Cirrhosis of the Liver Community
BANDING ?
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BANDING ?

I would like to know more about this.
- My Son had it done 5 times at age 18.That was 1989 and he hated it,he completely stopped everything.My Liver Doctor said something about scoping me for Banding and I told him I would like to wait if possible,because of the bad exp from the pain my Son went thru.I know some of you have had this done,so please dont Sugar Coat it,just give it to me as you experienced it.Thanks in Advance..
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From the Cleveland Clinic...

Portal Hypertension

Portal hypertension is an increase in the pressure within the portal vein (the vein that carries blood from the digestive organs to the liver). The increase in pressure is caused by a blockage in the blood flow through the liver.
Increased pressure in the portal vein causes large veins (varices) to develop across the esophagus and stomach to bypass the blockage. The varices become fragile and can bleed easily.

What causes portal hypertension?

The most common cause of portal hypertension is cirrhosis, or scarring of the liver. Cirrhosis results from the healing of a liver injury caused by hepatitis, alcohol abuse, or other causes of liver damage. In cirrhosis, the scar tissue blocks the flow of blood through the liver and slows its processing functions.

Portal hypertension may also be caused by thrombosis, or clotting in the portal vein.

What are the symptoms of portal hypertension?

The onset of portal hypertension may not always be associated with specific symptoms that identify what is happening in the liver. But if you have liver disease that leads to cirrhosis, the chance of developing portal hypertension is high.

The main symptoms and complications of portal hypertension include:

• Gastrointestinal bleeding; black, tarry stools or blood in the stools; or vomiting of blood due to the spontaneous rupture and hemorrhage from varices.

• Ascites, an accumulation of fluid in the abdomen.

• Encephalopathy, confusion and forgetfulness caused by poor liver function and the diversion of blood flow away from your liver.

• Reduced levels of platelets or decreased white blood cell count.

How is portal hypertension diagnosed?

Endoscopic examination, X-ray studies, and lab tests can confirm that you have variceal bleeding. Further treatment is necessary to reduce the risk of recurrent bleeding.

What are the treatment options for portal hypertension?

The effects of portal hypertension can be managed through diet, medications, endoscopic therapy, surgery, or radiology. Once the bleeding episode has been stabilized, treatment options are prescribed based on the severity of the symptoms and on how well your liver is functioning.

First level of treatment

When you are first diagnosed with variceal bleeding, you may be treated with endoscopic therapy or medications. Dietary and lifestyle changes are also important.

Endoscopic therapy consists of either sclerotherapy or banding.

Sclerotherapy is a procedure performed by a gastroenterologist in which a solution is injected into the bleeding varices to stop or control the risk of bleeding. Banding is a procedure in which a gastroenterologist uses rubber bands to block the blood supply to each varix.

Medications such as beta blockers or nitrates may be prescribed alone or in combination with endoscopic therapy to reduce the pressure in your varices and further reduce the risk of recurrent bleeding.

Medications such as propranolol and isosorbide may be prescribed to lower the pressure in the portal vein and reduce the risk of recurrent bleeding.

The drug lactulose can help treat confusion and other mental changes associated with encephalopathy.

Dietary and lifestyle changes

Maintaining good nutritional habits and keeping a healthy lifestyle will help your liver function properly. Some of the things you can do to improve the function of your liver include the following:

• Do not use alcohol or street drugs.

• Do not take any over-the-counter or prescription drugs without first consulting with your physician or nurse. Some medications may make liver disease worse, and they may interfere with the positive effects of your other prescription medications.

• Follow the dietary guidelines given to you by your physician or nurse. Follow a low-sodium (salt) diet. You will probably be required to consume no more than 2 grams of sodium per day. Reduced protein intake is required only if confusion is a symptom. Your dietitian will help you create a meal plan that helps you follow these dietary guidelines.

Second level of treatment

If the first level of treatment does not successfully control your variceal bleeding, you may require one of the following decompression procedures to reduce the pressure in these veins.

• Transjugular intrahepatic portosystemic shunt (TIPS), a radiological procedure in which a stent (a tubular device) is placed in the middle of the liver.

