Allergan in the News

Allergan, maker of the Lap-Band® and many other medical devices, made the bariatric headlines on October 30, 2012, when a news article (click here to read it) revealed that they’re considering selling the Lap-Band® part of their business. I don’t have all the details behind the story, but I do have plenty of opinions about it, so I’m sharing those opinions with you in this article.

 

BIG NEWS IN THE BAND WORLD
 

     The Reuters article said that that Allergan is considering selling the Lap-Band® to another medical device company due to declining sales of the band. Not surprisingly, this news has caused some excitement in the bariatric surgery community.

     I have a hard time drawing any conclusions (pro or con) about the band itself based on the Reuters report. The decline in Lap-Band® sales could be the result of management or other business problems rather than due to a problem with the band itself. It's highly unlikely that Allergan will ever reveal the whole story to anyone but their team of attorneys and board of directors. 

     So, what could this hot news story mean? As you read on, please remember: these are only personal opinions from an ex-bandster who’s fairly well-informed but not a medical professional and in no way associated with Allergan or any other medical device or other company in the world of bariatric surgery. For what it’s worth, here’s my take on the story.

     The US economy is in tough shape, the popularity of bariatric surgery in general is leveling off, and insurance coverage for bariatric surgery is still a challenge. Allergan is not alone in this - Johnson & Johnson must face the same challenge in marketing the Realize™ Band. The story of what's really behind all this is clouded by the reactions of the media and of band-bashers who sing the "I told you so" song because they assume (without any credible basis at this point) that Allergan's decision is related to the safety and/or efficacy of the band.

SO, WHAT’S THE REAL STORY?
 

     All the other bariatric surgery procedures now performed in the USA can have serious complications and failure rates, but it's easier to point the finger of blame at a single manufacturer of a medical device than it is to blame the thousands of surgeons who are doing bariatric procedures that don't happen to use a medical device. The FDA isn't looking over the shoulders of all those surgeons the way it scrutinizes Allergan or Johnson & Johnson. When Dr. John Doe stops doing bariatric surgery and goes back to yanking out gall bladders, no one leads a parade down Main Street waving banners about the dangers of the procedures Dr. Doe was doing. Except in rare cases (such as the sad story of my original surgeon), nobody's even discussing Dr. Doe's surgical expertise or behavior. It's an example of what I call the David & Goliath Syndrome. A big company like Allergan is an easy target thanks to its size and visibility. The general public may step on Dr. Doe's fingers but otherwise will kick him to the curb in eagerness to throw rocks at Allergan.

     One of the hurdles facing any manufacturer of an adjustable gastric band is that it is (in my opinion) the bariatric procedure that requires the most patient education, aftercare, and support. In the 5 years since I was banded, I have encountered plenty of evidence of bariatric clinics doing a great job of that, but I've also encountered clinics that are failing at it, to the detriment of their patients. Not because they're doing something wrong, per se, but because they're directed by a surgeon (or team of surgeons) who was trained to think of surgery of any nature as an in-and-out deal. They're used to seeing the patient 3 times: a pre-op visit; in the operating room (with an unconscious patient); one post-op visit; and never again unless the patient experiences a complication that requires more surgery. That's fine when the surgery involves removing a gall bladder or a mole or a wisdom tooth, but it's a set-up for failure with band patients. The bariatric surgeon who vetted Bandwagon told me several years ago that the band manufacturers make few demands on the surgeons or clinics that buy their products because they don't want to marginalize the customers who don't follow the manufacturer's advice but have acceptable patient outcomes.

     Avoiding marginalization of customers is a smart business decision but a poor medical decision, and I think it's a mistake for us to view surgeons only as super-wealthy, super-powered medical demi-gods anointed by a Supreme Being and the ASMBS. They're also customers, and just like you and me when we're shopping for a new car, they're looking for a product that has reliable quality and performance at a price they can live with. They are business people who want to make money (to pay their staff, their malpractice insurance premiums, their colossal student loans, and their kids' college funds). Sure they want to practice the art (and science) of medicine, but they can't do that very well if they can't pay their bills.

