I'm a partly-retired Advanced-Practice health care provider and long-time health educator, and have been for - ack! - 25 + yrs, mostly in pediatric oncology, as a Clinical Nurse Specialist, (parallel degree/training to a Nurse Practitioner) the first 10 yrs, then public health since. I taught nursing and medical students at UCLA Medical School early on, as well, shortly after Graduate School in Nursing at UCLA . I also write lots of patient education materials for several doctors and Band surgeons. I have worked formally for my own Band surgeon, as the Patient Educator, for about 4 years. I'm in the process of completing a very comprehensive book on "Banding - how to do Great " - and hope it will be ready by Fall, 2009 - way too many other things I love to do!
When I was banded in early 2003 in Tijuana, there was very little info available about banding, so I had to do a huge amt of research before I was comfortable with it, and was pretty sure it would work for me. Then even more research and contacting other Bandsters and European surgeons to learn how to do well. As a medical person, I'm used to researching everything to death before I use or recommend something. I want to see PROOF something works, not just hearsay or subjective testimonials.
I have only worked part-time for a number of years, so, for the last 5+ yrs, the band has been pretty much my "specialty", I guess. I write, teach, consult, trouble-shoot, and speak about the band regularly, as a health educator and successful Bandster. I own or co-own 2 online Band boards with 2000+ band patients that I teach and support, in addition to my local patients and the Kuri patients who wish my advice and support. I also volunteer as much time as possible on OH, both posting and replying to emails.
I no longer recommend ANY surgeon, and strongly recommend against going to Mexico for surgery. While some there possibly continue to be good surgeons, surgery is only the very first, and simple, step of a lifetime of care. A number of serious, ongoing patient care issues are very adversely affecting pre-op and post-op lifetime care of some surgeons, in my opinion. Further, when we choose a Mexican doc (or any surgeon far away) , we MUST assume a great deal more responsibility ourselves for learning and doing what is needed to do well. We just will not be able to see them as often as if they were in the same town, and i feel followup care will badly suffer. It takes a TEAM of band people working together to provide us the care we need for the many years after surgery - Nurse Practitioners, band-knowledgeable nutritionists, psychologists, skilled fill people, in-person support groups, and a huge amount of teaching. These are just not possible, IMO, from a surgeon hundreds/thousands of miles away.
I feel strongly now that choosing a local band surgeon is far better than going to Mexico, even if more expensive initially. The price will even out in a few years, and may well be far LESS than going to another country. There are many unexpected costs when our surgeons and care team are not quickly accessible. Many have gotten into serious trouble, and many have lost their bands from lack of quick care. Our health and safety are the most important things in the world, and worth every cent of care. Choose a skilled local surgeon for your best chance at doing well.
Additionally, none of the Mexican surgeons can obtain the newest generation of Inamed bands, the AP bands, and I feel they are clearly superior, with the least risk of serious and expensive problems. To directly quote one very well-known Band surgeon in January 2009:
" Personally I feel that the AP's are so much better that it would be malpractice to put a 4cc band in. I would say 90% of band surgeons are using AP bands now. They do cost more. I am positive there are fewer slips, not sure about erosions yet. We haven't had one AP slip since we started using them 18 months ago. We haven't had any pouch dilations either. "
If we have absolutely no choice but to choose a surgeon far away, I feel we must choose one with very good banded and well-trained and successful Patient Facilitators and Educators, to guide and teach both pre-op and post-op, and who are well-versed both in English and in person band care and needs. I also feel strongly that there must be excellent followup care and teaching through a formal, professionally-run online Forum , such as an online teaching Board, if we are to have any chance to succeed. Teaching, trouble-shooting, advice, and guidance must be given by medical professionals trained in anatomy and Physiology and band care , not left totally to volunteers who are not formally trained or up-to-date with band information and research - even though they are sincere and mean well.
