WHAT WILL BE THE WEIGHT LOSS METHODS OF THE FUTURE?

[Guest guest]

Hi All:

I was banded in July 2004 and will be banded 5 years. I check the board monthly

and am so glad there is so much more information available today than there was

when I was researching weight loss surgery.

I chose to be banded because it was a reversible procedure and I thought in 10

or 20 years, with medical technology as quickly as it is progressing, banding

would no longer be done, RNY, DS and VSG would be long gone as viable surgical

options and instead replaced with true, safe, non-invasive procedures. My band

is just fine (Thank God) but I have never believed that it is a lifetime

implant. For example, my dad's pacemaker has already been replaced and my mom's

hip replacement from 10 years ago needs to be revised. These are lifetime

implants. Hopefully, our bands will last 10-15 years-let us pray!

For newbies out there, no matter how good insurance you have, never asssume

emergency surgery for you is going to be free or lowcost. For those of us thast

have insurance (with a wls exclusion), an emergency medical fund is essential. I

have been thrilled when I read about one you being able to save enough for

plastics but I have never read anyone mention that they have money set aside

just for a wls emergency. IT IS essential. I travel extensively for work and

wherever I go, I have the name of the local band surgeon and where to go for a

fill.

Here are my stats. I am 35 yrs. old, 5'5 " and started at 260. I lost 10 pounds

on the pre-op liquid diet which took me to 250. I lost another 30 pounds on the

6 week liquid diet which took me to 220. In the next 2 years I lost an

additional 40 pounds which took me to 180 in 2006. I am now 200 so i have lost

and maintained a 50% weight loss. Was weight loss surgery a good investment? I

think so. I like to do a cost per pound analysis. I have currently spent $3500

for fills and $8500 for the surgery. $12000 for 60 pounds or $200 a pound. For

those of you bandsters that paid out of pocket divide your pounds lost by your

surgery and maintenance visit costs and you'll get a cost per pound.

I would love to see posts on this forum from patients 5-10 years out of band

surgery--what ever type of band you had. Share with us what the " weight loss

real world " is like.

More importantly, the questions I'd like to pose to everybody out there. What

weight loss surgeries will we be discussing on this forum 10 years from now?

Will our bands be still in place? Will the DSers have a modified new DS? Will

the RNY still be the gold standard in the U.S. I'm not looking to start a debate

about weight loss surgery methods or inspire negativity or drama.

Just posing a straight up question to look 10 years into the future. As you can

imange 10 years ago, we were discussing phen-fen and had no idea what a RNY or a

DS or a VSG or a gastric band was! So 10 years from now guys, what do ya think?

Will peple have gastric stimulators, a revised TOGA procedure via endoscopy,

biodegradable bands (yes, gastric bands that do their job and break down in the

body with no surgery), brain electrodes to lose weight (like recently featured

on Oprah), a weight loss pill.

I am not a medical person but I love to discuss technology. So chime in

everyone. What new wl technolgy will we be discussing 10 years from now on

these boards? What kind of surgery do ya think our docs will be doing 10 years

from now?

Moonshadow Sandy and Dan--your posts have kept me motivated for years.Keep up

the good work! My question to Sandy, Dan and the other band experts is this: IF

YOU HAD TO GET YOUR BAND REMOVED, WHAT WOULD YOU CHOOSE TO DO? Would you replace

your band with the new AP band (if your doc allowed it, would you replace it

with the same 9.75 cm band, what would you do?

I have had no probs with my band other than little restriction. I have not had a

fluoro in 3 years (i know I need one every year-easier said and done). My fill

levels have never had a leak (4cc in, 4cc out, etc.). I have only lost .1 cc of

fill ever--total. I will be getting a fluoro in Mexico in a few months. I am not

concerned about my minimal restriction--I've always had it. I'm very thankful

that I've always been able to get down water and pb only 3-4 times a year.

The more time passes the less restriction I feel. When I fly (which is 4-5 times

a year), my band tightens up. I wish I was a flight attendant lol! Has anyone

lost restriction as the years go by?

By the way, I am filled to 6cc in a 4cc (9.75) band and I have little

restriction. I do like my band and am not thinking about a revision. I'm happy

with my 60 pond weight loss and will try to lose 60 pounds in a year's time.