• Distal splenorenal shunt (DSRS), a surgical procedure that connects the splenic vein to the left kidney vein in order to reduce pressure in your varices and control bleeding."

http://my.clevelandclinic.org/disorders/portal_hypertension/hic_portal_hypertension.aspx

Stomach problems are unrelated to your liver. If they really are your stomach. You should consult with a gastro to diagnose the problem.

Cheers!

Hector


20 Comments Post a Comment
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Hi countygirl and welcome to MedHelp’s "cirrhosis of the Liver" community.

I'm not sure what the procedure (endoscopy-scope) was like in 1989 but over the last couple of years I have had it done 4 times and honestly when I woke up I couldn't tell I had it done. The procedure only takes about 15 minutes. It is very important to have the endoscopy so you may receive your diagnosis. This is to determine the grade of varices (extremely dilated sub-mucosal veins in the lower third of the esophagus) one, two or three. Without it you run the risk of a blood vessel bursting causing hemorrhaging.

Although I have grade 3 varices I have been very fortunate not to have had a bleed at which point is when banding is needed. Don't feel alarmed if you are diagnosed with grade three but don't take it lightly as it is a very serious condition and you will need to follow doctor’s orders for prevention. Here is a link to that explains treatment options for varices.

http://www.medicinenet.com/bleeding_varices/article.htm

I hope it helps you out :)

Randy
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Thanks Randy! So you have not had the Banding done or have you?Im not so worried about them scoping,more worried about Banding.I have not yet had bleeding .They have told me I have Portal Hypertension,but dont they have to go in and scope to find that out or is it because I have HBP now from all this.
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Banding is not used until bleeding occurs. I myself have not had any banding. The scope is necessary so you know the grade of varices and what restrictions you should folllow. It is in your best intrest to have the scope (endoscopy) ASAP. Below is a link to a post made yesterday by a very well informed member of our community. Please take a moment to read the information provided and pay particular attention to section i've inserted below.

http://www.medhelp.org/posts/Cirrhosis-of-the-Liver/Varices--Nadolol--blood-labs/show/1763659

"Patients with Cirrhosis Who Have Recovered from Acute Variceal Hemorrhage
Patients who survive an episode of acute variceal hemorrhage have a very high risk of rebleeding and death. The median rebleeding rate in untreated individuals is around 60% within 1-2 years of the index hemorrhage, with a
mortality of 33%. It is therefore essential that patients who have recovered from an episode of variceal hemorrhage and have had no evidence of hemorrhage for at least 24 hours be started on therapy to prevent recurrence prior to discharge from the hospital."

Varices are due to portal hypertension.

Randy
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What are the symptoms of portal hypertension/varices.  I had cirrohsis stage 2 when I started treatment - I am 2months post meds.  I know whether i stay undetected or not, i will still have cirrohsis.I asked  my doc (GI) what it would be like to live with a diseased liver, and he was so vague, there was really no answer.  I am concerned now about the hypertension, varices, ascites.  I still have a constant dull pain and messed up stomach.  Thanks.  **
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3097131_tn?1357088481
Thanks for the info and especially the LINK you gave me.I guess I need to get it over with and set an Appt..It's definitely Worth It now that I hear it in that way..Without Health You have Nothing!


Special Thanks to Hector for the post on that Link also it was touching !

Cheers!
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I can only Recommend you ask your Dr. about Portal Hyp. with having Stage 2 Cirrhosis I am surprised your Dr. hasnt mentioned it to you.


God Bless,
    Country
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First let me agree with Randy. Having an endoscopy and banding is a preventive measure that you should want to do. As Randy said, it is used to prevent a life-threatening bleed. It can save your life. This is a very serious matter. Many patient die from bleeds not their liver failing. That your doctor did not make this point to you is very unfortunate. Also if your have cirrhosis and portal hypertension you should be taking a beta blocker (I take Nadolol 20 gm) to slow the heart and reduce your blood pressure. Please read my comments to "Crossroadec" about this. Also note my comment that once a patient has one bleed they most likely will have future bleeds and survival rates for those patients that have bleed are reduced. The objective is always to stop that first bleeding.

