical. Yes, I might never have had the surgery if I knew I required upto 10 fills in the first year. But if I had still had the surgery, I would have been far better prepared at this stage for all the fills I'm going to need before I acheive my target weight loss. I am now planning on a fill every 6 weeks and I expect the ride to be a lot smoother from now on.

Please give this question some thought: If you had been told before you had the surgery that you needed 1 fill for approximately every 12 pounds of weight that you needed to lose (and I'm now genuinely coming to believe that this is a fact, although the actual number could easily be anywhere from 10 to 15 lbs), would you still have had the surgery? Thanks very much, Judy. I genuinely appreciate your good wishes. I think, though, that I did hit the sweet spot on my first fill. And then I lost some weight and it passed. I actually think I've hit my sweet spot again on this fill (although it might be a bit early to tell, since my fill was only 5 days ago), but I'm sure that this, too, will pass and I'll need another fill as soon as I lose another 10-15 lbs.

Thanks. The last thing Romero said to me as I was leaving after my last fill was "See you in six weeks." If that's the norm (and I am now almost convinced that it is - this is the one dirty little secret about banding), and it takes a full day for a fill at OCC plus a $375 price tag all-in, it only makes sense to check out the local guy where a fill should take less than an hour and cost a lot less. So it might take an extra poke or two with the needle. I think it's a small trade off.

Thanks for your feedback, Teri. I have been reading your posts with great interest and your story has been inspirational -although I must confess I wondered what kept you motivated through the ordeal (other than the huge investment, of course, and no reasonable way to back out). You have been far more patient and positive than I could ever hope to be. Tell me, though, would you have recommended this surgery to a friend during those 8 months? Would you recommend it now to someone who was looking for reasonably quick results - say, looking to lose 75 pounds in a year following surgery?

It's very interesting you should say that. When a lot of people were jumping down my throat, I showed my journal to me editor. Her response was: "So you're saying that the surgery was a big success, but there were a few minor logistical problems and frustrations, right? New patients should be a lot more receptive to that than a flawless, rosy picture. Especially since you're empowering them with preparedness for the little bumps!" Thank you for confirming her assessment.

A fill center has just opened 15 mins away from me. The doctor does not use fluoroscopy but I'm not sure that it makes that much difference. $300 on first visit, $155 each thereafter. I'm headed to TJ for my second fill tomorrow. If my results are not satisfactory, I'm leaning towards giving the local guy a try.

You're definitely right and I'm beginning to see that. I am angry with the deception, but I am working on getting past that and revising my expectations. I am also working on a way to try and ensure that this happens less to future bandsters. Thank you very much. I greatly appreciate the concern. I've lost my enthusiasm and while I stayed overnight last time, I'm just not motivated this time nor convinced that an overnight stay improves my chances of success. However, I'm very curious to know why my last restriction ended just 2 weeks after my first fill - has the saline leaked, has my stoma unpuckered, do I have a defective band, has the band re-adjusted? But I'm not very hopeful of getting a conclusive answer, so I'm emotionally preparing myself for another vague and unscientific response. And if it's another bust, I'm done with OCC; I'm going to give the local FillCenters a crack. While there's a lot to be said for OCC's high volume of fills, I want a relationship with my doctor and some feeling that he cares about my success and that I'm not just another statistic for him who is forgotten 3 minutes after I walk out the door.

As the saying goes: from your lips to god's ears. I feel I was cheated and scammed that I was never informed that it would take 4-5 fills to find my sweet spot - the lies are clearly documented in Ortiz's book and not specified at all in 'Dummies'. I am working on adjusting my emotions to get past that and move forward from here. I want to have an open mind when I get my 2nd fill tomorrow. Thanks for your encouragement. It's precious.