     Finally, keep in mind that someone, somewhere is going to end up with the Lap-Band in some form. It is highly unlikely that Lap-Band® research & development, its technology and FDA approval, to say nothing of the existing customer base, will drop to the bottom of the bariatric pond and never be seen again. Both Allergan and the new owner will legally and ethically have to stand behind their product, with the details of that worked out to the last detail by teams of expensive attorneys and insurance companies. Even surgeons who stop doing band surgery to concentrate on other procedures will still have the basic skill and knowledge to provide fills and other aftercare to their band patients.

     Although I lost my beloved band in April 2012, I do not regret having Lap-Band® surgery and if I were starting my WLS journey today, I would ask my surgeon's opinion about the Allergan decision and also ask how (or if) it will affect his/her practice. The answers to those questions would be towards the top of a long list of questions I'd be asking before deciding to have surgery. And if I still had my band, I'd be asking my surgeon the same questions so that I could go forward with some degree of comfort (if not 100% satisfaction) that I'd have someone to turn to should I need band help in the future. I most certainly would not be rushing off to make an appointment with the Speedy Weight Loss Surgery Revision Center, or at least not until I'd done plenty of homework on the procedures offered by the quacks at Speedy. Trading in a car just because it's 2 years old has never made sense to me, and if it isn’t broke, why fix it?

     Although my journey from Lap-Band® to vertical sleeve gastrectomy ended up taking 6 months, I'm still nagged about it by a little doubting voice, especially when my sleeve is giving me trouble. Should I have chosen the sleeve, or not? Should I have risked the return to morbid obesity, or gamble on more surgery? There are no easy answers to questions like that. If there were a cure for obesity, I'd be first in line for it, but until that cure is invented, I'm making the best of what I've got.

I've been publishing the Bandwagon on the Road e-newsletter for 2 years. I loved doing it and even more, I loved the conversations it generated with my readers. That kind of thing is what makes it possible for me to stay on track in my weight loss journey. But right now, I've got too much on my life's plate (though absolutely no potato chips) and not enough cash in my hand to pay my mailing service bills, so I'm setting the newsletter on the back burner (with absolutely no mashed potatoes) for now.

I will, however, be posting articles here on my blog more often. I'm planning on one a week, posted on Tuesdays. So stay tuned!

Feeling better

A blood test showed that I'm anemic. We're not sure why - whether it's from low caloric intake, or a GI bleed. I had to do a hemoccult test that showed I'm bleeding somewhere in there, and since my mom had colon cancer, I have to take it seriously even though colonoscopies done after past positive hemoccult tests showed nothing serious. So I have an appt with my gastro doc next week, and no doubt he's going to want to do another colonoscopy. Oh, goodie.


I've been taking an iron supplement for a week now and already feel much, much better. Still struggling with the hunger, but it's easier for me to deal with that when I'm not exhausted. In the past week I've been able (occasionally) to eat a bit more than 1/4 cup of food at a time, and I'm hoping that when I get up to the 1/2 cup I'm supposed to be eating, my body will realize it's not going to starve to death and stop torturing me with blood sugar fluctuations.

Almost 2 months post-op

This Thursday will mark the 2-month anniversary of my sleeve surgery. I'm still struggling to adjust to eating and living with my sleeve. My surgeon & dietitian, my internist's NP/diabetes educator, and a nurse at Anthem BC/BS all seem to feel that if I could eat more than 1/4 cup of food at a time, I wouldn't be so hungry only an hour after eating. Since eating more than 1/4 cup makes me sick, I'm not able to test that theory right now. I'm getting a lot better at knowing when to stop eating and at avoiding dumping, but having to eat every 1 to 1-1/2 hours (which is what the NP/diabetes educator recommends) is a pain in the butt, especially when I'm at work, where I'm not allowed to eat or drink except during my one 15-minute break. And this isn't a nagging hunger. It's a screaming hunger, because my blood sugar has nose-dived and my body thinks I'm about to starve to death and cranks up the production of grehlin and other hormones to motivate me to eat again.


The other problem is my fatigue and low energy. I've been tested for anemia, dehydration, and various vitamin/mineral deficiencies and hope to get the test results today.

The good news is that I've lost 17.4 lbs so far and I'm fitting into smaller clothes again. I'd forgotten that it can be fun to go closet-shopping. I still can't fit into last winter's clothes but today I'm taking a bag of fat clothes to Goodwill.