There is no such term as "Stage 2 cirrhosis". Cirrhosis is stage 4 liver disease. Perhaps you mean Child-Pugh Class B cirrhosis? This is decompensated cirrhosis, meaning your liver is beginning to fail and it can no longer perform all of its functions properly. This is when the complications of cirrhosis first appear. Ascites, hepatic encephalopathy and bleeding varices are the major ones and there are many other less life threatening ones. Decompensated cirrhosis is also called End-Stage Liver Disease as without a transplant it is fatal in time.

Hope this helps!

Hector
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446474_tn?1404424777
From the Cleveland Clinic...

Portal Hypertension

Portal hypertension is an increase in the pressure within the portal vein (the vein that carries blood from the digestive organs to the liver). The increase in pressure is caused by a blockage in the blood flow through the liver.
Increased pressure in the portal vein causes large veins (varices) to develop across the esophagus and stomach to bypass the blockage. The varices become fragile and can bleed easily.

What causes portal hypertension?

The most common cause of portal hypertension is cirrhosis, or scarring of the liver. Cirrhosis results from the healing of a liver injury caused by hepatitis, alcohol abuse, or other causes of liver damage. In cirrhosis, the scar tissue blocks the flow of blood through the liver and slows its processing functions.

Portal hypertension may also be caused by thrombosis, or clotting in the portal vein.

What are the symptoms of portal hypertension?

The onset of portal hypertension may not always be associated with specific symptoms that identify what is happening in the liver. But if you have liver disease that leads to cirrhosis, the chance of developing portal hypertension is high.

The main symptoms and complications of portal hypertension include:

• Gastrointestinal bleeding; black, tarry stools or blood in the stools; or vomiting of blood due to the spontaneous rupture and hemorrhage from varices.

• Ascites, an accumulation of fluid in the abdomen.

• Encephalopathy, confusion and forgetfulness caused by poor liver function and the diversion of blood flow away from your liver.

• Reduced levels of platelets or decreased white blood cell count.

How is portal hypertension diagnosed?

Endoscopic examination, X-ray studies, and lab tests can confirm that you have variceal bleeding. Further treatment is necessary to reduce the risk of recurrent bleeding.

What are the treatment options for portal hypertension?

The effects of portal hypertension can be managed through diet, medications, endoscopic therapy, surgery, or radiology. Once the bleeding episode has been stabilized, treatment options are prescribed based on the severity of the symptoms and on how well your liver is functioning.

First level of treatment

When you are first diagnosed with variceal bleeding, you may be treated with endoscopic therapy or medications. Dietary and lifestyle changes are also important.

Endoscopic therapy consists of either sclerotherapy or banding.

Sclerotherapy is a procedure performed by a gastroenterologist in which a solution is injected into the bleeding varices to stop or control the risk of bleeding. Banding is a procedure in which a gastroenterologist uses rubber bands to block the blood supply to each varix.

Medications such as beta blockers or nitrates may be prescribed alone or in combination with endoscopic therapy to reduce the pressure in your varices and further reduce the risk of recurrent bleeding.

Medications such as propranolol and isosorbide may be prescribed to lower the pressure in the portal vein and reduce the risk of recurrent bleeding.

The drug lactulose can help treat confusion and other mental changes associated with encephalopathy.

Dietary and lifestyle changes

Maintaining good nutritional habits and keeping a healthy lifestyle will help your liver function properly. Some of the things you can do to improve the function of your liver include the following:

• Do not use alcohol or street drugs.

• Do not take any over-the-counter or prescription drugs without first consulting with your physician or nurse. Some medications may make liver disease worse, and they may interfere with the positive effects of your other prescription medications.

• Follow the dietary guidelines given to you by your physician or nurse. Follow a low-sodium (salt) diet. You will probably be required to consume no more than 2 grams of sodium per day. Reduced protein intake is required only if confusion is a symptom. Your dietitian will help you create a meal plan that helps you follow these dietary guidelines.

