Gastric Band Surgery Q&A Part 2

by Christine on October 4th, 2011

filed under Christine's Life Updates, Gastric Banding Surgery

Periodically I go into the Google Analytics of my website and discover that some viewers are asking questions about the gastric banding surgery and looking for the answers at my website. Here is the lastest group of “Questions and Answers” about the gastric banding surgery that might be of use to new bandsters.  This is Part 2 of the Q&A. Read Part 1 of the Q&A here.

 

How do I know if my gastric band is too tight?
If you cannot take a swig of water immediately after a fill, then your gastric band is definitely too tight. That’s the easy part.  However, finding the right balance between “tight enough to lose weight and be happy” and “too tight” might be a difficult balance to achieve. I know that I struggle with this almost 3 years after surgery! If you are finding that you cannot eat enough calories to survive (you know, if you’re dizzy and having a hard time concentrating because you’re not eating enough), then your band is too tight. If you find yourself choosing protein shakes, milkshakes, ice cream, and soup all the time because anything more solid than that is painful, then your band is too tight. If you find yourself barfing during most meals because your food is always getting stuck, then your band is probably too tight.

All that being said, I like to have my band pretty tight—maybe even tighter than most people. I know that I can’t eat certain foods, especially breads and pastas. Just because I can’t eat certain foods doesn’t mean that my band is too tight. I know a lot of bandsters that can no longer eat steaks or dry chicken. Again, this is normal and not necessarily an indication that the band is too tight. On the other hand, if you simply cannot be happy unless you have steak, and you find your band too tight to eat steak, then you might want to consider getting some saline taken out.

All in all, there’s no real hard and fast rule about finding whether the band is too tight or not. It’s really a matter of personal preference. However, a good rule of thumb is that if you cannot swallow any liquid, or if you have problems eating solid foods of any kind, then you should definitely loosen your band a bit. Other than that, it’s a matter of what you can live with or not.

 

How long is the gastric band waiting list?
Honestly, I think it depends on what region of the world you live in, what hospital you are going to, what surgeon you are seeing, etc. I know in the UK, the country only allocates a certain amount of money for the gastric band surgery, and so you might be on the waiting list for quite a while. According to www.gastricband.org.uk the waiting list in the UK can vary from anywhere between 3 months to four years.

I was banded in upstate New York, USA. I was not placed on any waiting list. Once I completed all my pre-surgery testing and requirements, I was immediately put on the pre-surgery diet. My surgeons gave me 2 months to lose 25 pounds on the pre-surgery protein shake diet, and as soon as I lost that weight I had my surgery. And yes, my insurance paid for the surgery in its entirety, but that really depends on your insurance carrier, your health background, the hospital you’re going to, and a lot of other factors.

I really recommend you check out the forums at www.lapbandtalk.com, especially the regional forums to inquire about this question.  (FYI, LapBandTalk.com is free to use and is a fantastic resource for anyone considering the banding surgery.)

 

Does gastric banding hurt?
Yes, the surgery itself does. But I personally found it to be a tolerable pain, that did not last very long (only a few days…maybe 7-10 days) and went away little by little, every day.  I’ve read other blogs from banders that found the pain to be too much, too intense, and last too long. I think part of the pain has to do with your tolerance, as well as your surgeon’s capabilities.

The band should not hurt once your body has healed from the surgery. If you are in pain several week or months following your surgery, you should definitely talk to your surgeon to find out what’s going on.

Will throwing up hurt the gastric band?
Fantastic question!

In my personal opinion and experience, I think all bandsters experience purging/throwing up due to food getting stuck in the band. Bandsters have all kinds of terminology for this experience, such as “sliming” or “B/Ping” etc.  This is a very common occurrence, especially once the band gets close to your “sweet spot,” which is the optimal tightness that allows you to live and eat happily but still allow you to lose weight.

Despite the common occurrence of the purging episodes, throwing up can hurt the gastric band, so you should really be careful about it. I believe the band is most vulnerable during the early stages of the process, when the band is deflated and fits loosely on the stomach. If you have a violent barfing episode, the heaving of the stomach can dislodge the location of the band around the stomach, thereby reducing the effectiveness of it. If the band becomes dislodged, you might not realize it right away. The doctor can find if the band has moved by using an X-Ray, or if after a few weeks or months you are not losing weight.

However, it also makes sense to me that barfing can hurt the band if it is filled with saline and tighter. When you are heaving, your stomach might press against the band with such a force that it could rupture the band. (Think of it like squeezing against a full balloon. What happens? The balloon explodes!) If your band “pops” like a balloon, the only way to fix this is by replacing it with another surgery.

All that being said, I’ve personally never heard of anyone having these problems – either band slippage or band “poppage”—because of a barfing episode. It’s just something to be aware of and watch out for. I think this is relatively rare.

