Tuesday I go in for my last appointment per my insurance requirments and I will be meeting with the surgeon. Here are some questions that I put together with the help of Tessirose (I
1. What kind of band will I be getting and what size is it? (At my first appointment, the surgeon said I have a choice between Realize and the Lapband. He said that there is no difference, but it seems like there has to be some kind of difference. Don't you think? Maybe I'll ask my surgeon if his best friend was getting the surgery, which would he suggest.
2. Will I have any fluid in the band when it is placed? (I asked the NP this question at my 4th month visit and she said band would be primed, but there wouldn't be a fill. Just want to double-check)
3. How long do I have to wait for my first fill? In between fills? (NP said I'd get my first fill after 4 weeks and they usually start at 4 cc - kind of sounds like a lot for a first fill from what I've read.) Also want to get his philosophy of how long I need to wait inbetween fills.
4. Do I need to lose weight prior to surgery? Will he not do the surgery if my liver is too big? I've read that liver size really shouldn't matter to a good surgeon.
5. Will I be able to get my pain med prescription prior to surgery so I can have filled before I have surgery? What about ambien - can I take with pain meds?
6.Ideas for Vitamins and supplements. (My NP said Flinstones are fine for vitamins. Seems hard to believe that children's vitamins are okay for adults too).
7. Will he be giving me something to prevent gallstones?
8. My father and brother are prone to bloodclots. I've never had one, but should there be any extra precautions taken since I have a family history.
9. Last question I have depends on my surgery date. I'm hoping he can get me in first week of July. If not, then I need to ask him how my vacation end of July can fit into my surgery/recovery.
Hope you all are having a wonderful weekend. It is beautiful here today. Sunny and warm with a slight breeze - not a cloud in the sky. Perfect pool weather. I got a little crispy so decided to come in and blog for a while. Later tonight the plan is for the kids to do smores over the fire pit, while the hubby and I sip grand marnier. Yum...
I wish I'd had this list of questions when I went in for my surgery! Awesome!
ReplyDeleteGreat questions to ask - and boy this reminds me when I was at your stage of the game. We think things through thoroughly and that's the beginning of it all - it really helps.
ReplyDeleteGreat set of questions Bonnie!! As for the first fill - it really depends on what band you get. The Realize C band (what I have) is 11ccs and most people don't feel anything until around 8. I have been told that some feel something around 5 so that is what my doc starts with. He is pretty conservative (or at least his PA/NPs are) so I doubt they would start that high if they saw problems in any of there patients. A smaller band or even just a different band may start showing restriction at different points. If they didn't start with 5 I am not sure if I would ever have gotten to restriction!!! The only other thing I would maybe ask is even if liver size "shouldn't" matter would your risk of complications be lower if you did lose weight in your liver. Even a great surgery may appreciate the extra room :) Good luck!
ReplyDeleteMake sure to ask how responsive they are to when you feel like/need/want a fill. Some Docs seem more flexible about letting their bandsters come in before their next appt. if the most recent fill hasn't taken. Others aren't. I feel like some docs make it seem like they will work with you, but then don't really when all is said and done.
ReplyDeleteI think the Realize Band has a slimmer profile and the structure of the band is different which I believe has been proven to cause less instances of erosion. (Check that last bit out, but I swear I read that somewhere.) Realize also has a mechanism that hooks to the ab muscle wall. I think the Allergen Lap Bands need to be sewn in?
My nutritionist that is in-house with my surgeon's office said if you take kid's vitamins to take two, I believe. I decided to just opt for Centrum Chewables. They are huge and not super tasty but they are made for adults so I worry less about not getting proper supplementation. I just chew them really well and take a quick sip of water to wash them down in the morning.
OH! I wish I would have asked if my doc could take photos of my band after it was placed. I'm jealous that some others have this as a momento/reminder that they, in fact, do have a band. The day of surgery, I asked my doc and he poo-pooed the idea. Perhaps if I would have mentioned it earlier he's be more open to the idea. I guess I'm kinda sick, though, wanting pics of my insides! LOL
Here is a list I found online:
Differences:
* Port: REALIZE Band has a lower-profile port than the LAP-BAND
* Port Attachment: REALIZE Band uses a self-clamping system and the LAP-BAND is anchored with stitches to attach to the abdominal muscle wall
* Gastric Band: The REALIZE Band has one smooth inner balloon reservoir for the saline solution, whereas the LAP-BAND has seven baffled mini-reservoirs
* Band Size: The REALIZE Band is available in one universal, adjustable size, and the LAP-BAND is made in two different sizes, either standard or large
* Fill Volume: The REALIZE Band has a fill volume of 9cc, and the LAP-BAND is either 10cc for the standard or 14cc for the large
Some of this info is old, I believe. I think Realize makes more than one size now. Yep, here it is: Ongoing Innovation
REALIZE continues to develop and improve their gastric banding system with a focus on patient safety and comfort. In 2009, the REALIZE Band-C was introduced, designed with the same successful high-volume, low-pressure system as the original band, but with improved design features.
