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Dan's Lap-Band I've always been a fat guy. I weighed 8 lbs. 15 oz. when I was born on February 5, 1943, and have been growing fatter most of my life since then. As a child I learned to read early and was very good at "school things” and "inside things". This is fortunate, as I was allergic to grass, dust, pollen, and most anything that floated around in the air. I always had dreams of being an athlete and playing football, but the allergies and associated sinus and bronchial infections kept me from being very active in outdoor activities, particularly those which involved rolling around on the grass. This gave me ample opportunity to read and do sedentary things inside, the academic things I was particularly good at. When I was about eleven, my mother took me to a specialist to check out my Basal Metabolism Rate to see if I had a slow metabolism that was causing my obesity. However, it showed that my metabolism was normal. Despite that, the doctor prescribed some sort of "uppers” for me, probably Dexedrine or Benzedrine. I don't recall them having much effect on weight, but they did make me hyper and jumpy. I think I only took them for about six months, because my mother and the doctor realized they weren’t helping. I continued to do academic things and to focus on a sedentary hobby, amateur radio. Almost all of my adult life I weighed in the 300 - 320 pound range, with occasional excursions outside of that. After my first marriage ended, I got down to 240 for a year or so, but returned to the "normal” range thereafter. After marrying Gail in 1991, we both got our food plans working, and I was down to 240 in the fall of 1992. Starting at Thanksgiving of 1992, when one of my retinas first tore, I spent almost six months essentially immobile. During that time, I had six surgeries on my eyes, and had to be face down at all times (whether lying down, sitting, or standing) during that time for the surgeries to heal. Fortunately, I was able to do that and was able to keep my vision. But during that time, I couldn't drive, rarely left the house, was afraid and depressed that I'd go blind. Naturally, I watched a TV that was face up on the floor, read, and ate. I ate a lot. In that six months, I went from 240 to over 300, and was over 300 for the next ten years until after getting my lap-band. I reached a peak of 355 in 1998, and finally tried Fen-Phen, Meridia, and Phentermine. I also started getting more exercise at the gym pretty regularly, working with a trainer. As long as I was on drugs and exercised, my weight stayed around 300-325. In early 2003, while investigating weight loss surgery alternatives on the internet, I stumbled on information about the Lap-Band and other Laparoscopic Adjustable Gastric Bands. I'd already decided that none of the gastric bypass procedures were of interest. There was just too much permanent rearranging of your insides and too many risks and side effects. So, I started looking around for information from those who have had the procedure, as I didn't know of anyone in Boise who had been banded and couldn't find any doctors in Boise who did the band. Searching on the web I found several Yahoo groups that dealt with banding. Those included Bandsters, SmartBandsters, and one of the many regional groups, PNW_Bandsters. There are also a multitude of other groups available that have the word "Bandster” in them, plus others that can be found by other searches. My favorite groups at present are SmarterBandsters (for those already banded), SmartestBandsters (for those who've been banded a year or more), and BandsterWorkout (about exercise for banded folk). There are also several dozen personal websites available where others have told of their banding experiences, which can be easily found with a Google search. I’ve since added my own at www.gailndan.com/lapband, of which you're reading a part at present. The regional PNW_Bandsters group was particularly helpful with providing me with information, including information about the Splash & Bash held in the Seattle area. I knew my insurance would not cover any weight loss surgery (it is a specifically named exclusion), and I'd found that surgery in places like Salt Lake City, Seattle, San Francisco was in the $25,000 range. Meanwhile, my research had led me to two of the top band surgeons in Mexico, Dr. Ariel Ortiz in Tijuana and Dr. Roberto Rumbaut in Monterrey. Both of them had performed hundreds of banding surgeries over many years, and Dr. Rumbaut had been banded himself, as well. At first I leaned towards Dr. Rumbaut, mainly because he was not in Tijuana. As a college student over forty years ago I’d visited Tijuana to visit bars and strip joints, and couldn’t imagine having surgery in such a place. However, the trip to Monterrey was triple the cost from Idaho and took more than twice as long, which seemed to be troublesome for someone returning from surgery. I kept investigating Tijuana, however, and