 

Why has the gastric band come loose?
Oh dear! Your gastric band may have come loose for a number of reasons. Perhaps there’s a leak in the band itself, in the tube, or the port, or in any of the connections. There’s a lot of ways a leak can occur in the whole gastric band mechanical system. The band could also be loose if it merely has slipped from its ideal location. For instance, if it slips up the stomach, you probably would feel like it is very loose.

These are very serious causes, and only your surgeon can fix these problems if they occur. However, there might be a fairly simple reason for your band feeling a little looser. Your band is a semi-permeable membrane, which means that your band can actually absorb and release liquid through its lining! A lot of bandsters feel like their bands get tighter when they are stressed out, or feel like they get looser when they are dehydrated, like after a night of drinking. Therefore your band might feel a little bit loose just because you’re dehydrated. Eat something salty and drink a lot of water and see if your band feels any better in a day or two.

If you suddenly feel like your band is much looser than it was before, then you really should make an appointment to see your surgeon. He can check to see the saline level in the band or do an X-ray to see if the band has slipped, both of which are fairly painless and non-invasive tests.

 

Does a gastric band affect pregnancy?
The gastric band does not have to negatively affect pregnancy, but it’s important to understand the unique concerns that expecting mothers might have. Read my article about pregnancy and the gastric band here.

 

Can gastric band slip and then go back again?
If your gastric band has slipped from its location around your stomach, it’s possible but unlikely that it would go back again. If it slips, it is most likely to stay “slipped” until your surgeon goes back to replace it in the correct location.  Sorry! I stand corrected! See Angela’s comment at the very end of this post. Angela said that this very thing happened to her…her band slipped out of place. She had an un-fill, and then the problem corrected itself.  I had no idea that this was possible. Interesting, and thank you for sharing Angela!

 

Can you feel the gastric band through the skin?
No, you cannot feel the gastric band through the skin, but you may be able to feel the gastric band’s port through the skin. The port is the receptacle where your surgeons inject the saline. Read more about the components of the gastric band system in this article.

 

Gastric banding menus
Here are some resources for finding out what to eat –or not eat!—with the gastric band:

  •  This page lists the post-surgery diet requirements, as well as a list of foods that are typically not processed well by band patients.
  • Here is a list of mushy food ideas.
  • This forum has a lot of great food ideas.
  • This website has some food ideas.  

 

How much food can I eat during the mushy stage?
You should only be eating no more than a cup of mushy foods at any given sitting.

 

How do you locate the lap band port to make it unnoticeable?
It’s unlikely that a severely overweight person can see the port through their skin. However, as you lose weight and get closer to your goal weight, the port may become noticeable, either by touch or by site. I had many talks with my surgeon about this very topic of moving my port (which had become dislocated) to a place less noticeable. There are a variety of locations where your surgeon can put the port to minimize its appearance through your skin, from putting it under the abdomen, moving it to your side, etc.  Read about these options in more detail here.

 

Will the port from my gastric band protrude if I lose a lot of weight?
It might, possibly yes.  See this page for some ideas about moving the port if it is really bothering you.    Please note that the different banding systems have a different profile port. For instance, the Lap Band system uses a port that has a higher profile, which means that it sticks out further than other systems.  I have a Realize Band system, which uses a smaller profile port, which means that it’s flatter and thinner than the Lap Band system. However, many surgeons find the Realize Band port to be difficult to access when the patient is very overweight and has a lot of fat covering the port. It’s difficult to find where the port is because it is so much flatter, so the doctor might have to jab around with the needle a little more to find the injection site. Even more reason to find a surgeon with a  lot of experience, so you can minimize the needle-jabbing process!   My surgeon told me that a lot of doctors put a smaller profile port on male patients and a higher profile port on female patients. Doctors do this based on their experience and comfort level. You should discuss the type of hardware that he’s putting in you before your surgery, so you are aware of what you’re getting. Don’t forget that you can have an opinion about what kind of system you receive from your surgeon!

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Pregnancy and the Gastric Band

by Christine on September 23rd, 2010

filed under Gastric Banding Surgery, General Information

Pregnancy and the Gastric Band

When I underwent my gastric banding surgery, I was surprised that there was not more information available about issues concerning pregnancy.  This seems particularly important because the band may severely limit the ability to consume food, perhaps a healthy variety of food, which is important when a woman becomes pregnant.  In fact, with all my consultations with doctors, the only question on this topic that was posed to me was, “do you believe you may be pregnant?”  They confirmed any pregnancy doubts with two pregnancy tests prior to surgery; had I received a positive test, I believe I would have been denied the surgery.