Second level of treatment

If the first level of treatment does not successfully control your variceal bleeding, you may require one of the following decompression procedures to reduce the pressure in these veins.

• Transjugular intrahepatic portosystemic shunt (TIPS), a radiological procedure in which a stent (a tubular device) is placed in the middle of the liver.

• Distal splenorenal shunt (DSRS), a surgical procedure that connects the splenic vein to the left kidney vein in order to reduce pressure in your varices and control bleeding."

http://my.clevelandclinic.org/disorders/portal_hypertension/hic_portal_hypertension.aspx

Stomach problems are unrelated to your liver. If they really are your stomach. You should consult with a gastro to diagnose the problem.

Cheers!

Hector


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3097131_tn?1357088481
Alright you two have talk me into it,I will be setting an Appt. to have the Scoping done..You are right,it all is scarier than just going and getting it done and over with.I am on a low dose of BP med.20mg of Lopressor.Gotta go for now.
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That is very good to hear country girl! You have to take your health into your own hands and not trust it entirely to someone else, learn as much as you can about your disease so you may better communicate with your doctor and decide what treatment options are best for you. You have done that today! I will be wishing the very best for you :) Take care.

Randy
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446474_tn?1404424777
Countrygirl,

Glad to hear we persuaded you. Here is more information on the importance of preventing the first bleed...

Mortality/Morbidity

"Patients who have bled once from esophageal varices have a 70% chance of rebleeding, and approximately one third of further bleeding episodes are fatal. The risk of death is maximal during the first few days after the bleeding episode and decreases slowly over the first 6 weeks. Mortality rates in the setting of surgical intervention for acute variceal bleeding are high.

Associated abnormalities in the renal, pulmonary, cardiovascular, and immune systems in patients with esophageal varices contribute to 20-65% of mortality."

http://emedicine.medscape.com/article/175248-overview#a0199
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Here is the information from the AASLD Practice Guidelines "Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis"

What you are about to have done...

Diagnosis of Varices and Variceal Hemorrhage

"The gold standard in the diagnosis of varices is esophagogastroduodenoscopy (EGD). In a consensus meeting it was recommended that the size classification be as simple as possible, i.e., in 2 grades (small and large), either by semiquantitative morphological assessment or by quantitative size with a suggested cut-off diameter of 5 mm, with large varices being those greater than 5 mm. When varices
are classified in 3 sizes—small, medium, or large—as occurs in most centers by a semiquantitative morphological assessment (with small varices generally defined as minimally elevated veins above the esophageal mucosal surface, medium varices defined as tortuous veins occupying
less than one-third of the esophageal lumen, and large varices defined as those occupying more than one-third of the esophageal lumen), recommendations for mediumsized varices are the same as for large varices, because this is how they were grouped in prophylactic trials.

As shown below, nonselective -blockers prevent bleeding in more than half of patients with medium or large varices. Therefore, it is recommended that patients with cirrhosis undergo endoscopic screening for varices at
the time of diagnosis. Since the point prevalence of medium/large varices is approximately 15%-25%, the majority of subjects undergoing screening EGD either do not have varices or have varices that do not require prophylactic therapy. There is, therefore, considerable interest in developing models to predict the presence of highrisk varices by non-endoscopic methods. Several studies have evaluated possible noninvasive markers of esophageal varices in patients with cirrhosis, such as the platelet
count, Fibrotest, spleen size, portal vein diameter, and transient elastography.

However, the predictive accuracy of such noninvasive markers is still unsatisfactory, and until large prospective studies of noninvasive markers
are performed, endoscopic screening is still the main means of assessing for the presence of esophageal varices Cost-effective analyses using Markov models have suggested either empiric -blocker therapy for all patients with cirrhosis or screening endoscopy for patients with
compensated cirrhosis, and universal -blocker therapy without screening EGD for patients with decompensated cirrhosis. Neither of these strategies considers a recent trial showing that -blockers do not prevent the development of varices and are associated with significant side effects, nor do they consider endoscopic variceal ligation as an alternative prophylactic therapy. Until prospective studies validate these approaches, screening EGD is still the recommended approach.