realized that as a city of a couple million people, it had both good and bad parts of town, and I’d only seen the bad ones those many years ago. I learned from patients of Dr. Ortiz and patients of other Tijuana physicians that I’d get great care in an excellent hospital, and wouldn’t be taken to any of the less desirable parts of town. So, I finally settled on Dr. Ortiz for my surgery. Despite all of the above research, I still had a little bit of a nagging doubt. So, I booked Dr. Ortiz for surgery on Monday, April 28, 2003 and sent him a deposit. I chose that date since I’d made a reservation to attend the Seattle Bandster Splash & Bash, an event that includes the chance to meet other Bandsters, hear doctors and other speakers discuss the band and living with the band, and have lots of fun as well, April 26th and 27th . So I bought a ticket to Seattle for Saturday morning, going on to San Diego on Sunday afternoon, and coming home to Boise from San Diego on Thursday. I felt that the Bash would be my last chance to change my mind, even though I was almost positive that this was the right decision. I figured that if I found out that all of the Bandsters were crazy, had terrible problems, or something else that would change my mind, I’d just fly home to Boise and take the losses on the ticket and the deposit as a bad choice that was cheaper than having a bad surgery. Within a few hours in Seattle I knew that these people were smart, had made a wise decision, and had greatly improved their lives. I called Gail, my wife, and told her that I was definitely getting the surgery. I was also able to hear and meet Dr. Pedro Kuri, another top lapband surgeon, and he confirmed that Dr. Ortiz was an excellent choice. It turns out that Dr. Kuri had taught Dr. Ortiz some of the medical school courses on the gastrointestinal system. After hearing the speakers and enjoying the hot tub party and the experiences of other Bandsters, I headed off to San Diego on Sunday afternoon. I was met by a driver at the airport baggage claim and whisked away to the Lucerna Hotel in Tijuana. I spent Sunday evening trying to relax and have a “last supper”. I just had a burger and soup, avoiding most of the “last supper” syndrome that some future Bandsters experience. (This means spending days or weeks pigging out on things that they expect to never eat again). The hotel desk let me know that Mrs. Ortiz, the doctor’s mother, would pick me up early in the morning to take me on to the pre-surgery tests and the hospital. On Monday morning, I met the charming Mrs. Ortiz in the hotel lobby and we headed off for the day of tests. One of the ways that costs are kept down for the patient is by using individual clinics for the various tests. We went to one clinic for an X-ray, another for blood and urine samples, another for an EKG, yet another to see the nutritionist, and so forth. Tijuana has dozens of medical clinics of all sorts in one relatively small area. Although most of the patients in each of the clinics were local people, and some of the staff didn’t speak much English, Mrs. Ortiz escorted me to the appropriate places, told them what I was there for, and waited nearby. Although we got to chat some while we were waiting, she also kept busy on her cell phone arranging things for other patients, keeping in touch with patients who were in the hospital, and so forth. Since there was often a while to wait, I was glad I’d brought a book to keep me occupied. Had my Spanish been better, I might have been able to talk with some of the others who were waiting. By about 3 PM, we’d finished all the tests and we went to the doctor’s office where I met Dr. Ortiz in person at last. I immediately felt like we’d known each other for a long time, and was completely comfortable with him. After finishing up the financial arrangements with his office staff, Mrs. Ortiz took me off to OASIS Hospital. It is a small hospital near the bull ring and beach in Playas de Tijuana, about seven miles from the hotel and clinic area, which is called the Zona Rio, or River Area. I was taken to a room, changed into the obligatory hospital gown, and waited for them to take me away for surgery. It turned out that I walked down the hall to the operating room and climbed onto the table. The operating room was beautiful, with a wall of windows that overlooked beautiful gardens. I remember thinking that I hoped the doctors were used to paying attention to me and didn’t just stare out the window at the view. They did, of course, pay attention to me. Within a few minutes I was out, and in less than forty minutes Drs. Ortiz and Martinez were through with my surgery. The next thing I knew I was waking up in my hospital room, feeling a bit groggy and sore, but not in any real pain. My stomach was bruised and had five little scars on it, the largest about ¾ inch long. The incisions were closed with “super glue” and there were no bandages or stitches at all. On Tuesday morning my lungs felt congested, but