The REALIZE Band-C offers: streamlined, pre-curved design for easier placement; expanded adjustment range to accommodate larger patients; widest band available at 23mm, to decrease slippage potential; radiopaque band and tubing, to enhance visualization under fluoroscopy; and changes to the locking mechanism to ease placement and allow intra-operative repositioning.
SO EXCITED FOR YOU!!! If I think of more questions I will put them here :)
Great list!! Most of the things you mention were answered by the NP or the Nutritionist I saw in my practice, but here are some things I asked the surgeon:
ReplyDelete1. Have any of your patients had problems with slipping or erosion?
2. How long have you been working with gastric bands and how many surgeries have you done?
3. On average, what percentage of excess weight have your patients lost? 50%, 75% etc.
4. How will you determine my goal weight?
Wishing you the best of luck!!!
Good list Bonnie. I would ask if they keep you overnight after surgery. I know every hospital is different. I stayed overnight (thank god), but I know a lot of people go home the same day.
ReplyDeleteI use adult gummy vitamins - they are really good and go down fine. I get them at Costco, but they have them at Target too.
They will give you heprin for blood clots no matter what, but if you're really worried about it there are other options. My bff had Gastric Bypass she had a thing inserted into a vein that would break up clots because she has a genetic clotting disease.
Hope everything goes well Tuesday! Are you going to force them to submit to insurance on Wednesday? :)
I'm so excited for you. This is a fun stage!
ReplyDeleteAll great questions. My dr. said both bands were very similar and he just rotates which band he uses, unless a patient has a special request. He installed the Realize band for me, just because I requested something with a lower profile port. Good info on the Realize band shared by Grace.
I take two Flintstone chewables daily. If you take any other meds, bring those in and ask what you can take the morning of surgery and what pills you can take afterwards. I swallow the rest of my pills aok still. If I'm afraid a pill is too big, I break it up with a knife.
When is your first checkup following surgery (mine is one week). My dr. does the first fill at the 6 week check up. Find out how much the fills cost. My first three fills are free (okay, not free--just part of the overall surgery package :) and then after that each fill is just a regular copay (in my case speciality dr. is $30).
Question to ask is what kind of presurgery diet, if any does the dr. require. There is such a variety out there. My dr. required a 10 day liquid diet (which included fruits, veggies, turkey sandwich if desp). I primarily had two protein shakes and a small meal during this stage and lost 6 lbs. Kept under 1000 calories a day. I think the main concern is they don't want us pigging out everyday before surgery. :)
When I was in the hospital they called in my pain meds (liquid Lortabs) to pick up on the way home. I took it only the day of surgery and the next. I have not really needed it.
Definitely let your dr. know about the family history of blood clotting. I had an injection in the tummy right before surgery to prevent clotting. Then of course those lovely massaging sox. They sent me home with a pair and told me to wear them for a week. :)
Hope some of this helps. You have so much info out there from blogland you will be very informed and ready to go. I wish you the best on a speedy approval.
Happy weekend!
Great list of questions. I am going to let my surgeon decide on the band when he is in there. He said that sometimes he thinks that the other band would fit someone's anatomy better than the chosen one. He told me that if I wanted he would have both available and pick which one would fit me better.
ReplyDeleteGood Luck on Tuesday!
I'll just try to answer what hasn't been addressed so far:
ReplyDelete*Liver size does matter, and even a skilled surgeon can nick one. Having said that, it seems to me that you're not so obese as for that to be an issue. Does your doctor make you do a pre-op phase (sorry I can't remember if you mentioned that or not)? If so, that really helps with a fatty liver. Shocker, but I was not completely compliant with mine, but for the most part did my week or two of liquid diet.
*You'll get your home pain meds right before discharge (even if you're same day). Usually, there's an outpatient pharmacy. If not, it will be your first stop on the way home. The hospital canse you up before you leave. ASK FOR IT.
Great list of ?s you have...
ReplyDeleteHere's a question worth asking....make sure they do a "fundopilcation" (sp?) technique. Where they pull your stomach wall up and over the band and secure it with sutures at the top of the band....I think it's pretty standard these days, but sttill good to double check...it's meant to reduce slips
Thanks so much for your great responses. I don't know why I'm nervous about the appointment. I think a part of it is that I'll be getting my surgery date which will make this all real.