The frequency of surveillance endoscopies in patients with no or small varices depends on their natural history. EGD should be performed once the diagnosis of cirrhosis is established.

In patients with compensated cirrhosis who have no varices on screening endoscopy, the EGD should be repeated in 2-3 years.

In those who have small varices, the EGD should be repeated in 1-2 years.

In the presence of decompensated cirrhosis, EGD should be repeated at yearly intervals.

EGD is expensive and usually requires sedation. It can be avoided in patients with cirrhosis who are already on nonselective -blockers for other reasons (e.g., arterial hypertension. In those on a selective -blocker (metoprolol, atenolol) for other reasons, switching to a nonselective
-blocker (propranolol, nadolol) would be necessary. A procedure that may replace EGD is esophageal capsule endoscopy. Two recent pilot studies show that capsule endoscopy is a safe and well-tolerated way to diagnose
esophageal varices, although its sensitivity remains to be established. Thus, capsule endoscopy may play a future role in screening for  sophageal varices if additional larger studies support its use.
EGD also remains the main method for diagnosing variceal hemorrhage.
The diagnosis of variceal hemorrhage is made when diagnostic endoscopy shows one of the following: active bleeding from a varix, a “white nipple” overlying a varix, clots overlying a varix, or varices with no other potential source of bleeding."

http://www.aasld.org/practiceguidelines/documents/bookmarked%20practice%20guidelines/prevention%20and%20management%20of%20gastro%20varices%20and%20hemorrhage.pdf

Cheers!
Hector
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Avatar_f_tn
thanks for the info - i have a couple of questions.  Is this something that is more likely to happen with stage 3 or 4, or is it if you have any scarring of the liver? I have none of the symptoms listed, i just got concerned after reading all of the info - my dr has never mentioned anything to me about this. I have an appt with him next week about the pain i am having in the stomach "area" and also I have had a really weird dull pain that just comes out of nowhere and moves up my esophagus. I thought with all of your experience you might have heard of something like this.  again  thanks so  much.  This entire experience is really still freaking me out!!
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446474_tn?1404424777
Is this something that is more likely to happen with stage 3 or 4, or is it if you have any scarring of the liver?

Only when liver disease has progressed to stage 4/cirrhosis and Child-Pugh Class B cirrhosis.

If you have no complications from your cirrhosis then your cirrhosis is still compensated.

Complications of cirrhosis only occur when the liver becomes decompensated. When the liver is so diseased it can not perform all of it functions. That is why the complications appear. This is call Child-Pugh Class B cirrhosis.
Ascites, Bleeding varices, hepatic encephalopathy all occur in a person with decompensated cirrhosis. When a person has their first episode of ascites, or their first bleed or overt hepatic encephalopathy they are then considered to have decompensated liver disease.

When you have compensated cirrhosis the liver even though it is scarred can still perform all of its functions. Many people with Child-Pugh Class A cirrhosis don't know they are very ill because they have few if any symptoms. The most common being fatigue.

"A really weird dull pain that just comes out of nowhere and moves up my esophagus." Burning in the esophagus is commonly caused by G.E.R.D. (Gastroesophageal reflux disease). Here are some of the symptoms. People experience different symptoms and will not experience others. All Gastroenterologist know about GERD and it is easy to treat.

Not everyone with GERD has heartburn, but the primary symptoms of GERD are heartburn, regurgitation, and nausea.

Heartburn usually is described as a burning pain in the middle of the chest. It may start high in the abdomen or may extend up the neck or back. Sometimes the pain may be sharp or pressure-like, rather than burning. Such pain can mimic heart pain (angina). Typically, heartburn related to GERD is seen more commonly after a meal. Other symptoms of GERD include:

Hoarseness. If acid reflux gets past the upper esophageal sphincter, it can enter the throat (pharynx) and even the voice box (larynx), causing hoarseness or sore throat.
Laryngitis
Nausea
Sore throat
Chronic dry cough, especially at night. GERD is a common cause of unexplained coughing. It is not clear how cough is caused or aggravated by GERD.
Asthma. Refluxed acid can worsen asthma by irritating the airways. And asthma and the medications used to treat it can make GERD worse.
Feeling as if there is a lump in your throat
Sudden increase of saliva
Bad breath
Earaches
Chest pain/discomfort. Seek immediate emergency medical help (Call 911) for any chest pain.