I feel my primary allegiance is to the Kuri clients, since I personally know many of them so well after 6 years banded, and I devote the largest percentage of my available teaching time to their needs online and otherwise. I have my own very active Band board, primarily for Kuri patients, where we emphasize the essential teaching and support needed to succeed. I also feel a commitment to help ALL bandsters do well, so I give time to several other boards almost daily. I try to post on OH often, and also spend time daily on another of my own Boards, started with my good Band Buddy, Dan Lester. He is another longterm, wise, and very successful Bandster. We have just had the 1900th member join. We give very personal advice and suggestions, and all questions are answered quickly.
http://health.groups.yahoo.com/group/SmarterBandsters/ - for those interested. All BANDED people are welcome, but please no pre-Bandsters. There are other larger boards that address the many routine, pre-Bandster questions.
I was very lucky to get great fills and care from a VERY knowledgeable local Band fill person in Portland and never needed to fly all the way back to Tijuana for care. I feel choosing a local band surgeon is extremely important, as we cannot be crawling back onto a plane for another country, when we are ill and in trouble. I also followed the band rules pretty well - but certainly far from perfectly. About 80% good choices is about all humans can manage, and the band is usually very forgiving when needed.
However, I committed to make the many changes needed with banding - and to do ANYthing else needed to regain my life and health. We must be very honest with ourselves about a real commitment to change. If we are unwilling to commit to many changes and new things, particularly better eating and regular exercise, the Band is not for us at this time. Please be very honest with yourself about this. The Band surely is not for everyone. It cannot be a quick decision, or scheduled quickly to accommodate a surgeon's schedule. Some people spend more time researching a new car than this major surgery that will affect every day of the rest of our lives.
I lost about 25# after scheduling band surgery, and then I lost another 104# after banding, in just about 11 months, by the simple ways we all know - good fills, more fill as needed but NEVER TOO MUCH, reasonable exercise, the 1200-1500 nutritious cal a day (as for most women starting less than 350#), enough fluids, no liquid calories including no protein drinks or juices, and - importantly - flexibility and patience. There were no special tricks at all, just some hard work and commitment. BUT I DID quickly realize that I needed some help with making the lifestyle changes needed.
In addition to serious therapy, which I strongly recommend to learn what unmet needs we are trying to "feed" with food - and then learn how to meet these needs withOUT the extra food that is killing us -
I used Guided Imagery and found it an extremely effective way to facilitate the many lifestyle and behavioral changes needed to do well. I believe this was a huge part of my own Band success, and I strongly encourage it.
The psychological parts of banding are by far the hardest parts, IMO, and Guided Imagery is an excellent tool for emotional and lifestyle changes, particularly with medical needs. It is used successfully all over the world in many medical situations, but poorly understood or used in the US - just like the Band itself. Guided Imagery is even more important, now that I am at goal, to keep my "head" in the right place and not go back to old, bad habits. I continue to use it weekly, and have had little trouble most of the time maintaining my loss for more than 5.5 yrs, so far. You can learn more about how Guided Imagery can specifically help BANDSTERS on my website, below, if you're interested .
I've learned everything I possibly can about the band, it's physiology, it's needs, glitches, preventing problems and trouble-shooting, and the ways to make it work for me and others, from the band surgeons and fill people I work/worked for and regularly consult for information. I'm happy to share what I have learned, just as others before me took the time to help ME when I was new. I surely am not always right, and continue to learn more every day, but I believe that I have seen most of the things, and heard most of the questions and problems that arise with banding, and learned the solutions, after 6 years of this. When I offer suggestions, it is from my own experience and that of the people I work with and for, and from other Kuri patients, as well as patients of many other doctors.
I have many years as an Advanced-Practice medical provider, BUT I post here only as an experienced band patient and band educator. As with all suggestions or advice - take it or leave it! Nothing is right for everyone. I can only share what I believe, teach, and have seen work. I hope my experiences and perspective can help you succeed in your own weight loss efforts! You're free, of course, to choose any other path to success.