Thanks very much for sharing your experience, Pam. And more importantly, your thoughts and feelings around your experience. I had my first fill almost 6 weeks ago, started with a little restriction and have virtually no restriction now. Not quite a Paris trip, but I was part of a big reunion this week and have been eating anything and everything I want. I tried to tell one of my friends that I was banded, but she would not believe it based on my eating patterns. I'm back to OCC on Tuesday 8/7 for another fill. I guess another doctor will take another blind shot at a black cat in a dark room and try and maximize my fill. If it sounds like I no longer have much faith in this process, that's because it's exactly true. Yeah, yeah, it's a tool and it takes time and I have to be patient. None of that is easy when there appears to be no certainty that the fill will ever be optimized and the thoughts of many continuous trips to TJ flood my sensiblities. I'm glad you're doing well. It gives me a little more hope.

Well, I can certainly relate to this. Both about the ability to eat anything I want, in just about any quantities I want (ok, I do feel full a bit earlier, but that's after eating 80-90% of my pre-banding quantities) PLUS the confusion surrounding this result. My biggest complaint about this procedure is the lack of consistent and reliable information of what to expect and how to interpret individual experiences. You can make the best ______ (fill in the blank) in the world, but if it doesn't come with a reliable instruction manual, it's can be pretty worthless! I certainly hope you'll continue - I'd love to hear the rest of your experience.

Thanks very much for the encouragement and the positive feedback. But on a practical level, how really do I get there? I have a feeling that both Dr. Romero and Dr. Acosta are throwing darts at a dartboard in a a darkened room with blindfolds on and my chances of hitting the sweet spot is totally random. Studies have already shown that the chances of success at a given endeavor reduce dramatically with each false start - humans try successively less hard with each attempt at the same task. I'm already feeling my motivation start to diminish as the doubts of my conviction of success escalate.

Well, it's exactly one month since my first fill and even after having 5 adjustments on that trip, I have virtually no restriction at all at any time of the day or night. I have just made another appointment to go back to TJ for a fill on 8/7. I'm trying hard to ignore the voice in the back of my mind that's saying that this whole thing is a big scam!

You're very welcome. And good luck with your Aug 6 surgery!

Each individual's response to pain and recovery is different, but I felt pretty close to normal a couple of days after the surgery. In addition to physical considerations, I also had to deal with emotional factors and making changes in my lifestyle. I gave myself 3 days to recover and created a situation where I could extend it to as much as a week if the need arose. I was back to a normal routine by the 4th day.

Fills are free. The $100 charge is for fluoroscopy.

I was thinking that a slight overfill would lead to more rapid weight loss which should then optimize the fill fairly quickly. So a slight overfill would be self-fixing while an underfill can only be fixed by a return trip. Still, your point is well taken. However, these are all relative terms anyway. One person's feeling of overfill or optimal fill is just that - a personal feeling. Since there's no real way of measuring, it really just depends on each individual's expectation rather than an absolute. What's missing, I think, is a scientific metric. Perhaps a measured dose of barium and a timed passage through the stoma? And the metric should ideally be the length of time it takes X amount of barium to pass through the band, rather than the amount of saline in the band which is a fairly useless measurement, IMO.

Sounds like you found an excellent 'artist.' Good for you. My restriction is moderate. But I'm still losing weight (although very slowly) and most of the loss has come from just drinking protein drinks for almost a week, not the lap-band restriction. The first opportunity I get, I'm going to get another adjustment. I'm not sure I'll go back to TJ, though. If it's all guesswork (or artistry) anyway, I might be better off somewhere closer. I met a friend yesterday who had his surgery locally 2 weeks before mine. He's already lost 55 lbs, but he had a lot more to lose than I did. Still, it's a higher percentage of total loss and I'm envious.