I have one “real life” friend named Andrea that had the gastric banding surgery performed perhaps six years ago. Two years ago she had a baby. When we were talking about the band, I asked her if she had the band taken out when she discovered that she was pregnant. “Oh no!” she said. (I’m paraphrasing here.) “There’s a gross misconception that you need to ‘eat for two’ when you’re pregnant. It’s not true: you only need to eat 10% more than you normally would. So if you eat 1500 calories a day, then you only need to eat an extra 100-150 calories for the baby. That’s totally do-able with the gastric band in place.”

Good point, and it made me realize that I knew very little about pregnancy and the gastric band. I hope this blog article is informative for anyone who has the band who is considering getting pregnant or who has recently discovered that they are pregnant!

What effects does the gastric band have on pregnancy? For instance, does the lack of eating decrease a woman’s fertility rate?

Actually, the gastric band may be able to increase a woman’s ability to get pregnant. According to Ajay Goyal, MD, FACS from the New Jersey Bariatric Center, “being seriously overweight causes an increase in the level of two key hormones related to fertility – estrogen and testosterone…[an increase in these hormones are] directly related to infertility, causing irregular or heavy periods.”  A high BMI increases the risk for pre-eclampsia, gestational diabetes, hypertension, and spontaneous abortions.

The weight loss that comes with gastric banding surgery may actually improve a woman’s fertility by helping her achieve a healthy, regular menstrual cycle.

A recently study in Australia compared birth outcomes for pregnant women in three categories: women that have had gastric banding surgery, morbidly obese women, and a sample of normal-weight women. The study showed that babies produced from banded patients were healthy. Furthermore, women that had the gastric band gained significantly less weight during pregnancy and had significantly lower pregnancy-induced hypertension than obese patients.  The babies’ mean birth rates were comparable in all three subject groups.  This study is good news for women who have had gastric banding surgery and want to get pregnant.

It’s important to note that any weight loss surgery (gastric banding or gastric bypass) itself does not directly impact an individual’s fertility.  Weight loss surgery impacts the stomach and intestines and should not disrupt the functioning of the baby-growing organs in women or the baby-making-seeds in men.

Can you have the surgery if you are planning on getting pregnant in the future?

Absolutely.  Most bariatric centers recommend that you wait at least one year before getting pregnant. This is because surgeons want you to lose weight and increase your ability to have a safe pregnancy. Achieving a healthier weight, which may also eliminate diabetes and heart problems, will help achieve a healthy pregnancy.  Practicing safe sex for this one-year period is very important. (Note that gastric bypass patients may need to discuss oral contraceptives with their surgeons; not all oral contraceptives may be absorbed after the procedure.)

What happens if you get pregnant while you have the gastric band? Will you need to have it taken out? How safe will your baby be if you have the band?

You probably won’t have to get the band or port taken out. Unless you have complications, you should not need to get your band out. However, you may need to make an appointment to see your bariatric surgeon to have a small amount of saline taken out of the band so that you can eat a little bit more.

Despite the assurances of bariatric centers attesting to the safety of the band, the results of at least one Austrian study from 2001 were a little disturbing.  The researchers followed 215 morbidly obese women of reproductive age that had had gastric banding surgery.  Of those women, seven had unexpected pregnancies. Five of those were full term and two women had first trimester miscarriages. Two women had serious band complications (1 intragastric band migration and 1 balloon defect) which required re-operation.

Other studies are more assuring. A 2001 study followed 20 women (who had gastric banding) who had completed a total of 22 pregnancies. All 22 pregnancies were successful and complications were minimal.

One gastric banding patient had a remarkably easier pregnancy after receiving weight loss surgery as compared to her pregnancies before surgery.

I had two miserable pregnancies both resulting in emergency caesareans. In the second one it was difficult to monitor the baby in labour as the fat made it hard to pick up his heartbeat. I had to have an emergency caesarean which was awful. The theatre table was a bit narrow and I was terrified of falling off. The pregnancy was awful too as my diabetes meant the baby got very big. I hated having the growth scans since the scanners struggle to get good pictures and I felt really guilty.

After my gastric bypass I tried pregnancy once again. It couldn’t have been more different. I was more comfortable, less breathless and everything was so much easier. I had a normal sized baby and was thrilled to give birth naturally. (See source)

Will you need to get the band deflated when you find out that you’re pregnant? This is a point of contention in the medical community, but more recent evidence says probably not. Most recent studies have shown that when the band is totally deflated, pregnant women gain more weight than is healthy for the baby, which in turn is linked to an increase in the incidence of fetal macrosmia and gestational diabetes.  Most surgeons these days are recommending that you keep your band inflated, or to take out only a small amount of saline from the band.

However, one UK website said that the band should be emptied at 12 weeks pregnancy.  Another resource said that the band should not be re-inflated until after breastfeeding has fully completed.  These conflicting opinions may be confusing to you, so it’s best if you discuss your options with your bariatric surgeon.

Will I be able to take in enough nutrients for both me and the baby?

