We are feeling very discouraged. We need to hear from those who have had fills and gotten to the effective point of restriction. How did you keep your spirits up while you were able to eat way too much and knew you needed another fill? Did you diet during that time? Did you know soon after your fill that you needed another one? Did your doctor ask you to wait 8 weeks between fills, like ours did?

Our scenarios : Surgery for both was 2/24/04. Sister has had two fills under Fluoro. She is at 2.2ccs. I have had one fill under fluoro. and am at 1.5 ccs. Even though doctor was watching the liquid speed through the stoma, he would not add more saline than he had added. He said we would be calling him that night because we would be throwing up even water. If the fills are done under fluoro, why can't the doctor get our stomas to the correct point of restriction? He swears he is being aggressive about the fills. All I can say is that neither of us feels the least bit restricted and have not yet started utilizing the band in our weight loss.

We tease each other that any weight loss thatwe have will be a result of the "placebo effect." We feel like we are living in "the twilight zone" when we tell our surgery center's director, the one who schedules the fills, that we need another fill. She is exasperated with us. She says, "Are you telling me that you can eat as much as you could before the surgery?" We tell her that is exactly what we mean. We are not trying to eat as much, but the only thing that seems to be stopping us is sensibility and willpower. She seems to think that any amount of band restriction should help with food restriction. We think that as long as the stoma is large enough for our food to slip through into the big old lower stomach, the band is not working to keep us feeling full with less food in the stomach, and what good is that?

Will those who have dealt more effectively with this stage of bandsterlife please step up and tell us how you handled it? Do we just wait and wait until we have enough saline in our bands to begin real weight loss? Do we diet as hard as we can for as long as we can and pretend the band is working for us? Do we pressure the surgery center for more fills until the doctor gets it right?

We knew the day after our fills that nothing was different. We knew that we would need another fill. We're wondering whether the doctor is prolonging the process so that he can collect many fees from from us. We're hoping that is not true, but at $250. per fill.... No, I'm sure he doesn't need the money. He just seems to think that a fill of any amount of saline at all should keep you restricted for a period of time.

So, we need to know: is it all or nothing with the stoma, or is any restriction better than no restriction? Maybe our anatomies are such that we will need the full 4ccs. Who knows? We just can't fathom having to wait 8 weeks and then another 8 weeks and then another to find out.

Please, successful bandsters, give us the benefit of your experience. We are feeling lost and perhaps regretful that we didn't choose the bypass. I know it's sacreligious to say that on a bandster website, but we are truly frustrated and upset. We're feeling like we're not going to be able to make it work.

Thank you, CandyB.

Candy -

I am so sorry that you and your sister are experiencing this.

NO - it is not supposed to be so hard. NO - the barium does NOT speed through the stoma with proper restriction.

Even though I will be the first one to tell you that you cannot compare fill amounts because each person is different, I am a little concerned that your sister, at 2.2ccs, feels NO different. Is that really true? She has never felt the golfball feeling from not chewing well enough? She can honestly eat just as much/just as fast as before, with NO feelings of discomfort?

It is hard for me to believe that at 2.2ccs NOTHING has changed. So, if that is indeed the case... I would hazard to guess that there really is NOT 2.2ccs in her band.

I cannot believe that Shelly's experience is not but a freak occurence, but... Is it possible that the saline is not making it out of the port and into the band?

Another possibility is that there is a kink in the tubing, and the saline is not passing the kink to fill the band.

Another possibility is that the tubing is leaking.

It is possible that both of you need extremely high fills, but I almost feel that would be less common than the other possibilities that I list.

All I can say is how my doc does a fill - it is under fluoroscope, and he puts in enough saline to completely close me off. I drink some barium, and I can feel that it just sits there, and I cannot take even one more sip, and the doc can see that the stoma is full, and no barium is going through. Then he backs the fill off to let the barium go through to a point that he believes is slow enough to work, but not so slow that I cannot eat or drink anything.

My doc has lots of experience, and all docs have their own way, but I get a video tape of the procedure, and I can physically see how it all works.

If your doc is willing, ask him to close you off completely so that the both of you are 100% certain that the Fluid is actually making it into the band. Then have him back off so that the barium is going through at a reasonable pace - you should see a steady stream.