I understand you are freaking out. This diagnosis can be very stressful as we think this shouldn't be happening to me. In time you will adjust more and more. Luckily you are not too ill now and have time to intervene. You have more option now than if you didn't find out until you were feeling very ill. Try to take it one step at a time. Don't look at the big picture it can be overwhelming for any on us. You are learning and becoming educated for you will understand your options better. All this is a good thing. You are getting help and being proactive that is a huge step and very very important. You are taking responsibility and moving in the right direction. You have a lot going for you. That is all to your advantage.

Keep us up to date with your progress.

Cheers!

Hector
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Avatar_m_tn
I've had numerous banding sessions over the years, and they have not been too bad.  My doc has you do a liquid diet for a day after, and then soft food for a couple of days after that.  For me, there was very little pain after the procedure. I have a low tolerance for pain, so  it may actually be easier for the less whining patient.  Some discomfort when swallowing food for the first couple of days, and then it's back to normal.

Both my hepatologist and gastroenterologist believe that, as a preventative measure, large varices should be banded before they bleed .  I had numerous large grade 3 varices and required a few banding session over 2 years.  Now, it has been 4 years since I've needed banding and the last scoping showed very small (no grade) varices. I also take a beta blocker to reduce the portal hypertension.

It is good that you decided to have that scoping done. As others have noted, this is one complication that needs to be closely monitored.

Good luck!

el
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thanks for the info.I am going to have this done immediately,as soon as my doc schedules it.You guys dont know how much you have helped me so far..Im not done yet,I still have lots more Q's,but today Im enjoying the Holiday,So HAPPY 4TH OF JULY to all and May God Bless Everyone!
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Thanks so much for the info - I feel much better now!  I have a doctor (GI) with, I think, very little experience and I always have gotten vague answers from him. Now, like everyone else I wait to see if i clear the virus.  Hector, i know your situation  is so much worse than mine, and I pray that things go well for you.

later
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446474_tn?1404424777
Good news.
None of us are done yet. I will never be done with hepatitis, as I need a transplant and with a transplant I have to take meds and have periodic blood test for the rest of your life. But we learn to take it one step/day at a time. One appointment, one blood test, one scan, one drug etc.at a time. Just like life.

Have a happy holiday!

Hector
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Thanks for the kind words. I am doing fine right now and an optimistic things will work out in a good way in the future. I have many friends who are also transplant patients so I do not feel alone or isolated because of my illness. We all have our issues and this one of liver failure and liver happens to be mine.

It is unfortunate that there are so many doctors who really don't communicate well with there patients. It can can more anxiety than there needs to be. The un known called be scarier than the actual facts.

Hang in there are stay compliant with your treatment so you can have the best outcome.

Cheers!
Happy holiday!

Hector
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3097131_tn?1357088481
Well now I will have to wait till my 12 week treatment is done before they will do anything..Just a update!
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Sounds like you've got a plan. Good luck with your treatment. I'm not as knowledgable as Hector. He keeps us all informed! My experience with banding has been great. I've had 3 this summer and 1 more before school starts.
What I've recognized is that the 1st bleed could have been avoided. I was working too hard toward the end of 48 week triple therapy. I relied on caffeine, B12, and chocolate to get me through work. I had to have insurance though. I was under a lot of fatigue and stress and my liver was tired from all the treatment meds.
Now I have taken coffee down to maybe one ounce mixed with ovaltine in the morning. Praying and meditating more. Eating a high alkaline diet instead of acid diet, which I had done before, but now am diligent! The number one thing is I take my pulse several times a day. If it is above 75, I go inside and rest.
I hope all goes well for you. It's a mess, but you can still have your life back. Gradually, and with wisdom. Right? lol
Keep us posted, Karen :)
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