All the best,

Angel

Banded July 2004

Drs. Ortiz/ez Tijuana,Mexico

band filled 6cc in 4cc (band still in good position but little restriction)

cannot get any more fills--band full

260 starting weight

250 surgery weight

200 plus or minus 5 pounds current weight

50 percent weight loss

goal weight 135-140

[Guest guest]

Hi Angel,

I am 4 years out.

Starting weight 280

Weight today 150

My original goal was 150, I my lowest was 140 for about a minute, I am still

trying to get back down there!!

I was one of the fortunate ones who's surgery was covered by insurance, so I

paid a $400 copay.

Would I do it again?  In a hearbeat!! 

Patty

Tufts NEMC

Dr Tarnoff

02-28-05  280/150/150

WHAT WILL BE THE WEIGHT LOSS METHODS OF THE FUTURE?

Hi All:

I was banded in July 2004 and will be banded 5 years. I check the board monthly

and am so glad there is so much more information available today than there was

when I was researching weight loss surgery.

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[Guest guest]

Welcome, angel! What a wise and thoughtful post! You have raised some extremely

important issues.

A few thought from me:

The band is reversible, as they love to advertise, but it is not that easy.

Removal surgery can be very difficult and lengthy, as a lot of scar tissue grows

over the years and the band must literally be carved out. There is occasionally

permanent stomach damage. But the gut is still intact, unlike the bypass, so the

band is still the safest procedure, imo/

2. The bypass has actually been around for more than 30 years, in one form or

another. the older versions had a lot more problems, though.

3. We all hope that the band will last forever in us, but this is unlikely. It

has no moving parts to break down like the pacemakers or hip replacements,

though, so IF we are religious about taking care of our stomachs and never

keeping a too-tight fill (which means KNOWING what a too-tight fill is) we have

the best chance of keeping the band a very long time. The longest one in someone

presently is about 14-15 years, i think.

4. Emergency fund - absolutely! Insurance is no insurance that there will not

be a lot of co-pays or worse. There was an excellent article in TIME magazine a

few weeks ago - on the cover - about " Think you're insured? Think again " . And

if we self-pay and think we are choosing the lowest cost option by going to

Mexico, this is often not true. over the years, Mexico can add up to much more

than a local doc - not to mention the inconvenience, inability of patients to

receive the safest AP bands (released 2007)from Mexican surgeons, and lack of

comprehensive followup due to distance.

It's imperative to count up all costs over at least 5 years when we are figuring

costs.

5. The old bands like all of us got a few years ago are obsolete and are not

used by the US docs any longer. Their slip and erosion rate is rising badly, and

I'm sure it will continue to do so. If I lost my band for any reason, I would

either have it replaced with the new AP, or I would consider a Gastric sleeve.

not sure, and hope to never face this decision!

6. Future WLS options? As more is understood about obesity and the brain, i

think new and safe medications will be developed. I don't think surgery will be

needed often - or hopefully at all. The problem with all the options, though -

is that they may reduce or even eliminate hunger - but that is not why we all

got fat! We ate for emotional reasons, not because of hunger. The emotional

eating will not stop, and we will still have to work on this ourselves.

7. That is a very high fill level!! We just cannot keep this much pressure on

the band, especially these old bands. I'd really, really urge you to get a

fluoro asap and not wait months. When we get to a good weight, we need some fill

OUT to minimize stomach pressure and all the trouble that comes from a tight

fill for too long.

I'm concerned if you have this high a fill, yet are " losing restriction. " please

be seen asap.

Sandy

>

> Hi All:

>

> I was banded in July 2004 and will be banded 5 years. I check the board

monthly and am so glad there is so much more information available today than

there was when I was researching weight loss surgery.

>

> I chose to be banded because it was a reversible procedure and I thought in 10

or 20 years, with medical technology as quickly as it is progressing, banding

would no longer be done, RNY, DS and VSG would be long gone as viable surgical

options and instead replaced with true, safe, non-invasive procedures. My band

is just fine (Thank God) but I have never believed that it is a lifetime

implant. For example, my dad's pacemaker has already been replaced and my mom's

hip replacement from 10 years ago needs to be revised. These are lifetime

implants. Hopefully, our bands will last 10-15 years-let us pray!

