My Understanding of Fills - Correct Me if Wrong

From what I am understanding, after Lap Band surgery, the doc will usually do no fill or not much of a fill. Then, even though you may still have very little restriction, your first few fills may not be very much, I am assuming because the doc is wanting you to get used to the progressive restriction (thereby reducing the amount of problems adjusting) rather than just dumping it all in you at once. Is this correct?

Yes, that's fairly accurate. You don't get fills during or immediately after sugery because you are healing. The band is stitched in place so it doesn't slip. All that has a healing process. Gettiing a fill would irritate it and slow the healing process. The fills are progressive for a reason. One, you don't want to get sick or lose to fast. the other is that there is a fat layer around the outside of your stomach. As you lose weight, that fat layer decreases in size which causes your band to loosen. As a result, you feel less restriction. the fill helps fill up the space left by the lost fat. Does that make sense? Aggressive fills are painful and not very healthy. You would end up vomiting a lot and being miserable. Dehydration from not being able to take in liquids would also be a problem. who wants to go to the emergency room for an I.V. drip? Not me. So, it all goes in a progression as your body adjusts and your eating habits change.

My first fill was 3 cc in a 10 cc band. 2nd fill was 1 cc and my third fill was 1 cc. I already had .5 in there from surgery when he tested it for leaks and emptied it, so I have a total of 5.5 cc. My doctor is not aggressive with fills. I'm 7 months out and have only had 3 fills. all doctors are different, but I'm very happy with him not rushing it and making my life miserable.

i consider my doctor pretty aggressive when it comes to fills... or maybe it's because i live 4 hours away from him. my band was primed with 1.5cc in a 10cc band. my first fill was 1.8cc and my second fill was 2cc... so now i have a total of 5.3cc in my band less than 60 days after my surgery.

Yes, absolutely correct. Unfortunately, most doctors are extremely conservative with fills and you end up like me...15 months post-op and still very little restriction. I will be going in for fill #8 in September and I'm hoping to finally find the sweet spot everyone raves about.

Defintely keep insisting on fills until you find adequate restriction. My original surgeon was very conservative and after 8 months of being banded with no restriction, I changed doctors.

I just wanted to add that I think it is good when offices are a bit conservative with fills. I think maybe that is when they are making sure to educate us that it is our job to work with the band. I know I would like something to be a quick fix, but I have to be the one responsible for stopping when I am satisfied. I think there is a bit of a learning curve and maybe getting smaller fills will help us learn to work with the band.

Just out of curiosity....

How many of you who say your doctors are "very conservative with fills" pay for your fills out of pocket versus have fills that are covered by insurance?? Maybe I am a little jaded, not that someone should get filled too fast, but surely there is a happy medium. Do you think they are lining their pockets with your fill money or legitimately being cautious??

I am scheduled for my first fill on the 25th, I was banded May 30. All of my fills are covered in my fee. I paid out of pocket, but it was just a one time fee ($17000):biggrin2:, that covered the two week medifast diet (which was incredibly disgusting!), any preop labs or tests ( I didn't need any), all appointments, surgery, anethesiologist (sp?), hospital/surgery center, all fills, and any surgery related to the band/port for the first two years. The only extra thing I've had to pay for was my vitamins and my post op perscription.

I'm GLAD I don't get aggressive fills. I'm learning to eat with the help of the band, and not depending on the band and having to deal with PBs, vomiting, and not being able to eat a lot of foods. To me that is not quality of life, and I'm in this for my HEALTH and quality of life. Vomiting daily, is not what you should be experiencing. That's trading one eating disorder for another as far as I'm concerned. I've heard of to many people tossing up their food just to lose an extra pound a month. I've had three fills in 7 months, so no, I don't think my doctor is trying to make a quick buck off of me. He is SUPER nutrition conscious and I'm grateful for that. I am not self pay, I have insurance, but he is out of network for me, so there is a bit of a cost involved, and I have a $400 deductible. I wouldn't say he's conservative in the amount he puts in, that's in the average range, but is more conservative in how often he does it. I've lost close to 60 pounds in 7 months, so I'm happy with that.

I also paid out of pocket for everything. I was trying to say the same things as Aubrie - I worry when I read so many times about people so tight and all the troubles they have keeping things down. I just can't imagine living like that. I want to be a healthy weight - but I also want to have total health. At this point, I am not willing to risk moving to quickly to restriction to get there. The office I go to does stress that you should be able to eat normal foods comfortably and tries to keep fills as reasonable as possible so you feel like you can come in to take ccs out as necessary too.

Perhaps true to a point, but the main idea is that the band is a tool to help us. That tool only works when it is running at proper capacity. Proper capacity varies greatly with each individual and if the goal is healthy weightloss, why make someone (like myself) struggle over a year with lack of restriction just because the doctor is conservative? I don't think so, and this is why I changed doctors. Just because one or two fills is good for someone else, that doesn't mean they are enough for me.

It's very critical to learn and understand your individual restriction level and insist on additional fills if needed.

Aubrie, that is an awesome loss! Unfortunately, I've only lost 63 pounds in 15 months and am still struggling with restriction as a few others on this board seem to be as well. Since the band isn't a one-size-fits-all approach, it is important to remember that what works for some, doesn't necessarily work for others. I appreciate all of the support I've received from this website....this is a vital part of my success (or failure) with the band.

re: "surely there is a happy medium. Do you think they are lining their pockets with your fill money or legitimately being cautious??"

Bandsters need to adapt to a whole new world postOp. Besides the issue of physical healing, there are changes in eating behavior, personal emotional evolution, social context, and nutritional realities to master.

We can not amputate the past or our own bad eating habits. We must train our rational facilities to replace the emotion-driven unbalanced metabolism of our Morbid Obesity feasting response to food.

There are obvious pros and cons of any WLS.

Also any Band fill protocol will have those happy/unhappy whatever the schedule.