How does your doc decide how much to fill?

Just curious, I got my first fill, and my doc didn't really go by a certain amount, he went by feel. He says he fills until the pressure feels just right, and that is where he stops. My fill was awesome for all of 3 or 4 days, but it's gone now. It'll be 2 weeks on Wednesday, and I'm thinking I should hightail it back in. I think it got about 6.5 in my 10 cc band last time. Any reason to wait longer?? Is there really any need to worry how much is in the band, or is it better to just go by feel and results?

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Catherine
Banded: 8/6/07

I hope Wendel chimes in here and attaches his bit about fills, it is very informative. But basically, everyone's anatomy is different, our stomac walls are not the same thickness. For example you and I would absolutely not have the exact same feeling of restriction at say 7cc's of fill. Perhaps your stomach wall is thicker than mine, maybe I'd need 7.5cc's to feel restriction. So while the band holds a defined amount of fluid, what the band is restricting (your stomach) is not always the same thickness. And that thickness changes as you lose weight. There is a fat pad on your stomach that shrinks as the rest of you shrinks and you lose some restriction along the way.

RARELY does anyone hit their "sweet spot" of restriction the first fill. Most posts here and on other boards seem to indicate it takes at least three fills and quite often four or five to reach that good level of restriction. More often than not, most people don't get much of anything from their first fill. If they get any restriction it is only for a few days. Occasionally people don't get the restriction form a fill until 10 days to 2 weeks after the fill, and no one really knows why that is, it just seems to happen for some people. That usually occurs in later fills, though. Not the first one.

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Quando Omni Flunkus Moritati
(When all else fails, play dead) H371/S327/C:AWFUL
Fell off the wagon in a big way, got back on with my first fill ever 4/29/08; second fill 4/2009
Small AP June 21st, 2007 by Dr. James Wagner @ Hurley in Flint, MI

Getting filled under fluoro allows the doc to actually SEE how restricted a patient is. Does your doc offer fluoro (sort of an xray image)? Many patients who are filled under fluoro seem to have better restriction earlier and have less fills to get to their "sweet spot" and also seem to have less unfills.

No reason to wait longer. If you feel like you need a fill I would go back in. Even if he only gives you .5 ccs.

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Julie
banded 6/6/06
Dr. McKeen, San Jose CA

320/213/goal 199. Almost there!

Thread Starter

Yeah. I hate going back in so quickly and not having lost much weight since the last fill. That guilt thing runs deep, doesn't it? It has occurred to me that I need to get over feeling like I'm losing weight for the doctor, and that I'm doing this for ME. MY money, MY band, MY fills. MY weight loss.

Frustrating. :(

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Catherine
Banded: 8/6/07

Don't be frustrated. What you are experiencing is completely natural. It took me about 6 months and 5 fills to finally get good restriction. I have heard some people with your bandsize need 7ccs. You have gotten a good start. Don't be afraid to ask for a fill. Its your band.

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Julie
banded 6/6/06
Dr. McKeen, San Jose CA

320/213/goal 199. Almost there!

I usually only get .2cc at a time. Mine varies certain times of the month. One day I can eat a lot and the next I will throw up.

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Surgery Jan.23,2007

This may help you in understanding the restrictive mechanism of a Lap-Band®. The INAMED protocol for Lap-Band® fills calls for a six-week delay after surgery, prior to any fills. The purpose for the six-week delay is for the patient’s stomach to heal from the surgery, as well as allowing time for the Lap-Band® to “Seat” or “Nestle” into the fat pad between the stomach wall and the interior wall of the Lap-Band®. Prior to receiving an EFFECTIVE fill, it is VERY uncommon to have any restriction from a Lap-Band®. Some patients will NOT lose weight, or may even GAIN weight until they have received an effective fill in their Lap-Band®. Normal weight loss with a properly restricted Lap-Band® is between 1 and 2 pounds per week.

The normal cycle of fills, restriction and weight loss is as follows:

1. The patient's Lap-Band® constricts when the patient receives a fill. Swelling for a few days after receiving a fill is very common. Many doctors require a patient to go on a liquid diet for a day or two after receiving a fill. A fill may have a “Delayed Action” of up to two weeks. A “Delayed-Action” means that the fill may not become effective for up to two weeks after the fill. That is why the INAMED protocol states that fills should not be performed on patients who will not have access to medical care for at least two weeks after a fill.

2. The patient's stomach capacity is lessened as a result of the restriction caused by the Lap-Band®.

3. The patient loses weight because they cannot eat as much food.

4. The residual fat-pad between the inside of the Lap-Band® and the outside of the patient's stomach reduces in size because of the overall weight loss in the patient.

5. The reduction of the residual fat-pad causes the Lap-Band® to become loose again.

6. At that point, the patient needs another fill, because the Lap-Band® is loose, and the patient has a loss of restriction, which allows the patient to eat larger amounts of food.