Others have other experiences to share, that are equally valid.
I email and talk with a number of different, international Band docs regularly , to ask questions, update my knowledge, and continue to learn, and get their thoughts on my book's information and for answers to my general Band questions. Band knowledge continues to evolve and improve every month, and it is both a very fascinating and interesting, as well as a personal, thing for me.
When I was new, and even now, most of what I learned was from other experienced and successful Bandsters before me, so I am committed to now spend time teaching and helping others do well too. We are all in this tough joourney together.
This ongoing research and band-related work also helps me keep focused on my own weight maintenance and continuing good choices most of the time. Many at-goal Bandsters revert to old habits again, and regain - and some very badly.
Our new habits must be permanent , if we want our Band loss to be permanent.
I consider that I will always be morbidly-obese - I am just "in remission" for as long as I am vigilant. This outlook keeps me focused and committed to my lifesaving Band. I don't want to be one of those who regain. Many are unable to remain at a goal weight, and return to old, harmful habits again. I am SO thankful to have reclaimed my life, I will always be very careful. I eat quite normally now, but stay within the calorie range I know will support my continuing maintenance - about 2000 -2200 cal or so a day - and get very regular exercise. I know and accept that what I learned with Banding will be what I need to do for the rest of my life.
Since I reached goal January 2004, I'm maintaining fine, with the usual up-and-down 3-5# on either side of my normal-BMI goal. I have returned to my very active life as a world traveler, professional published nature photographer, cat lover, and health educator. I do a lot of volunteer work in various health-related areas and clinics, medical relief, our church outreach to the homeless and ill, and pet rescue, and stay pretty busy. I have been working hard on my Band book, and hope to finish and release it soon.
My Band journey was not completely trouble free, and most of us experience small quirks or glitches along the way. I had the usual occasional vomiting until I took the band rules very seriously. I got a couple accidental overfills, one of which sent me to the ER at 3 am, it was so painful. I had a very bad aspiration pneumonia in about my 4th month - mostly from inhaling water and pouch contents when I flipped my kayak in a lake - but if there had not been lunch in my pouch, I don't think this would have happened. I don't really count that as band-related. But this is why I'm so vocal about avoiding reflux. The possible resulting aspiration pneumonia is TRULY miserable, and is pure hell to recover from, even when we are very healthy otherwise. I have never been so sick in my life; it took me a full month to recover, and the first 2.5 weeks I was literally barely able to crawl out of bed. PLEASE don't put up with ANY reflux and put yourself at risk for this pneumonia! It's dangerous in many ways.
There will always be small glitches and irritations with this fickle band. We have to be very flexible and patient, and just keep plodding along with our eyes on our goal. The Band and fills are FAR from perfected, but it is still the safest and most effective form of WLS, imo. I believe the small Band glitches are far better than the permanent glitches of ill health, increasing disability and death - if we do NOT have WLS ! Current studies now show that band loss is just as good as bypass loss, but far safer. While the bypass people lose faster the first 1-2 yrs, by the 3rd year band loss equals bypass loss. by the 4-5th year, when most bypass people have regained, band loss EXCEEDS bypass loss. See this link:
That is a bit about me!
PS - there is a rumor going around as of August 2008 that I have lost my band to an erosion. This is not true - I have had no problems at all, my band is intact and functioning perfectly, and I remain at my 23-24 bmi goal weight.
Sandy R, BA, BSN, MN
www.BandsterME.com - my website - Guided Imagery for Bandsters, Band articles, links, stories and general Band information.
[email protected] - my email address
http://health.groups.yahoo.com/group/SmarterERBandsters/ - my private band teaching board with my band buddy Dan L, banded the same time as I was, and also at goal for more than 5 yrs. We don't believe in sugar-coating, but in "tough love", when needed.
Surgeon: Pedro Kuri, M.D.
I no longer recommend Dr. Kuri, sadly, under any circumstances.
BC/BS, self pay