First Fill (Conclusions) Since my first fill, I have discovered the conditions of sliming (which, it turns out, was what I was experiencing in TJ) and PB'ing, another thoroughly unpleasant experience. I have found that turkey and chicken are the most frequent causes of PB'ing for me while fish and red meat go down fairly easily and smoothly. This is almost the opposite of most of what I've read, but I'm beginning to realize that this procedure is in its infancy and there are simply no absolutes, just a long series of educated guesses. Clearly the surgery is an exact medical science and OCC has perfected it. As best as I can tell through my research and experience, the procedure of fills and adjustments is much closer to an art than a science. And the results each individual encounters are fairly hit or miss, in spite of the fill doctors' high level of competence and skill. I have now had the opportunity to test my adjusted band fairly extensively and my early conclusion is that while I have some restriction, I am not at my optimal fill level. I would guess that my optimal fill is 5.0 cc. The band prevents me from eating too fast, it keeps me from not chewing enough and whenever I eat too soon after drinking a lot of liquids, I can usually count on an incidence of sliming. At a normal meal, I can eat around 2/3rds of my pre-banding capacity, which is significantly less than my goal of 1/3rd, but still a definite improvement. More importantly, I am far more aware of my eating habits and patterns, more than on any recent diet, and this is contributing towards slow but continuous weight loss. I am afraid of what will happen once the novelty and attention wear off. In an ideal world, I would head back to TJ for another adjustment sooner than later, but I must first get around a fairly busy schedule over the next 4-6 weeks and also justify the cumulative expense for what feels like a relatively tiny adjustment. And I am a little fearful of repeating my past experience. I have mixed feelings about the repeated attempts at fine tuning my first fill, since it got me a lot closer to optimal than the first attempt. I am certain that I would be extremely unhappy if I had returned with 4.0 cc, since it provided no restriction at all. But I wonder if I wouldn