I didn’t think much about it at all as I often get some bronchial problems after flying, probably due to the bad and dry air on planes. They also told me that the surgery often causes pressure on the diaphragm, which can add to breathing problems. By the next day, however, they were trying to get me to get out of bed and walk the halls, which is standard advice after most surgery, and particularly band surgery. However, I was having great trouble breathing and didn’t think I could walk much at all. I had trouble making it just to the little bathroom, maybe ten feet from my bed. At first I believe they thought I was just being lazy, rather than really having great trouble breathing. Soon, however, they realized that I was having a genuine problem, which was confirmed by checking my oxygen saturation level and giving me a lung X-ray. Dr. Ortiz brought in a pulmonologist who put me on antibiotics and oxygen after he confirmed that I had pneumonia. The pneumonia undoubtedly came from a combination of aspiration and the germs that were already in my lungs. About six years earlier, I had a UP3 (uvulo-palato-pharyngoplasty) to cure my sleep apnea. That opened up my palate and throat, but made it much easier for anything in my mouth to get into my lungs. Since I had a large and fat stomach, my band was particularly tight and the post surgical swelling made it difficult for liquids, including saliva, to get into my stomach. This meant that some of these fluids were aspirated, or taken into my lungs, adding to the problem. The excellent care I received in the intensive care unit of OASIS Hospital confirmed my beliefs that I’d made a wise choice of where and when to have my surgery. I was still having problems on Wednesday, and Gail was worried about me. So, that evening she phoned Mrs. Ortiz and told her she was flying down the next day. Mrs. Ortiz assured Gail that I was improving, but understood perfectly and arranged for her to be picked up at the airport and brought straight to the hospital. Most Mexican hospitals are very family oriented and recognize the important support that comes from having loved ones nearby. The rooms at OASIS are equipped with the bed for the patient and also a bed for a companion to stay with the patient. Most band patients take a partner or friend with them for the surgical procedure, although there are always some of us who go alone. Since we’re escorted at all times in Tijuana, or else in an excellent hotel or hospital, even women traveling alone never need to fear going to Mexico alone for surgery from Dr. Ortiz. I was improving, but still glad that Gail was able to come. We stayed together at the hospital until Saturday, when all the doctors came to visit and I was checked out; the room looked like a medical convention with four doctors all present to check up on their “special patient”. I believe I was the first patient they’d had with a previous UP3 procedure and they found me an interesting challenge and wanted to see how I’d done. Since my insurance wasn’t paying for the lapband procedure, we assumed that it would also not pay for the extra hospital cost of the three days in Intensive Care. When they brought us a bill for the total hospital cost, and then showed part of it paid, and a balance due for us to pay, Gail was smart enough to ask for a totally separate bill that showed nothing but charges for “neumonia” (Spanish for pneumonia). They gladly gave us a separate bill that showed nothing but the fees for three days of Intensive Care. The pulmonologist also provided us with a bill that only mentioned the six days of care that he provided for “neumonia”. After returning home, I sent the bills in to the insurance company and they paid the 80 percent called for in my policy without any problem. I’m sure that if they knew of the surgery they would not have paid. We returned to the Hotel Lucerna for one more night and headed back to the San Diego airport with our driver on Sunday morning. The trip back home was tiring, since I was still on antibiotics, but was not a big problem. On Monday morning, I went to my own doctor and he continued me on another ten days of antibiotics to finish off the pneumonia. I stayed home from work for another week to be sure I was over it, and all was well after that. I was still not back at full strength for another couple weeks, but that was due to the pneumonia, not the surgery itself. Most people go back to desk jobs within a few days to a week after surgery, but the pneumonia made it two weeks for me. After all, even though the surgery is generally quite quick, under an hour in most cases, the effects of anesthetics hang on for some time. Since recovering from the pneumonia, I’ve continued to do extremely well, with no illnesses and no problems that weren’t of my own making. Since I was so tight in the beginning, and had pneumonia, I lost weight more rapidly than most people are able to do. Many don’t lose much at all during the first six weeks, as they