Lapband?

First to address Vickie’s comment: when I hear a story like that (which pierced my heart) I am ashamed of the medical profession I’ve been a part of for over 25 years.  I know the “old theory” of not letting the patient be any part of their medical care, not “concerning” patients (esp women) with actual diagnosis. Yes, I’ve nursed during the period where teminal diagnosis’ were withheld due to “causing undo stress”.  All that ever did was allow the doctor to be non-confronting and the patient silently worrying about what might- or might not be happening. In the meantime everyone was tiptoeing around issues instead of openly talking about end of life reality.  Imagine not holding, saying goodbye or even knowing the sex of a child you loved for almost 9 months? How heartbreaking.

So, the surgical weight loss seminar: I was surprised at the number of people in the room.  I know they hold the seminars twice a month. The lapband is a new offering in Billings this year and I have the feeling that most people came for that info (could be wrong though).  Probably 25 people were there and ALL fell into the obese catagory (several Mobidly).  Which surprised me a little, usually when I attend any weightloss clinics I look at half the people and think “why are you here?” Anyone with under 40 pounds to lose shouldn’t even be considering surgery.

First the statisics. Bypass $29,000; Lapband $20,000 (this is of course uncomplicated).  They gave a list of what most insurances cover and I don’t know about mine. I’m not sure which one it’ll be as it’s new on April 1st.  Even if it does cover, we have a $500 deduct/10 % copay. so that means $2500-$3000 (IF it’s covered). Most insurances had caveats of BMI of 40% or 35% with co-mobidities (diabetes, HTN)

I am completely ruling out bypass. It’s irreversible. Simple for me–not a chance. So I’m not going to talk about it.

Lapband though? Yea, it’s a possibility.  First of all, it’s done by arthroscopy so no huge incision, and most importantly it’s reversible.  The band can be deflated if the side effects are too much.  Time off work is pretty minimal. Mostly it isn’t due to the procedure, but learning how to eat.  The eating regime is pretty strict. A post-lapband woman talked to us. She had a very positive experience and lost 70 pounds.  She said the band “talks” to you and if you have one sip too much or ONE bite too much, you’ll know.  If you don’t chew the food well enough, you’ll know it.  So she chose to take a week off work to recover and learn to eat.

Recently she is having issues with band slippage.  She had been vomiting due to a viral illness and she “knew something was wrong” with the band (she didn’t say if it was pain or prolonged vomiting), so she had it checked and her stomach had pushed over the band where it isn’t supposed to be (I didn’t really understand). Anyway, she has to have it adjusted. I don’t know if this entails another surgery.

One interesting thing, one guy stated he had the surgery in Great Falls (240 miles north, closest available last year), and could he continue his follow-up in Billings?  The surgeon said “no”. Basically, they aren’t going to take on someone else’s work and the potential for lawsuits. So now this guy is stuck driving 240 miles (one way) for his care.  and the band takes a lot of  f/u to adjust the tightness to get desired results. Note to self, make sure plan to live in same area for years.

It was overwhelming how many people in the room spoke up and said they’d had the bypass surgery (and obviously not working for them).  Both procedures somehow block  grehlin production (grehlin stimulates the brain to eat).  So along with smaller stomachs, people simply don’t have the desire to eat–for about 18 months.  Then grehlin stimulus starts in again, so that’s why you see so many people put weight back on.  (think Al Roker, Carly Wilson). I’ve heard of people over and over who’ve regained the weight.  That’s also why the surgery isn’t a miracle–it still has to be paired with diet/exercise.  Both are more important than ever.

The lapband has been in existence since around 2003-04.  That isn’t very long in medical terms for long-term side effect profile. That worries me.  The surgery requires a special regime of vitamin and protein supplements. (altho not as limiting as bypass). Normal food, eating is done. I am saddened by that. Not overeating–but just eating with friends & family.  I’ve always hated when I’ve had to say “oh, can’t eat that” (refering to a diet). As if a bite of a dish would put me in my grave.  It’s important to my kids to get together over a nice dinner or a bowl of ice cream in the evening.  It’s comfort, tradition, family.  Don’t know I’m ready to give that up.

Which tells me at this point the lapband isn’t where I want to go. .. Yet.  I am going to make an appointment to see the bariatric physician for their medical weight loss program. I’ve got to look into the factors that cause emotional eating and replacing that response with something else.  They also use phentermine for appetite control.  If  don’t overcome that issue then surgery won’t be a long term answer either.  Just another failed diet.  An expensive failed diet.  I have been trying it all on my own for 20 years and it isn’t working, so I am going to give the medical profession on3 more shot.  If this doesn’t work, then I’ll look into saving for the lapband–but if, and only if, my insurance will cover it.  I will not indebt my family over $20,000 just because I can’t say no to an oreo. (yes, I know it’s more than that-but sometimes it’s not, sometimes it’s just the oreo).

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