Believe me, if you get closed off completely, you will feel it - it feels as though an elephant is sitting on your chest and you can't breathe, even though you can breathe just fine.

Hang in there, girls. It really does work, honest. If your doc cannot give you fills that work, perhaps you can find someone who can?

I do understand your frustration and yes right after my first fill which was done under fluoroscopy I went to drink water and I knew right then I could have had a bigger fill.

Most doctors want to fill slowly so your body and brain can gradually accept change. I personally disagree, there are surgeons in Europe that put saline in the band during placement and you feel restriction at the get go.

I was self paid, went to Mexico to have my band placed and had to find my own fill doctor. After that first fill I decided to find another doctor. This new doctor listens to us (I've referred him to others in my area), I tell him how much I would like to have of-course with health in mind and he works for/with us.

Perhaps you could look for another doctor, maybe get a second opinion.

We're feeling like we're not going to be able to make it work.

The determination of whether the band will work for you, whether you'll be able to make it work, is not made in the first few weeks. Clearly there is a disconnect between what your doctor thinks you should be feeling and what you ARE feeling, so you and your sister should work on that. But that is NO reflection on whether/how you will use the band to attain your goals!

One thing that doesn't get said enough is that time is the X factor in banded life---time to get restricted, time to learn how to live with that restriction, time to learn other ways to handle cravings and emotional impulses, time to learn to stop criticizing ourselves and gain control and accept the slower pace of weight loss. All of these things will come, but problems arise when we don't allow proper TIME for them to happen.

To answer some of your questions specifically:

Do we just wait and wait until we have enough saline in our bands to begin real weight loss? Do we diet as hard as we can for as long as we can and pretend the band is working for us? Do we pressure the surgery center for more fills until the doctor gets it right?

Yes, no, YES. Dieting as hard as you can will only result in weight lost and a doctor who now thinks you don't need a fill. Usually, a lack of weight loss is one indication that a fill is in order, so don't go out of your way to try to lose weight if you're not adequately restricted. Waiting can be hard, sure, but how long have you waited to get banded? How many years did you assume the weight-loss battle was hopeless? You're closer now to having an effective tool in your arsenal than you've ever been before, so why despair and tear your hair out now? A few more weeks won't change the eventual outcome.

Inamed looks down on doctors who have a strict fill schedule. It is NOT the right way to determine whether a patient needs an adjustment. Of course, your doctor may just have a restrictive schedule on its own, like mine does: my surgeon's office only does fills once a month, so if you miss getting on the schedule one month it's at least a 4-week wait for the next time. Is that what's going on?

Personally, I think 8 weeks between fills is a perfectly decent time. Fills can surprise you, kicking in days or weeks later. And if this is your first experience with restriction you really don't want to be surprised by the way it feels. Much better to take it really slowly so you can avoid swallowing more than your pouch can handle (which is REALLY easy to do in the early days).

Hang in there, ladies!! Your day will come, and then you'll look back on this frustration and see it as a minor blip.

Candy,

Sounds like you need another fill doc. Since you had your bands in the US, (I am assuming) is it not possible to go somewhere else for your fills?. Sounds like your doc doesnt have a lot of experience with fills. The other thing you could try is to call Inamed the lapband manufacturer and see if they could place a call to your doc.'s office. Sounds like he is hording fills! Usually first fills dont take as well as second or third fills. I was at Texas Bandsters Bash and Dr. Rumbaut was explaining why first fills seem to evaporate and why they dont take as well as second or third fills. The rationale is that when the band is empty after surgery and a fill is performed, not all of the first fill goes to the band itself but may sit in the tubing . When you get a second fill, they remove the liquid and measure how much they pull out and then add an incremental amount like .25 CC. The new additional fill acts as a vacuum and pushes all the Fluid to its destination.So what I am saying is that they may have put 1.5 CC in your band, but when they remove it there is a chance that there is air being drawn out (which is good) and then they are putting it all back in. THere is also a chance that you will lose fluid by osmosis. When a fill is conducted they use a huber needle. Please understand how little a CC is. It is less or equal to a teaspoon, so when you get a fill of .25, we are talking about such a small quantity of fluid that even the slightest amount that doesnt reach the band and which may not be visible to the eye can change how much restriction you have. Fills are not rocket science, but an artform even with flouro. So what may look good under flouro can vastly change when you leave the docs office. Most people complain that their fills tighten up a bit a few days later. I would try to find someone more experienced to do your fills. Just a little of my history:

First fill six weeks post op: 1.00 CC - no restriction at all

Second fill was one week later because I complained: 1.75 CC (some restriction)

Could still eat 8-10 oz of food at a sitting

Third fill: 2;00 CC - Very good restriction for about 4 months

Could eat about 6oz of food

Fourth fill: 2.25 CC - Very very tight for about 2 months and then it loosened up some and I believe this is the sweet spot, but will probably loosen up a bit more in the oncoming months. I can eat about 5-6 oz of food, but earlier in the fill, could eat about 3-4 oz only.

Now I know this is different for everyone, but other than the first or second fill, I waited about 3 1/2 months between fills because I thought I had adequate restriction and I was losing steadily. But there were moments that I could eat a horse and days where 1/2 boiled egg was too troublesome and I drank Protein shakes. Even good restriction varies from day to day. HOwever, I was lucky. My doc listened to what I had to say about restriction rather than let any kind of schedule dictate my success.

Yoiu have to be your own advocate. Keep calling and track what you are eating in a diary and take it to your doc. If you are eating healthy food, protein and veggies and are able to eat 3 cups of this, then you truly do not have restriction. If you are able to eat one cup of healthy protein and a veggie and start getting full, then you probably have some restriction.The band even when you are very restricted wont keep you from downing milkshakes or eating mash potatoes, french fries etc. Even I can eat those and would not lose weight. For many months, I ate a cup or more of solid Proteins and complained to my doc I was eating too much. He said, are you happy and losing weight? I said yes. I also wasnt hungry between meals when I was sticking to the program.

Good luck and I hope you find the solution you are looking for.

Babs in TX

334/219/180

-115

6/23/03

oops

Originally posted by bbrecruiter2000

Please understand how little a CC is. It is less or equal to a teaspoon,

There are 5cc's (5 mL) in a teaspoon.

So 1cc is one-fifth of a teaspoon. You can picture 0.1 cc as follows: take a teaspoon, pour of four-fifths (80%) of it. That's 1cc. Then pour out nine-tenths (90%) of what's left. That's 0.1cc.

I guess I like my posts so much I'm putting them all in here twice!

Hey Sue,

I stand corrected. Thank you for pointing that out!! I should know this since all of my kids meds are administered in CC's and based on my calculations I would be overdosing them!!! LOL. But it does support the case that the fills amounts are so small and done with the naked eye and there is room to error by as much as .25.

Babs in TX

334/219/180

-115

6/23/03

I understand your frustration, but think you may be SO frustrated that it's impacting your assessment of what's going on. I had all my saline removed yesterday, in anticipation of plastic surgery. I absolutely have less restriction that I did yesterday morning. But I am still restricted compared to pre-band. Can I eat a lot more solid food than I need to keep my body healthy? Sure. Can I eat what I did in September 2002? No way.

Now, WHAT ARE YOU EATING? Give us a peek at what a day's worth of food for each of you is.

Also, call Don Mills at Inamed and tell them that your doctor is one of those every-eight weeks guys and ask that his rep goes over scheduled fills with him. Inamed is all about surgeon education, because they need their product to succeed.

Sue

Babs--Yup...teensy, weensy.

1: Obes Surg. 2004 Mar;14(3):387-91. Related Articles, Links

_

Adjustable gastric banding: assessment of safety and efficacy of bolus-filling during follow-up.

Kirchmayr W, Klaus A, Muhlmann G, Mittermair R, Bonatti H, Aigner F, Weiss H.

Department of General and Transplant Surgery, University Hospital, Anichstrasse 35, A-6020 Innsbruck, Austria.

BACKGROUND: Individual band-filling on demand of the morbidly obese patient is a major advantage of adjustable gastric banding. An increasing number of patients results in an enormous amount of outpatient follow-up visits, which inspired us to compare a stepwise band-filling strategy with a single bolus injection 4 weeks after the operative procedure.