don’t have much restriction until they get a proper fill in the band. In two months, I lost sixty pounds, which was caused by my very tight restriction and the results of my pneumonia. I can’t stress too strongly that this is not typical and shouldn’t be expected. A more normal weight loss in the first two months might be ten to twenty pounds. In addition to my problem with the pneumonia, I was larger than many banded people, and am male. In general, larger people and males lose faster, regardless of other issues. In the next two months, I lost another fourteen pounds, a rate of loss that is much closer to normal. By that second two month period, I was exercising regularly, which also helps. I am normally in the gym five or six days a week, both lifting weights and engaging in various aerobic types of exercise. These include the treadmill and bicycle, and, more recently, playing racquetball. Any exercise that gets your body moving and your heart rate up is good to do. Lifting weights is also good because it builds muscle to take up the space of some of the fat you’re losing. In addition, converting fat to muscle is good because a pound of muscle burns more calories than a pound of fat does. After losing seventy-four pounds in the first four months, I lost twenty-three more pounds in the next four months, also a reasonable and typical rate. Many physicians recommend a weight loss of a pound or two a week at most, and after the first two months I’ve lost at that type of rate. After ten months from surgery, I'd lost a total of 107 pounds, ten of them in the ninth and tenth month period. This tapering off of weight loss is typical for a variety of reasons. I had less to lose, so consuming the same amount of food means less weight loss. In addition, the more I lose, the more muscle I build. During the eleventh through fourteenth months my weight remained more or less stable, within a four pound range up and down. Why didn't I keep losing? First, I was near a goal weight. My weight was in the 211-219 range, and my goal is about 199. Second, I was traveling a great deal and eating less appropriate foods than I normally do when at home. Third, due to the travel and a couple of bouts of bronchitis, I got very little exercise, which I consider to be the biggest problem. The exercise is absolutely vital to facilitate weight loss and improved health. At the end of fourteen months I got an abdominoplasty (tummy tuck), and that story is related on another page. I don’t think of the change in my body just in terms of weight loss but in changes in my life. My pants used to be a size 56 and are now a size 38 or 40. My shirts were 3X or 4X, and are now XL. I can now shop in regular stores, and not just in the “fat guys’ store”. I can also fit in restaurant booths, exercise easily, and do a whole host of other activities that just weren't possible when I had another 140 pounds on my body. The only problems I’ve had have been of my own making. On a few occasions, I’ve overeaten, eaten too fast, eaten bites that are too large, or eaten the wrong foods. Those have caused food to get stuck in the stoma, or opening between the upper and lower stomach. In those cases, I’ve either had pain for several hours, or I’ve vomited the food to solve the problem. Both serve as excellent reminders that I’ve done something wrong, and encourage me to avoid that behavior in the future. My other problem was caused by getting a fill from a different doctor than my own surgeon. Although the doctor was excellent, and knew what he was doing, I didn’t follow his suggestion. He told me that I was filled too tight and that I might not be able to get food through the stoma. I “knew it all”, thought I could read the fluoroscope screen better than he could, and told him I was fine. After not being able to eat for a week, and having considerable pain, I returned to Dr. Ortiz to have the fill removed, to let the stuck food go through, and to get my band filled properly. At age sixty-one, you’d think I would have learned to listen to the people I’m paying to provide medical care to me, but I didn’t listen to the doctor. From now on, I’ll be sure to do what I’m told so I don’t repeat a painful experience. Are there any downsides to the band? Not as far as I’m concerned. There is almost no chance of serious complications arising. The problems I’ve had were due to my own failure to follow directions of doctors. The positives of improved health and mobility, the ability to shop in normal stores, and the ability to play racquetball again are crucial to me. I love my band, and have pictures of me at various stages in my banding journey at my website, http://www.gailndan.com/lapband/ I’m always reachable by email at honu@gailndan.com, and am happy to communicate with people who are interested in getting the band or who have one. For those who contact me by email first, I’m glad to talk on the phone or meet in person, as well.
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