The Sleevester

The other day, an acquaintance asked me if I'm a "sleever" now. My beloved band is history and I do indeed have a sleeved stomach (thanks to successful surgery on August 16th). My intensive 19 seconds of research revealed that the correct answer to the question is that I'm now a sleevester - a bandster who became a sleever.

I'm finding that recovering from sleeve surgery is harder and lengthier than recovering from band surgery. I feel OK, but have little energy and get tired easily. I've lost 10 lbs since the surgery, so that's cause for celebration. At my 2-week post-op appointment, my surgeon encouraged me to start transitioning from purees to solid food, and said that the hunger I'm having is because purees don't have the staying power of solid food. Well, I already know all the words to that song, but I'm still wondering about the hunger. I can eat only a few bites of solid food, and about an hour later I'm fiercely hungry again. It's very frustrating. Eventually my body should realize that 75% of my stomach is gone now and ratchet down the production of grehlin (hunger hormone) and acid. The sooner the better as far as I'm concerned.

I'm trying to learn my new "stop eating" signals. With my band, my main stop signals were pressure in my chest and a fullness at the back of my throat. Now I feel pressure or a burning sensation in my upper abdomen, and sometimes the fullness at the back of my throat. If I don't notice any signals and overeat, I feel slightly sick. And speaking of sick...it turns out that sleeve patients can dump (something I thought only bypass patients experience). My surgeon says that's because the stomach is too small to store food and therefore "dumps" it into the intestines, where it spikes the blood sugar. Sugary foods are the main culprit, and I'm finding that sugar lurks where you don't expect it, like creamy poppyseed salad dressing and my favorite Click vanilla latte protein shake. Giving up the Click saddens me because I love that stuff, but sugar in liquid form causes havoc (I get dizzy, sweaty, and nauseated) so quickly that I just can't do it, even if I try to drink the Click slowly. So I'm searching for other breakfast options that are quick, easy, and satisfying.

One of the arguments in favor of VSG surgery is that you're basically done when you leave the operating room. No fills, no unfills....it is what it is. But that's also an argument against VSG. Except for further surgery (which in my case would be duodenal switch since I'm already halfway to the switch part), there's no adjusting my stomach or restriction...it is what it is. So I have to find a way to live with what I've got, like it or not.

Second Chances

When I was first banded, I believed (and proclaimed) that one of the great things about the band is that if you get off track or backslide, you can always start over again. Get another fill, do a band refresher course, get back on the bandwagon, and eventually reach your weight goal. At the time, it seemed to be a benefit unique to the band, largely because of the “window of weight loss opportunity” myth widely circulated in the bariatric patient community. I thought that a gastric bypass, sleeve, or duodenal switch patient used up all their chances the first time they visited the operating room, and that we bandsters were a special breed.


Since then, I’ve watched dozens of WLS patients (bandsters and others) go back to the operating room again and again because their initial surgery choice disappointed them or caused complications. I realized that we do get second and even third chances, though with no guarantees of greater satisfaction or lesser complications. The new surgery choice worked for some, and not for others. I know of two ex-bandsters who died during or after their WLS revision, their deaths due more to a combination of terrible events than to the surgical procedure they had. I also know people who have succeeded wonderfully, and without complications, since their second or third bariatric procedure. Just as with the first try at bariatric surgery, it’s hard to predict how well patients will do after revision surgery. One thing does stay the same, though. At this time in history, there is no cure for obesity, not even the most drastic weight loss surgery, and because of that, weight regain is a specter that haunts us all.

Another bump in the road

My bandwagon hit another bump in the road in April. After my surgeon removed my band, she was unable to pass the bougie (calibration tube) through my esophagus into my stomach because of a stricture, so I woke up with 6 incisions, no band, and no sleeve. Extremely disappointing.

Since then I've had the stricture dilated from 13 to 17 mm (the bougie was 13.3 mm) by a gastro-enterologist who says my problems were caused by longterm "silent" reflux. I can remember going to an ENT doc in mid 1980's who said my chronic cough was due to reflux, not a throat problem. Since I'd never had any recognizable reflux symptoms (heartburn, acid regurgitation, etc.), I didn't believe him. Now I wish I'd sought treatment for the reflux, but I can't go backwards and somehow I'm determined to move forwards. I'm taking omeprazole every day and aside from regaining 20-25 lbs, feeling fine. I plan to take another shot at the sleeve surgery in August.