>

> For newbies out there, no matter how good insurance you have, never asssume

emergency surgery for you is going to be free or lowcost. For those of us thast

have insurance (with a wls exclusion), an emergency medical fund is essential. I

have been thrilled when I read about one you being able to save enough for

plastics but I have never read anyone mention that they have money set aside

just for a wls emergency. IT IS essential. I travel extensively for work and

wherever I go, I have the name of the local band surgeon and where to go for a

fill.

>

> Here are my stats. I am 35 yrs. old, 5'5 " and started at 260. I lost 10 pounds

on the pre-op liquid diet which took me to 250. I lost another 30 pounds on the

6 week liquid diet which took me to 220. In the next 2 years I lost an

additional 40 pounds which took me to 180 in 2006. I am now 200 so i have lost

and maintained a 50% weight loss. Was weight loss surgery a good investment? I

think so. I like to do a cost per pound analysis. I have currently spent $3500

for fills and $8500 for the surgery. $12000 for 60 pounds or $200 a pound. For

those of you bandsters that paid out of pocket divide your pounds lost by your

surgery and maintenance visit costs and you'll get a cost per pound.

>

> I would love to see posts on this forum from patients 5-10 years out of band

surgery--what ever type of band you had. Share with us what the " weight loss

real world " is like.

>

> More importantly, the questions I'd like to pose to everybody out there. What

weight loss surgeries will we be discussing on this forum 10 years from now?

Will our bands be still in place? Will the DSers have a modified new DS? Will

the RNY still be the gold standard in the U.S. I'm not looking to start a debate

about weight loss surgery methods or inspire negativity or drama.

>

> Just posing a straight up question to look 10 years into the future. As you

can imange 10 years ago, we were discussing phen-fen and had no idea what a RNY

or a DS or a VSG or a gastric band was! So 10 years from now guys, what do ya

think? Will peple have gastric stimulators, a revised TOGA procedure via

endoscopy, biodegradable bands (yes, gastric bands that do their job and break

down in the body with no surgery), brain electrodes to lose weight (like

recently featured on Oprah), a weight loss pill.

>

> I am not a medical person but I love to discuss technology. So chime in

everyone. What new wl technolgy will we be discussing 10 years from now on

these boards? What kind of surgery do ya think our docs will be doing 10 years

from now?

>

> Moonshadow Sandy and Dan--your posts have kept me motivated for years.Keep up

the good work! My question to Sandy, Dan and the other band experts is this: IF

YOU HAD TO GET YOUR BAND REMOVED, WHAT WOULD YOU CHOOSE TO DO? Would you replace

your band with the new AP band (if your doc allowed it, would you replace it

with the same 9.75 cm band, what would you do?

>

> I have had no probs with my band other than little restriction. I have not had

a fluoro in 3 years (i know I need one every year-easier said and done). My fill

levels have never had a leak (4cc in, 4cc out, etc.). I have only lost .1 cc of

fill ever--total. I will be getting a fluoro in Mexico in a few months. I am not

concerned about my minimal restriction--I've always had it. I'm very thankful

that I've always been able to get down water and pb only 3-4 times a year.

>

> The more time passes the less restriction I feel. When I fly (which is 4-5

times a year), my band tightens up. I wish I was a flight attendant lol! Has

anyone lost restriction as the years go by?

>

> By the way, I am filled to 6cc in a 4cc (9.75) band and I have little

restriction. I do like my band and am not thinking about a revision. I'm happy

with my 60 pond weight loss and will try to lose 60 pounds in a year's time.

>

> All the best,

> Angel

>

> Banded July 2004

> Drs. Ortiz/ez Tijuana,Mexico

> band filled 6cc in 4cc (band still in good position but little restriction)

cannot get any more fills--band full

> 260 starting weight

> 250 surgery weight

> 200 plus or minus 5 pounds current weight

> 50 percent weight loss

> goal weight 135-140

>

[Guest guest]

5. The old bands like all of us got a few years ago are obsolete and are not

used by the US docs any longer. Their slip and erosion rate is rising badly, and

I'm sure it will continue to do so. If I lost my band for any reason, I would

either have it replaced with the new AP, or I would consider a Gastric sleeve.

not sure, and hope to never face this decision!

> >

> > Hi All:

> >

> > I was banded in July 2004 and will be banded 5 years. I check the board

monthly and am so glad there is so much more information available today than

there was when I was researching weight loss surgery.

