What is a Band slip ? re-post

[Guest guest]

Sandy,

 

I also think that there is a degree of pouch dilatation.

 

Like I told you in other emails, Dr. Kuri told me that my pouch was " a little

dilated " and just fo 3 days of liquid and will get back to normal/

I do not have reflux, I pb may be every other week. I do not feel anything.

 

I think that after 2.5 years, I can say I learned that if I burb once is an

indication, if I do it twice, I better stop. Even after stopping eating, I will

continue burping withouth pb.

 

The key is to stop before that burp becames a pb.

 

Lidia

From: moonshadow.sandy <moonshadow.sandy@...>

Subject: What is a " Band slip " ? re-post

Date: Friday, November 21, 2008, 10:03 PM

What is a " Band slip ?

One of the serious potential problems with a Band is called a " Band

Slip. " The latest stats re band slips and erosions are now 3-7%. This

is a worrisome increase from the 1-3% rate it has been since FDA

approval in the US.

" BAND SLIP " however, is a very misleading term, because it's not the

band that moves at all; it is securely sutured in place. With

a " slip " the stomach moves up (herniates) thru the band, so it is in

a dangerous position.

There are different kinds of slips, with different symptoms. I often

read on other boards that slips always cause sudden inability to eat

or drink, but this is NOT TRUE at all.

A " small " slip, also called a " concentric slip " , occurs when the

pouch dilates from an overfill or overeating. The symptoms are SUBTLE

and easily blamed on other things. There can be a bit of new reflux,

finding you can eat more and more over time, ability to eat things

you could not before, etc. As you can see, all these things are

common with NORMAL band weight loss and are NOT clear signs of a

slip.

This is why periodic fluoros are a very wise thing - maybe every 6

months or so, or whenever there is a concern. I personally do not

believe, and most docs also do not believe, that a fluoro with every

single fill is needed or safe. I got and get now only the yearly

assessment fluoro. I never got a fluoro with any fill. IMO, Radiation

exposure is very good to avoid unless really needed. While the

radiation involved with a fluoro is small, NO radiation is entirely

safe, especially when the ovaries are right in the radiation field.

My opinion only, after research and discussing with many band

surgeons over the years.

CAUSES of these " small slips " , also called pouch dilations:

1.Trying to keep a too-tight fill ! Avoiding too-tight fills means

knowing (being taught) the definition of a too-tight fill and never

keeping one, thinking/praying it will lead to better loss. not only

does it often stall OUT weight loss, it leads to serious problems

sooner or later. It is VERY VERY hard to get out of the mind-set

of " weight loss at ANY cost " .

2. consistently eating more than 1-1.5 cups of food (after we have a

decent fill) whether we " can " or not. This type of slip can often

occur, especially, in those out 1-5 yrs, if they are not careful to

self-limit eating. After a time, it seems the esophagus does not give

reliable " soft stop " signs any longer - or perhaps we have learned to

ignore them and keep eating. This is a big reason we should work hard

on the emotional eating and lifestyle changes, so we just DON'T

overeat and eat mindlessly any longer. This is the hardest part of

banding, IMO. It's not jut about weight loss.

3. regular barfing/Pb's. IMO, more than 1-2x a month is TOO MUCH, and

we just HAVE to learn the band rules to eat safely. If we are barfing

regularly more than this, I believe we have too much fill for the

level of our band learning, and need some out while we learn better

habits to stay safe.

FIXES: These types of " small " slips , also called a pouch dilation,

are usually fixed by a complete unfill and rest period of a few weeks

to 1-2 months. the stomach then often can shrink back into a good,

safe position, and small, gradual refills can begin again. i

believe, after any dilation, that we have to be especially careful to

avoid another to tight fill.

Causes of these slips: trying to keep a too-tight fill, overeating,

barfing.

The " big slips " are far more serious. They are usually sudden, and

people have a very major change - usually inability to eat or drink

without pain and/or barfing. These slips can be very urgent, or

occasionally a real emergency, since the stomach can strangulate.

Thankfully, they are not very common (maybe around 3-4%)but require

urgent care. This is why, IMO, we must always know where to go and

prepare ahead of time, for local care by a very knowledgeable band

practitioner. I believe we must arrange for this before we are

banded, and it should be discussed by he Patient facilitators well

before banding. a few people have needed urgent local care and

sometimes re-hospitalization within the first few days of getting

home from surgery.

When one is in severe pain and vomit ting continually, it's not

practical or safe to try to get back on a plane to return to Mexico,

at last-minute plane fares. It's important to know that most ER's and

medical centers will not and cannot help with a band problem, as it

is a VERY specialized area. We must go to a medical center that does

bands, and hope they will accept a Mexican patient. Pathetically,

many will not.

CAUSES of big slips : almost always, it is from trying to keep a too-

tight fill that results in barfing and food intolerance.

FIXES: Most big slips require an emergency band removal. sometimes, a

new band can be placed at the same time. The new surgery is often

tougher than the first, because there is a lot of scar tissue to

remove and fit the band around. Sometimes, replacement is not

possible at removal, but may be possible after 6 months or so of

healing. There is an increased chance of another erosion if the band

is placed

again, though.

As always, PREVENTION of band problems is key to safety and success.

This requires ongoing teaching and ongoing learning to stay safe,

assess problems, and know when to get quick help.

c. sandy r, BSN, MN

band educator

at goal 4.75 ys

[Guest guest]

One of the serious potential problems with a Band is called a " Band Slip. " The

latest stats re band slips and erosions are now 3-7%. This is a worrisome

increase from the 1-3% rate it has been since FDA approval in the US. The new AP

bands, which almost all docs use now, have unique new features to educe slips

and erosions. none of the Mexican docs use this band till, and for this reason

alone, i would not be banded in Mexico today.