METHODS: 40 consecutive patients were prospectively randomized in 2 groups. 20 patients (Group A) had stepwise band-filling during 6 monthly ambulant visits. 20 patients (Group had a bolus-filling 4 weeks postoperatively and had the next follow-up after another 5 months. Weight loss, complications and procedural costs during follow-up were compared.

RESULTS: Patients of both groups did not differ in age, gender or preoperative BMI.There was no significant difference postoperatively in excess weight lost (EWL) after 9 months. Postoperative complications did not differ significantly.By means of bolus-filling, a 60% and 53% reduction in outpatient clinical work was achieved within the 6 and 9 months, respectively.

CONCLUSION: Postoperative management after gastric banding takes advantage of a single bolus-filling during the first postoperative 6 months due to sufficient weight loss, low complication rate but significant reduction of personal, financial and logistic efforts.

PMID: 15072661 [PubMed]

Sue,

You are totally a trip!!! Good luck with the upcoming plastic surgery.

P.S. Better yet, in addition to the above data, doc should get all of the responses from this thread minus names!!!

Babs in TX

Candy,

I so totally relate to what you and your sister are experiencing--it is a nearly identical story to my own. My doctor has a really protracted fill schedule---something I totally disagree with and have found to be completely infantalizing and maddening. I understand the reasoning that some unprepared bandsters might need to be gradually increased, fill-wise, so that they don't panic at the first signs of restriction. That said, the rest of us who are prepared to handle -- indeed, impatient to experience -- substantive restriction are left to founder in our own frustration and doubt and despair while we are forced to wait and wait and wait.

I just this Friday had my second fill, and I actually--praise God!--feel a difference. I know I need to be a bit tighter even than I currently am, but the relief I feel just knowing that the band *can* work is absolutely overwhelming. I was filled with 2 cc on my first fill, and 2.6 on my second, and I am *just* feeling the difference--so I think we prove what everyone on this good board says---everyone needs a different fill, and noone can really know what that will be in advance.

I was banded on 2/3/04 and have lost virtually no weight so far--maybe 8 or 10 pounds. I have been miserably careful, eating 1200-1500 calories per day, 80 oz Water, high Protein, low fat, almost no carb, etc. Until this fill on Friday, I have felt every miserable passing minute as a huge DIET, nothing more, and a failed one at that! All I could think of was how I'd murdered my metabolism so completely that I actually wouldn't be able to lose weight---like, physically wouldn't be able, and that I should have opted for a malabsorbtive (like the Bypass or the DS) procedure after all. But even in these last days (I am afraid to even type this, lest I jinx it), the terrible hunger is gone. I don't feel the panic between meals. I don't even have that much desire to snack--so far, anyway. The emotional eating is a different story--it will take more than the band to get it in check, and I am in a therapeutic post-op group to try to deal with the underlying causes for the emotional eating habits.

Even a week ago I would have said that my band was a failure. I was so so afraid that, despite what EVERYONE said, all the smart things about fills and patience, etc., that mine was just a disaster. I never wanted a Bypass, went through a lengthy process to change insurance companies in ordser to even qualify for the band instead, but I felt like I was going to be damned into getting one after all. And now, suddenly, I have some hope. I'd still like to see the numbers start to budge on the scale, but I feel undeniably different. So do whatever you can not to give up hope. Just keep bugging those bastards for your fill!!!

Chin up,

Sheila

I think Donali (as usual) hit the nail on the head. Your lack of restriction could be due to many things. My personal experience was that after I had my first fill I had restriction, but it gradually went away. Went back to the doc and he found that he was only able to withdraw part of what he had put in. The rest had leaked somehow. We tried again, but the same thing happened. The third time the problem was solved by using a thicker Fluid, not saline. I had great restriction. Perhaps ask your doctor to withdraw what you have in there to see if it is the same amount he put in?

It is, of course, crucial that you have a doctor who will listen to you and anwer your concerns with respect even if he disagrees about what course of action to take.

Please be patient. I know that's hard. But your band really will work for you - eventually. In the meantime, we're here for you.

Nancy

I want to thank all who posted replies to my plea for support. I have never felt so well-supported as I do in this forum. I have been thinking about all of your answers and questions. You have given me a lot to think about. Most of all, you have given me a realistic sense of hope that my band will work. It is essential to talk with people who have made it work.