> >

> > I chose to be banded because it was a reversible procedure and I thought in

10 or 20 years, with medical technology as quickly as it is progressing, banding

would no longer be done, RNY, DS and VSG would be long gone as viable surgical

options and instead replaced with true, safe, non-invasive procedures. My band

is just fine (Thank God) but I have never believed that it is a lifetime

implant. For example, my dad's pacemaker has already been replaced and my mom's

hip replacement from 10 years ago needs to be revised. These are lifetime

implants. Hopefully, our bands will last 10-15 years-let us pray!

> >

> > For newbies out there, no matter how good insurance you have, never asssume

emergency surgery for you is going to be free or lowcost. For those of us thast

have insurance (with a wls exclusion), an emergency medical fund is essential. I

have been thrilled when I read about one you being able to save enough for

plastics but I have never read anyone mention that they have money set aside

just for a wls emergency. IT IS essential. I travel extensively for work and

wherever I go, I have the name of the local band surgeon and where to go for a

fill.

> >

> > Here are my stats. I am 35 yrs. old, 5'5 " and started at 260. I lost 10

pounds on the pre-op liquid diet which took me to 250. I lost another 30 pounds

on the 6 week liquid diet which took me to 220. In the next 2 years I lost an

additional 40 pounds which took me to 180 in 2006. I am now 200 so i have lost

and maintained a 50% weight loss. Was weight loss surgery a good investment? I

think so. I like to do a cost per pound analysis. I have currently spent $3500

for fills and $8500 for the surgery. $12000 for 60 pounds or $200 a pound. For

those of you bandsters that paid out of pocket divide your pounds lost by your

surgery and maintenance visit costs and you'll get a cost per pound.

> >

> > I would love to see posts on this forum from patients 5-10 years out of band

surgery--what ever type of band you had. Share with us what the " weight loss

real world " is like.

> >

> > More importantly, the questions I'd like to pose to everybody out there.

What weight loss surgeries will we be discussing on this forum 10 years from

now? Will our bands be still in place? Will the DSers have a modified new DS?

Will the RNY still be the gold standard in the U.S. I'm not looking to start a

debate about weight loss surgery methods or inspire negativity or drama.

> >

> > Just posing a straight up question to look 10 years into the future. As you

can imange 10 years ago, we were discussing phen-fen and had no idea what a RNY

or a DS or a VSG or a gastric band was! So 10 years from now guys, what do ya

think? Will peple have gastric stimulators, a revised TOGA procedure via

endoscopy, biodegradable bands (yes, gastric bands that do their job and break

down in the body with no surgery), brain electrodes to lose weight (like

recently featured on Oprah), a weight loss pill.

> >

> > I am not a medical person but I love to discuss technology. So chime in

everyone. What new wl technolgy will we be discussing 10 years from now on

these boards? What kind of surgery do ya think our docs will be doing 10 years

from now?

> >

> > Moonshadow Sandy and Dan--your posts have kept me motivated for years.Keep

up the good work! My question to Sandy, Dan and the other band experts is this:

IF YOU HAD TO GET YOUR BAND REMOVED, WHAT WOULD YOU CHOOSE TO DO? Would you

replace your band with the new AP band (if your doc allowed it, would you

replace it with the same 9.75 cm band, what would you do?

> >

> > I have had no probs with my band other than little restriction. I have not

had a fluoro in 3 years (i know I need one every year-easier said and done). My

fill levels have never had a leak (4cc in, 4cc out, etc.). I have only lost .1

cc of fill ever--total. I will be getting a fluoro in Mexico in a few months. I

am not concerned about my minimal restriction--I've always had it. I'm very

thankful that I've always been able to get down water and pb only 3-4 times a

year.

> >

> > The more time passes the less restriction I feel. When I fly (which is 4-5

times a year), my band tightens up. I wish I was a flight attendant lol! Has

anyone lost restriction as the years go by?

> >

> > By the way, I am filled to 6cc in a 4cc (9.75) band and I have little

restriction. I do like my band and am not thinking about a revision. I'm happy

with my 60 pond weight loss and will try to lose 60 pounds in a year's time.