" BAND SLIP " however, is a very misleading term, because it's not the band that

moves at all; it is securely sutured in place. With a " slip " , the stomach moves

up (herniates) thru the band, so it is in a dangerous position.

There are different kinds of slips, with different symptoms. I often read on

other boards that slips always cause sudden inability to eat or drink, but this

is NOT ALWAYS TRUE at all.

A " small " slip, also called a " concentric slip " or " pouch dilation " ,

occurs when the pouch dilates from an overfill or overeating. The symptoms are

SUBTLE and easily blamed on other things.

There can be a bit of new reflux,

finding you can eat more and more over time, ability to eat things

you could not before, etc. As you can see, all these things are

common with NORMAL band weight loss and are NOT clear signs of a slip. A big

clue is if you have EVER had a fill way too tight that you did not have some

removed. Thee dilations happen mainly after big overfills.

This is why periodic fluoros are a very wise thing - maybe every 6 months or so,

or whenever there is a concern. I personally do not believe, and most docs also

do not believe, that a fluoro with every single fill is needed or safe. I got

and now get only the yearly assessment fluoro. I never got a fluoro with any

fill.

IMO, Radiation exposure is very good to avoid unless really needed. While the

radiation involved with a fluoro is small, NO radiation is entirely safe,

especially when the ovaries are right in the radiation field.

CAUSES of these " small slips " , also called pouch dilations:

1.Trying to keep a too-tight fill ! Avoiding too-tight fills means

knowing (being taught) the definition of a too-tight fill and never

keeping one, thinking/praying it will lead to better loss or get

better with time. not only

does it often stall OUT weight loss, it leads to serious problems

sooner or later. It is VERY VERY hard to get out of the mind-set

of " weight loss at ANY cost " , but we really must.

2. constantly eating more than 1-1.5 cups of food (after we have a decent fill)

whether we " can " or not. This type of concentric slip

(pouch dilation) can often

occur, especially, in those out a couple years, if they are not

careful to self-limit eating. After a time, it seems the esophagus does not give

reliable " soft stop " signs any longer - or perhaps we have learned to ignore

them and keep eating. This is a big reason we should work hard on the emotional

eating and lifestyle changes, so we just DON'T overeat and eat mindlessly any

longer. This is the hardest part of

banding, IMO. It's not just about weight loss, but changing

lifestyles so we can KEEP the weight off.

3. regular barfing/pb's. IMO, more than 1-2x a month is TOO MUCH, (after we are

thru the initial learning periods where we all goof) and we just HAVE to learn

the band rules to eat safely. If we are barfing regularly more than this, I

believe we have too much fill for the level of our band learning, and need some

out while we learn better habits to stay safe.

FIXES: These types of " small " slips , are usually fixed by a complete unfill and

rest period of at least a few weeks

to 1-2 months. the stomach then often can shrink back into a good, safe

position, and small, gradual refills can begin again. I

believe, after any dilation, that we have to be especially careful to avoid

another to tight fill.

There is no rush to re-fill, and we will need to be especially careful after

these slips, as we are more prone to future slips. You will need to eat very

carefully, and never (never) more than 1-1.5 cups per meal. A second slip is

much more likely to require surgery to repair or remove.

The " big slips " are far more serious. They are usually sudden, and

people have a very major change - usually inability to eat or drink

without pain and/or barfing. These slips can be very urgent, or

occasionally a real emergency, since the stomach can strangulate.

Thankfully, they are not very common (maybe around 2-3%)but require urgent care.

This is why, imo, we must always know where to go and prepare ahead of time for

local care by a very knowledgeable band practitioner. I believe we must arrange

for this before we are

banded, and it should be discussed by he Patient facilitators well

before banding. a few people have needed urgent local care and

sometimes local re-hospitalization within the first few days of

getting home from surgery. Our family docs must also know of our plans for

banding, so they can help later in an urgent situation. They can at least help

with finding care or re-admission if needed. They also need to know the basics

of banding, so, for instance, they don;t think that all that is needed for

reflux is meds - and are not aware this is a sign of a possible slip and needs

an eval.

For those banded in Mexico or far from their surgeons: When one is in severe

pain and vomiting continually with an urgent

problem, it's not practical or safe to try to get back on a plane to return to

Mexico,

at last-minute plane fares. It's important to know that most ER's and medical

centers will not and cannot help with a band problem, as it is a VERY

specialized area. We must go to a medical center that does

bands, and hope they will accept a Mexican patient. Sadly,

many will not.

However, in a very urgent situation, still go to the

ER of your closest band hospital. they an at least get you re-

hydrated mwith IV's , give pain meds, and you can ask (require) them to call

your band surgeon for further

directions. Carry your Inamed wallet card in your wallet, for this reason! The

you will always have your doc's contact info.

CAUSES of big slips : almost always, it is from trying to keep a too- tight fill

that results in barfing and food intolerance.

FIXES: Almost all -if not ALL - big slips require an urgent /emergency band

repositioning or even a band removal.

Sometimes, a

new band can be placed at the same time of the old must come out. The new

surgery is often

tougher than the first, because there is a lot of scar tissue to

remove and fit the band around. Sometimes, replacement is not

possible at removal, but may be possible after 6 months or so of

healing.

As always, PREVENTION of band problems is key to safety and success.

This requires ongoing teaching and ongoing learning to stay safe,

assess problems, and know when to get quick help.

Sandy R, BSN, MN

band educator

at goal 4.5 yrs