7. The patient receives another fill and the process starts all over again.

Most Lap-Band® patients receive several fills to adjust the Lap-Band® as their weight loss progresses, and there is less and less residual fat-pad between the inside of the Lap-Band® and the exterior of the stomach wall. Once a patient has lost all of their residual fat-pad, fills become less common. As the Lap-Band® patient progresses in their weight loss, the effect of very tiny fills (Less than .2ccs) becomes greater and greater. It is not uncommon for a late-stage Lap-Band® patient to experience a significant difference in restriction with as little as .05cc of fill.

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See my before & after photographs

Starting weight was 570 pounds
Banded 09/13/2004 by Dr. Neal, in Shelton, WA

"Why are you letting a number on a scale determine your level of happiness, and would it MATTER what the number on the scale said if you were at your perfect goal SIZE?"

Thank you! :)

__________________
See my before & after photographs

Starting weight was 570 pounds
Banded 09/13/2004 by Dr. Neal, in Shelton, WA

"Why are you letting a number on a scale determine your level of happiness, and would it MATTER what the number on the scale said if you were at your perfect goal SIZE?"

YEAH, Wendell chimed in!!! See, I said it was informative, didn't I?

__________________
Quando Omni Flunkus Moritati
(When all else fails, play dead) H371/S327/C:AWFUL
Fell off the wagon in a big way, got back on with my first fill ever 4/29/08; second fill 4/2009
Small AP June 21st, 2007 by Dr. James Wagner @ Hurley in Flint, MI

Thank you. I am considering consolidating the many posts that I have written about fills into one single post, as fills and questions about them seem to be a very hot topic on different message boards.

__________________
See my before & after photographs

Starting weight was 570 pounds
Banded 09/13/2004 by Dr. Neal, in Shelton, WA

"Why are you letting a number on a scale determine your level of happiness, and would it MATTER what the number on the scale said if you were at your perfect goal SIZE?"

I think that is a GREAT idea, but you and I both know that all this info is out there, and people still can't seem to use the Search function, or go look at the topics in forums before asking. I'd love to see it all condensed, but I dont know if it will stop some of the many many posts asking the same questions over and over.

Just an aside, I LOVE your posts and am soooooo glad you have come to join us from OH!

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Quando Omni Flunkus Moritati
(When all else fails, play dead) H371/S327/C:AWFUL
Fell off the wagon in a big way, got back on with my first fill ever 4/29/08; second fill 4/2009
Small AP June 21st, 2007 by Dr. James Wagner @ Hurley in Flint, MI

Thread Starter

[quote=faithmd;568792]I think that is a GREAT idea, but you and I both know that all this info is out there, and people still can't seem to use the Search function, or go look at the topics in forums before asking. I'd love to see it all condensed, but I dont know if it will stop some of the many many posts asking the same questions over and over.

I actually have read Wendell's post many times previously (through searches and random reading), but what Inamed suggests and what doctors actually do are two completely different things!

It seems to me that most people describe their docs as filling to a certain predetermined amount, rather than to a certain tension or pressure point. I'm thinking I like the way my doctor does it better - more chance of finding my sweet spot. Although, I am surprised that I lost restriction so quickly. I didn't really lose much these past 2 weeks. Maybe 2 pounds. Maybe I'm shrinking INSIDE :p.

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Catherine
Banded: 8/6/07

Thank you. :)

I won't have time for it for a few days, but I will post a consolidated fill post when I get it done. The issue of doctors not filling according to the INAMED (Now ALLERGAN) protocol is well-known. Perhaps by posting a comprehensive thread, with attendant explanations as to why such a protocol should be followed I can provide a persuasive arguement for people to use with their doctors who insist on using less successful fill techniques.

__________________
See my before & after photographs

Starting weight was 570 pounds
Banded 09/13/2004 by Dr. Neal, in Shelton, WA

"Why are you letting a number on a scale determine your level of happiness, and would it MATTER what the number on the scale said if you were at your perfect goal SIZE?"

[quote=homew6kids;568864]That is EXACTLY what is happening. The fat around your internal organs is the most dangerous fat to you, and your body is dropping weight there.

Take a cardboard tube from a paper towel roll. (Your stomach)

Wrap it in a pound of fatty bacon. (The residual fat-pad around your stomach)

Tie a balloon around the bacon and inflate it. (The lap-band®)

"Melt" a little of the bacon away underneath that balloon. (Lose weight)

That is exactly what happens when the residual fat-pad melts and loosens up the band.

If a person loses even a few ounces underneath the band, it's going to get loose and need a fill.

Graphic, but REALEASY to visualize, isn't it?

__________________
See my before & after photographs

Starting weight was 570 pounds
Banded 09/13/2004 by Dr. Neal, in Shelton, WA

"Why are you letting a number on a scale determine your level of happiness, and would it MATTER what the number on the scale said if you were at your perfect goal SIZE?"