First Fill (Part II) The next morning, I call Claudia at OCC and inform her that I'm heading back for another adjustment. I'm not much in the mood for walking this time, so I call the car rental company and purchase insurance for driving in Mexico. It costs $26, but subtract the $9 for parking and the $5 for a cab each way and it feels perfectly reasonable. I drive to the border again and, this time, just drive across. It takes only a few minutes to get to OCC. I drive into the underground parking garage and ask the security guard where I can park. She tells me that there is no guest parking, but then asks how long I'm going to be. I guess that I'll be there for about half an hour and she graciously allows me to park. Claudia has already informed me that Dr. Romero is off that day, and my appointment is with Dr. Acosta. The waiting room is already quite crowded and most of the patients are there for fills or consultations, since there are no surgeries on Saturdays. Around 10 minutes after I arrive, Dr. Acosta comes out and takes me into the fill room. He goes through his procedures and turns on the fluoroscope. This time, the image is clearly defined and I can easily make out all the organs and the band. As far as I can tell, Dr. Romero prefers to keep the fluoro on continuously at a low intensity, while Dr. Acosta prefers a much sharper intensity, but turns on the fluoro for only brief periods of time. This time I pass on the straw and sip the barium directly from the cup. I can see the barium going down clearly this time and although it creates the hurricane image passing through the stoma, it flows through fairly quickly. Dr. A plays with the adjustment while I drink water and then adjusts me to 4.6 cc. Dr. Martinez comes in briefly. I have the sense that he has a busy day scheduled, but that he wants to make sure that all his patients are well looked after. He tells me that he has done around 8000 fills, but that was before the advent of the VG band, and even with their lower numbers, both Dr. R and Dr. A are now much more proficient and experienced than him. He wants to be sure that I am properly adjusted this time and wants me to take the toast test. I sit in the waiting room until a nurse brings me two slices of dry whole wheat toast and I take small bites and chew thoroughly before swallowing. All four wedges of toast go down without any restriction at all. The waiting room is packed now and Claudia tells me that this has been a strange day since there were very few early appointments and many patients showed up a little late, so the schedule is fairly jammed now. Around 20 minutes later, Dr. A takes me into the fill room again. Once again we go through the preparation routine. This time when the needle goes in, the pain is significantly elevated. After all, it is being inserted into almost precisely the same tissue that has already been injected twice before. Dr. M pops in again and he is very gracious even though he is now clearly very pressed for time. Under the fluoro, it is clear that all the toast has already passed through the stoma. In spite of the increased fill, there is still virtually no restriction. The two doctors decide to bump me up by a full cc to 5.6. I've already been considerably longer than my guess to the security guard, so I'm not surprised when I return to the parking garage that my car is trapped behind another vehicle. It takes 15 minutes to get my vehicle untrapped, and then I am on the road. While I'm driving around looking for the route back, I feel a terribly strange sensation. As much as I swallow, I can't seem to get my saliva down. The back of my mouth seems permanently awash in liquid. This can't be good. Reluctantly, I make my way back to the clinic. I park on the street this time and head upstairs. It takes around 25 minutes before Dr. A can see me again. Even as we go through the now-familiar routine, it is clear that I'm over-filled. Dr. A and Dr. M consulted shortly after I left and decided that the toast test is simply not an accurate gauge. They're going to find an alternate test. This time when the needle goes in it really hurts. The skin above the port is tender and inflamed from the barrage of syringe pricks. Dr. A wants to take out .6 cc, but I am reluctant to give up that much. We negotiate and I convince him to take out only .2 cc. When I leave the clinic this time, I am filled with 5.4 cc of saline. I bump into Francisco in the waiting room and he gives me directions to the border. I climb into my car and head off again. Turns out the Avenue Heroes is closed each weekend and becomes a long lineup of cars backed up from the border crossing 1-1/2 miles away. From the clinic, I have to drive away from the border, turn left at the McDonald's, drive over the bridge and then return to join the back of the queue. From there, it can take anywhere from 1 to 2 hours to cross the border. As the line of cars inches forward, I start to feel the sensation of liquid backing up into my mouth again. I try and ignore it. I make a few phone calls to friends, I listen to music, but the sensation will not pass. I have been in the lineup for 40 minutes when I begin to approach the last exit before the border. And the sensation is still there. It's decision time. Also hanging in the balance is the knowledge that this is my last chance for making my 5:00 p.m. flight. If I return to the clinic now, I will almost certainly miss my departure. As I creep past the exit I know that I can't take the chance and I reluctantly pull out of line and head back. Back at the clinic, the last patient is in with Dr. A and the waiting room is empty. It is already just past the OCC's 2 p.m. closing time. While I'm waiting, I ask Claudia's permission to use the clinic's computer to try and find another flight home. Before I can finish doing that, Dr. A is ready for me. This time the pain of the syringe going in brings a tear to my eyes. For days later I can see a cluster of tiny inflamed red dots where the needles went in. The image on the fluoro is a jumbled mess; there are clustered pools of barium everywhere. Dr. A recommends a significant unfill back to 4.6. I think that 5.0 might be better. We split the difference and he adjusts me to 4.8. What he hints at, and what I realize is true, is that it's all guesswork at this point. The stoma is probably rather inflamed and swollen by the constant barrage of tightening and loosening and it will take some time to return to a normal state. We all leave the clinic together. The front exit is locked, so we leave through the garage. I drive to the back of the line to the border and it hasn't moved much, but at least I'm now a pro at getting there. It takes a little under 2 hours to cross to the US it keeps me close to the glimmer of actually making my flight. But by the time I return my rental vehicle and take the shuttle to the airport, my flight has already departed. While I'm waiting 3 hours at the airport for my new flight that will take my home through an absurd series of connections, I decide to have a cup of hot tea with lemon to soothe my insides. Twenty minutes later my mouth is once again awash in liquid. I call my bandster buddy and ask for her recommendation. She recommends that I continue home. If the problem persists until Monday, I can always make another trip down. She tells me that when she is severely restricted she has an ice cold drink and it usually un-restricts her. This is contrary to my sense of logic that tells me that heat soothes, but I'll try anything now. It's past midnight when I get home and the first thing I do is grab a popsicle from the freezer. Ten minutes later, I feel completely un-restricted and at least able to sleep. In retrospect, I would guess that the hot tea further inflamed the already senstive lining of the stoma and the swelling closed it entirely. The time lapse, further assisted by the cold of the popsicle, eased the inflammation and opened the stoma again. Dr. A and Dr. M had both recommended that I go on liquids for 5 days - instead of the usual 3 - to allow the stomach to heal. I started immediately upon my return, and sure enough, everything went swimmingly well. I had no need of returning to the clinic the following Monday as I had worried about at the airport.