Everyone who has had gastric banding surgery should take nutritional supplements. If you are pregnant or planning to get pregnant, this is even more important.  The gastric band means that you eat less; eating less means that you are consuming fewer vitamins and nutrients.  One researcher states:

Key supplements to increase include iron to form new red blood cells, calcium for mineralization of fetal skeleton, folic acid to prevent birth defects, vitamin B1 (thiamine), vitamin B12 and vitamin A. Women should also take protein supplements in the form of protein shakes or protein bars as one cannot take the recommended daily allowance of 60 grams of proteins per day from foods. I recommend taking at least half or 30 grams in supplements and the rest from foods rich in proteins.

The New Jersey Bariatric Center has a very informational list of proteins shakes and protein-rich foods that are recommended for pregnant band patients.  See this website.

One source states that a mother’s weight loss has a beneficial effect on fetal and infant outcomes, such as normal birth weight.

I found out that I’m pregnant! Now what?

1.       Contact your General Physical (GP) immediately to confirm your pregnancy with blood tests.

2.       Contact your bariatric surgeon to let them know and to schedule a time to chat with them about it. Don’t be in a hurry to get the gastric band deflated because you may not need it completely reduced.

3.       Arrange blood tests to assess your nutritional status. You may have nutritional deficiencies because of your surgery. Double-check what your nutritional health is by having a simple blood test done.

4.       Follow your doctor’s instructions regarding nutritional supplements. What you might need for supplements is probably different from what is recommended for non-weight-loss-surgery patients, so make sure you’re not following “blind” advice from a book. Instead, follow the instructions set out for you specifically by your own GP and surgeon.

5.       Do not continue to lose weight during pregnancy. You probably aren’t going to need to pack on 50 pounds for the baby, but it also isn’t going to be healthy to continue to lose weight. You will need to adjust your priorities and mindset; you’ll need to change gears from “weight-loss mode” to “healthy baby mode.”

Resources for Further Reading

Abenhaim HA, Kinch RA, Morin L, Benjamin A, Usher R. Effect of pre-pregnancy body mass index categories on obstetrical and neonatal outcomes. Arch Gynecol Obstet. 2007. 275(1): 39-43.  http://www.ncbi.nlm.nih.gov/pubmed/16967276

Beard et al. Reproductive considerations and pregnancy after bariatric surgery: Current evidence and recommendations. Obes Surg 2008. 18(8): 1023-1027.  http://www.springerlink.com/content/g1wp77705w52m641/

Biensman-Pailleux J and Gaucherand P. Laparoscopic adjustable gastric banding and pregnancy. J Gynecol Obstet Biol Reprod. 2007. 26(8):770-6.  http://www.ncbi.nlm.nih.gov/pubmed/17604570

Coupaye et al. Nutritional consequences of adjustable gastric banding and gastric bypass: A 1-year prospective study. 2008. 19(1): 56-65. http://www.springerlink.com/content/83t810685210612h/

Dixon JB et al. Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol 2005 Nov; 106:965-72. Abstract online at: http://general-medicine.jwatch.org/cgi/content/full/2005/1122/1

Dixon JB, Dixon ME, O’Brien PE.  2001. Pregnancy after lap band surgery: management of the band to achieve healthy weight outcomes. Obesity Surgery (11) 59-65. Abstract available at: http://www.healthierweight.co.uk/research/gastric-band-articles/lap-band-safe-during-pregnancy/

Jasaitis Y., Sergent F., Bridoux V., Paquet M. Marpeau L., Teniere P. Management of pregnancies after adjustable gastric banding. 2007. 36(8): 764-9.  http://www.ncbi.nlm.nih.gov/pubmed/17512137

Karmon A and Scheiner E. Pregnancy after bariatric surgery: A comprehensive review. Arch Gynecol Obstet 2008. 277(5):381-388.  http://www.ncbi.nlm.nih.gov/pubmed/18299862

Martin lF, Finigan KM, Nolan TE. 2000. Pregnancy after adjustable gastric banding. Obstet Gynecol. 95(6): 927-30.

Realize Gastric Band. http://www.realizegastricbandnj.com/realizeband/pregnancy-after-lap-band-realize-band-surgery.html [accessed 03 May 2010]

Weiss, Helmut, H Nehoda, B Labeck, K Hourmont, C Marth, and  Aigner. 2001. Pregnancies after Adjustable Gastric Banding.  Obesity Surgery. 11(3) 303-306. Abstract available online at: http://www.springerlink.com/content/9m1v493335135338/

Whitehead R.G. Dietary Reference Values. Proceedings of the Nutrition Society. 1992. 51:29-34. http://journals.cambridge.org/action/displayFulltext?type=1&fid=748416&jid=PNS&volumeId=51&issueId=01&aid=748408

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