> >

> > All the best,

> > Angel

> >

> > Banded July 2004

> > Drs. Ortiz/ez Tijuana,Mexico

> > band filled 6cc in 4cc (band still in good position but little restriction)

cannot get any more fills--band full

> > 260 starting weight

> > 250 surgery weight

> > 200 plus or minus 5 pounds current weight

> > 50 percent weight loss

> > goal weight 135-140

> >

>

[Guest guest]

Angel, I am not really pro-sleeve, as I don't like the thought of cutting out

90% of my stomach, and we do not know enough about the hormones like ghrelin to

be able to safely remove them. What if it turns out they have anti-cancer

benefits, or anti-heart disease benefits. I said only that might be my second

choice.

There is really no such thing as a " full " band. All of them hold much more than

the " suggested maximum " . The 4 cc band can hold 10-15 cc - but the stomach would

be closed off long before this.

There are quite a few people who ned more than 4 cc,

anyone needing more than about 3.8 cc needs to be followed very regularly with

fluoros, to be sure erosions are not starting.Some docs will do a fluoro every

6 months, and an endoscopy every year on such patients.

Erosions are a very slow process, almost always without pain, and can be found

early only on a fluoro. There are usually no symptoms other than a loss of

restriction, especially at a high fill level.

I'm afraid we cannot safely lose with less than 1000 cal a day, and 2 hrs of

exercise. This would put one in deprivation mode and the body would refuse to

lose after a short time. It's hard to accept that we are never trying to lose as

fast as possible, but that is true. We must eat enough for health, but just a

bit fewer calories than we need. We also cannot come even close to minimum

nutrition in so few calories, and that always catches up with us with wt loss

stalls.

If you're really interested in trying to lose more, we can go over the band

basics.

The first essential thing is to get that fluoro to be sure all is well.

Gald you have joined us!

Sandy r

> > >

> > > Hi All:

> > >

> > > I was banded in July 2004 and will be banded 5 years. I check the board

monthly and am so glad there is so much more information available today than

there was when I was researching weight loss surgery.

> > >

> > > I chose to be banded because it was a reversible procedure and I thought

in 10 or 20 years, with medical technology as quickly as it is progressing,

banding would no longer be done, RNY, DS and VSG would be long gone as viable

surgical options and instead replaced with true, safe, non-invasive procedures.

My band is just fine (Thank God) but I have never believed that it is a lifetime

implant. For example, my dad's pacemaker has already been replaced and my mom's

hip replacement from 10 years ago needs to be revised. These are lifetime

implants. Hopefully, our bands will last 10-15 years-let us pray!

> > >

> > > For newbies out there, no matter how good insurance you have, never

asssume emergency surgery for you is going to be free or lowcost. For those of

us thast have insurance (with a wls exclusion), an emergency medical fund is

essential. I have been thrilled when I read about one you being able to save

enough for plastics but I have never read anyone mention that they have money

set aside just for a wls emergency. IT IS essential. I travel extensively for

work and wherever I go, I have the name of the local band surgeon and where to

go for a fill.

> > >

> > > Here are my stats. I am 35 yrs. old, 5'5 " and started at 260. I lost 10

pounds on the pre-op liquid diet which took me to 250. I lost another 30 pounds

on the 6 week liquid diet which took me to 220. In the next 2 years I lost an

additional 40 pounds which took me to 180 in 2006. I am now 200 so i have lost

and maintained a 50% weight loss. Was weight loss surgery a good investment? I

think so. I like to do a cost per pound analysis. I have currently spent $3500

for fills and $8500 for the surgery. $12000 for 60 pounds or $200 a pound. For

those of you bandsters that paid out of pocket divide your pounds lost by your

surgery and maintenance visit costs and you'll get a cost per pound.

> > >

> > > I would love to see posts on this forum from patients 5-10 years out of

band surgery--what ever type of band you had. Share with us what the " weight

loss real world " is like.

> > >

> > > More importantly, the questions I'd like to pose to everybody out there.

What weight loss surgeries will we be discussing on this forum 10 years from

now? Will our bands be still in place? Will the DSers have a modified new DS?

Will the RNY still be the gold standard in the U.S. I'm not looking to start a

debate about weight loss surgery methods or inspire negativity or drama.

> > >

> > > Just posing a straight up question to look 10 years into the future. As

you can imange 10 years ago, we were discussing phen-fen and had no idea what a

RNY or a DS or a VSG or a gastric band was! So 10 years from now guys, what do

ya think? Will peple have gastric stimulators, a revised TOGA procedure via

endoscopy, biodegradable bands (yes, gastric bands that do their job and break

down in the body with no surgery), brain electrodes to lose weight (like

recently featured on Oprah), a weight loss pill.

