I was just given my first fill this past Monday, one day short of 5 weeks after my surgery.

I asked him, "How much are you going to give me?"

"You will tell ME," he replied.

My mouth fell open. Whatever could he mean?

I have spent months reading the boards and lists, with people posting, My doctor gave me "___cc's" ..... often followed with complaints that they didn't feel ANY sense of restriction, that they were still starving, and, in the worst of cases, that their doctor didn't want to see them again til at least another 6 weeks. And some of these fill appointments were EXPENSIVE and involved long drives and taking time off of work.

So here is how my "patient-directed and -led fill" proceded.

He palpated my sternal port position. He prepped the field. He mixed the solution (he prepares a custom solution of a certain osmolarity). He drew up the solution, inserted the syringe and needle into the port, then helped me to sit upright.

He then handed me a 12-oz bottled Water and requested that I take a small drink. He then asked me to tell him what I was feeling. I told him I could feel a sense of coldness in my lower esophagus. He pulled a bit of Fluid out, and I reported feeling the water gurgle down.

He then directed me to swallow again, and upon my explaining how the water felt going down, he continued to slowly withdraw a bit more fill. After several rounds of this, I was able to drink as rapidly as I cared to and finished the bottle. Burps also came easy at this point.

Thus I was pronounced properly restricted at one step removed from where I could still feel a sense of pressure under my breastbone when swallowing. We stopped where I had no unusual sensations of any sort connected with the swallowing of large gulps.

I went out and had a regular meal that evening. My "don't eat one more bite" full-enough signal is a diffuse tickling sensation over the entire rear pharynx. I am tight in the morning, needing a warm beverage to loosen me up enough for yogurt.

Now, at 4 days past, I am feeling a bit tight today, with my morning tightness not having dissipated very much today (tho it fully has on all previous days this week) but I was still able to eat and drink my fill. And I have had no problems getting down my many meds and supplements.

I had been simply starving for several weeks and was so wide open, I am relieved to have already reached the legendary "sweet spot". I am reminded that another patient of his who was banded in August was also given enough of a fill the very first time to reach her sweet spot. She later talked him into giving her a teeny tiny increase --- which she had to have fully removed (the increase, that is) a day later because she couldn't even swallow her spit.

So the moral of the story seems to be that asking for patient feedback in determining good restriction seems to have something going for it. Maybe when you only charge $50 a fill, there's not that much profit to be made from seeing your patient every month or two, again and again and again? My Mexican surgeon, with thousands of lap band installations under his belt, seems to simply be exceptionally skilled at quickly bringing a patient to the maximum freedom from hunger.

I love my band. I think I will name her Lola.

Awesome getting filled right is great. My surgeon is now having his pa do the fill and he has a theory that the needle dances/wiggles when you've hit your sweet spot. His fill did work well me me - now the problem is me and following the rules.

Wow! You are lucky. I can't get the fill thing right. I was okay for 4 weeks and then I couldn't eat at all. My doc took some out in his office and he took out too much. I had to get another fill under flouro and they were very conservitive. Only have 1.2cc's now and hardly any restriction. I have requested another fill and an going on January 12th to try a get just a bit more to get me to that elusive sweet spot. I've been at just about every number so I hope that maybe 1.5 will do it. That's what I am going to ask for anyway. I envy you!!:cheeky

My fill doc has me sit up and drink, too. Works great. He doesn't seem to be quite as careful and methodical as yours though. I can tell, however, that he also feels the needle (like Angie described) to see when to stop loosening the fill. It's a skill, that's for sure!

Well written Theresa.

Hi, Angie .... Just a 0.1cc or 0.2cc increase or decrease difference can be the difference between "I can't swallow anything but liquids" and "I have to eat Bandster Style & chew chew chew, but I'm NOT HUNGRY any more and I'm losing weight."

From my time on SmartBandsters support group at YahooGroups, I've discovered that many US doctors ARE very conservative. They start low and slow, they often don't want you to come back sooner than one month, and when there is need for an unfill, they tend to take out way too much --- or sometimes all of it.

Mexican docs, perhaps from having so much experience over the years, tend to use that "sit up and drink" style. As long as you don't lie to your doctor about what you're sensing, things seem to usually go well. They just don't want you to leave town for several hours.

I have also discovered that some people start tight and loosen up in a week, but others are like me and tighten up significantly about 4 days out. I'm still tighter in the morning, losest around supper, then tightening again late.

And Jessie Ahroni just told us all something I had never known before -- that a pre-dinner alcoholic drink will loosen your band!! :paranoid I learn something new every day still.

Anyway, why not take a bottle of room temp Water with you this next time, have your fill around 11am or 1pm, and suggest to him that the two of you try this?

I'm losing faster than I had expected to be, but I know with every pound lost, my caloric needs fall --- and that I will be losing slowly enough after I hit 180.