Progress report: my sister and I are going in for another fill this Thursday. We will make our best attempts to get the doctor to do the fills effectively. I will definitely be telling him some of the information you shared with me.

Another very good thing: at our next support group meeting, we will be able to talk with a two-year bandster. Our surgery center's director has been responding to our requests for band-related meetings.

I'll let you know how the next fill feels. I'm hopeful! Thank you, Candy

Sis and I had our fills yesterday morning (Next fill we're insisting on afternoon appts). The doc was able to pull out 1.5ccs, my whole first fill, same for sis - no leakage (whew)!

I think he is trying to work with us. He put 2.5 in, and I was completely blocked. Pulled out .3, still blocked. Pulled out .2, and he thinks it's good restriction (second fill for me). So, I'm at 2.0. Sis is now at 2.75 (third fill for her).

Another good thing - our surgery center's director assisted the surgeon with our fills - HE'S TEACHING HER HOW TO DO THE FILLS! I do feel that the center has begun to respond to the needs of the banded patients. When we had our surgery in February, our center had just been set up. Before that, our surgeon's colo-rectal surgery practice was handling everybody. So, I think things are getting better.

Also, I asked him to numb me this time, and I'm glad I did. I felt squeamish during the first fill. I didn't like the feeling of the needle being moved around while he was finding the right spot to get the saline in. It was much better for me to have the numbing shot, especially since he had to stick me three times to add and pull out saline. This part doesn't bother my sister at all, perhaps because she was a nurse. But I highly recommend numbing before a fill. (Just as I highly recommend an epidural during labor and delivery)!!

Another piece of follow-up: It was so satisfying to have our support group meeting last evening, a helpful ending to a fill-day. Our center's director, again responding to our urging, FINALLY split us into two rooms, bypassers and bandsters. She arranged for two INAMED reps to be there and a 13-month bandster for us to barrage with questions. It was a very, very helpful meeting. We finally felt safe and comfortable in asking our nitty-gritty questions - all of the band intricacies that the bypassers don't deal with. We truly were wasting each other's time when the meetings were not separated. Our director had us fill out a questionnaire about the split, and I think she really gets it now: WE WANT OUR OWN MEETING! The INAMED people were adamant about our insisting on it.

I think the most important reason for the bypassers and the bandsters to have separate meetings (and this came to me last night) is that, although we all chose WLS, and I love every one of the people in the group who have made this courageous choice, we chose different paths, and the individuals in each group need to feel that we made the right choice for ourselves.We need to feel good about choosing the band. They need to feel good about choosing the bypass. We need to be allowed to "band together". We need to feel free to talk about why we chose the band and not the bypass and vice versa. We need to be able to discuss the difficulties of each process, the downsides of each process without feeling like we're hurting the other guys feelings, or even expressing doubts about our own choices. The bypassers need to be able to rejoice in their amazingly fast weight loss. The bandsters need to be able to rejoice in the ways we feel our surgery was a better choice for us. I know we're all adults and can handle these differences, but it is a very primitive need to feel that your own group is best - it is called ethnocentrism. ( I admit it - I was an anthropology major, and I love the fact that I actually remember terms like this one)!

Back to the meeting:The INAMED reps were interested in what we had to say and could respond to our questions, comments, and frustrations, but they are not banded. They didn't seem to understand the "psyche" of an obese person who has chosen WLS. I guess that's what we all really need - the support of people who understand us on a deep level. Having a successful bandster there completed the support we needed. The INAMED reps could tell us how hard they are working to get our center up to speed for the bandsters. The bandster told us her trials and successes in the last 13 months. She looks fabulous, by the way. Her name is Colleen. She is tall and thin, has lost 105 lbs, and is maintaining at 150 lbs. She is not much of an exerciser, she admitted, but she tries to get some exercise - she likes to ride her bike - although she is trying to get more consistent about her exercise.

So, yesterday was a good day. Now, today, we will find out if we really have restriction. Since yesterday was a liquid diet day, we can't yet tell how each of us will feel . We're hopeful, and, at least, if we decide in a few weeks that we need more restriction, we know that we can get a fill within in a week or two of when we decide we need one. Feeling much better than I was a few weeks ago.

Thanks for reading this looooong post.

Candy