> > >

> > > I am not a medical person but I love to discuss technology. So chime in

everyone. What new wl technolgy will we be discussing 10 years from now on

these boards? What kind of surgery do ya think our docs will be doing 10 years

from now?

> > >

> > > Moonshadow Sandy and Dan--your posts have kept me motivated for years.Keep

up the good work! My question to Sandy, Dan and the other band experts is this:

IF YOU HAD TO GET YOUR BAND REMOVED, WHAT WOULD YOU CHOOSE TO DO? Would you

replace your band with the new AP band (if your doc allowed it, would you

replace it with the same 9.75 cm band, what would you do?

> > >

> > > I have had no probs with my band other than little restriction. I have not

had a fluoro in 3 years (i know I need one every year-easier said and done). My

fill levels have never had a leak (4cc in, 4cc out, etc.). I have only lost .1

cc of fill ever--total. I will be getting a fluoro in Mexico in a few months. I

am not concerned about my minimal restriction--I've always had it. I'm very

thankful that I've always been able to get down water and pb only 3-4 times a

year.

> > >

> > > The more time passes the less restriction I feel. When I fly (which is 4-5

times a year), my band tightens up. I wish I was a flight attendant lol! Has

anyone lost restriction as the years go by?

> > >

> > > By the way, I am filled to 6cc in a 4cc (9.75) band and I have little

restriction. I do like my band and am not thinking about a revision. I'm happy

with my 60 pond weight loss and will try to lose 60 pounds in a year's time.

> > >

> > > All the best,

> > > Angel

> > >

> > > Banded July 2004

> > > Drs. Ortiz/ez Tijuana,Mexico

> > > band filled 6cc in 4cc (band still in good position but little

restriction) cannot get any more fills--band full

> > > 260 starting weight

> > > 250 surgery weight

> > > 200 plus or minus 5 pounds current weight

> > > 50 percent weight loss

> > > goal weight 135-140

> > >

> >

>

[Guest guest]

Thursday, May 28, 2009, 2:02:21 AM, you wrote:

> I would love to see posts on this forum from patients 5-10 years

> out of band surgery--what ever type of band you had. Share with us

> what the " weight loss real world " is like.

I celebrated 6 years just a month ago. Sandy has a little bit of time

on me. I'm happy, 130 to 140 down from my high. Had a tummy tuck,

run half marathons, play racquetball, etc,, etc, at age 66.

As to what will be the weight loss method of the future, it will be

the EXACT SAME AS IT IS NOW.

CONSUME FEWER CALORIES THAN YOU BURN

We use all different methods to change the mix. Various diets,

various surgical procedures, various drugs, etc, etc. We chose a

system that works for (most of) us. But even the band can be beaten,

as you've found out. Like any tool, we have to use it or it won't

help us.

dan

--

" It's OK to be a little broken, everybody's broken in this life " Jon Bon Jovi

Dan Lester, Boise, Idaho, USA www.riverofdata.com/lapband

Banded 4/27/03, Dr. Ortiz, Tijuana

Started at 355, at goal in the 210-220 range for almost 4 years

Ultimate goal of 195 Tummytuck in Boise and SmartLipo in Tijuana

,

[Guest guest]

I would do whatever my doc recommended if further surgery was

desirable or even possible after removal.

But most important I'd do my best to follow proper bandster patterns

of eating to maintain my weight. Again, the band is just a tool. What

happens is up to me.

Thursday, May 28, 2009, 2:02:21 AM, you wrote:

> IF YOU HAD TO GET YOUR BAND REMOVED, WHAT WOULD YOU CHOOSE TO DO?

> Would you replace your band with the new AP band (if your doc

> allowed it, would you replace it with the same 9.75 cm band, what would you

do?

--

" It's OK to be a little broken, everybody's broken in this life " Jon Bon Jovi

Dan Lester, Boise, Idaho, USA www.riverofdata.com/lapband

Banded 4/27/03, Dr. Ortiz, Tijuana

Started at 355, at goal in the 210-220 range for almost 4 years

Ultimate goal of 195 Tummytuck in Boise and SmartLipo in Tijuana