ReplyDeleteI am SO psyched for you! You might also want to ask what the post-op diet will be like. For example, I knew I'd be on liquids for 2 weeks and my doc recommended 3 sugar free Carnation Instant Breakfast drinks (made with milk) per day, so I made sure to stock up on those in different flavors. (I liked those so much I still drink them a couple of times a week.) I can tell you that they brought me an Ambien tablet the night I spent in the hospital even when hooked up to the morphine pump, so I'd imagine it would be ok. Also, we don't malabsorb, and we get most of our nutrition from our healthy diets, so 2 Flintstones chewables (with iron) are plenty of "insurance" that we're getting the nutrition we need. But by all means - ask the doc! Best of luck to you, and I can't wait to hear about all of your successes.
ReplyDeleteSo glad to see that you are almost there!!! It seems like a lifetime.
ReplyDeleteGreat questions BTW.
My first Fill wasn't until 6 weeks out.
As for the diet, my Surgeon required a 4 week diet, but since he only required me to lose 11 lbs, I knew that I could lose at least 1/2 that in just water weight, so I only dieted about 2.5 weeks, and yes, I did eat a great Fillet Mignon Steak dinner the night before Surgery (early of course).
As for pain medications, my Surgeon's office gave me the Prescriptions to fill at my Pre-Op Appointment so that we could already have them Filled and ready to use once we got home.
And lastly, other than having my Vicoden Prescription changed to a liquid form, I take all my normal Prescriptions as is. EXCEPT for my Vitamins. I take the Lil Critter Gummy Vites. They taste great, and I get them at Costco.
Can't wait to hear when your Surgery date is!!
Wow.. I am late getting to this dance.. but I will add my two cents worth anyway Bonnie.
ReplyDeleteI have the Realize band, but I wouldn't fret too much on which one you get ... they are both good bands..I do not believe my band had any volume..
I would ask your doc if he is aggressive in his fills in the beggining.. I am just at 6 months now (at 8.5 cc) and I feel like I have good restrictin (but it took me 6 fills to geth there..
I would suggest a good quality chewable vitamin, my doc always has me on a B complex and calcium citrate supplement.
As far as the blood clots, they will probably not give you anything prior to the surgery (after all they will be concerned about bleeding and will have you stop any motrin and ibuprofen products 2 weeks before surgery).. but afterwards, they will get you up and walk you around and probably give you a shot of lovenox (blood thinner) to prevent anything (but it is good that you mention this, as you doc may want to add some things post surgery).
FINALLY you are near your surgery date.. you have been hanging in there for such a long time (and many thanks for all of your encouraging posts).. We will all be there for you post surgery when you have questions.. Like I said I am six months out and still have a ton!!! Be well Bonnie.. sending good vibes and lotsa hugs out to you
I'd add:
ReplyDelete- Port placement (can you pick?)
- Low profile port (LB now has one too, and I'd recommend getting the LB...with Realize think what happens to a skinny balloon when you bend it into a tight circle; creases and not a perfect circle, but both of them work fine).
- Single incision or how many?
- Can I take a laxative post-op?
- What should prompt me to call you just post-op?
- Can I get a prescription for anti-nausea meds to take at home (this has saved me several times and is especially important just post-op not to vomit)?
I can't find my full list I had, but I think those are the important ones. Good luck!!
excellent list!!
ReplyDeletelike grace posted, there is definitely a lot of differences between the realize and AP lap band....even just visual differences, the port is a lot different, google the pictures so you can see the difference. my surgeon did both but suggested the AP lapband, but that i should do my own research and make my own choice :-) i went with the ap lapband
I think those are all great questions and wish I had thought to ask my surgeon. Can you believe I still don't know what kind of band I'm getting?! Perhaps I'll print this out and give him a call.
ReplyDeleteLynda, I feel the exact same way. I'm supposed to start my two week diet this friday, and after reading this post, I feel like I am not as ready as I had thought!
ReplyDeleteI printed out these questions and comments, and will be taking them with me to my doctor's appointment!
Lynda and Ronke143 - I'm glad my post gave you some ideas for what you'd like to ask your doctor. I have my appt in a few hours and am nervous for some reason. Will let you know later how it goes.
ReplyDeleteThanks again to everybody who added to my list and gave great advice.
Bonnie, I can't wait to hear how everything goes for you. Let us know!
ReplyDeleteI can't wait for my final question time. I cut and pasted your list to use when my time comes
ReplyDelete