A Semi-Vicious Cycle (or) Let?s Hear It for Fluoro!

Alexandra · November 4, 2004

Remember my post about restriction being a mind game? Well, I think I’ve got it figured out. Bear with me and I hope I can explain this.

Back in late September I started feeling a little less restriction, so I made an appointment for a fill. Because of my doctors’ schedule, that appointment was about 6 weeks away. So what happens? Restriction immediately returns. At least, that’s what it felt like.

Then over the next few weeks I became aware of not only increased restriction, but some stranger symptoms I’ve never had before: a little extra gurgling, a sensation of food hanging up in my pouch only to go through all at once later on, and one episode of nighttime waking due to Fluid in my throat. I’m starting to worry, a little, but these are not major problems so I forge ahead.

So even though I doubt very much a fill is in order, I kept my appointment because I wanted to get a look at the situation through fluoro. I know that if there is anything wrong, catching it early is key to an easy resolution. Here’s what we discovered:

My band is fine, everything is in good position, but the barium hung up a little in the pouch before going through. The doctor explains that this could be the beginning of a slippage, where the stomach creeps up a little through the band, enlarging the pouch and creating problems. I’m not there, yet, but the pouch looks a little larger than he’d like and he’s a little concerned about the way some of the barium didn’t flow through readily. So he takes out .7 cc of saline to increase the size of the stoma, and I’m to see him in a month to see where we’re at.

Looking back, I think it wasn’t the restriction that changed, it was my behavior. Making that appointment sent my subconscious a signal that I can relax, eat “normally” (meaning faster), and not worry because in a few weeks my restriction will be back. So I start overdoing it slightly, without even being aware that I am, which makes my restriction FELT. It hadn’t gone anywhere—I was just less conscious of it because my habits were such that it didn’t need to.

I’m convinced I did this to myself by eating too fast, and therefore eating too much before I realize it. BAD BAD BAD BAD BAD!!! I’m so, so thankful that I have ready access to a doctor who uses fluoro to see the band every time. My symptoms could easily have been ignored because they weren’t causing any pain or major discomfort, until such time that another surgery would be required. As it is, a minor unfill is all that's indicated, and I'm confident that what's left in my band will keep me on the straight and narrow.

My focus now is not so much on losing weight, it’s about taking care of myself and my band for the long term. This episode points up the habits that I STILL have, and that only I can control over time. Somehow I feel like the hard work is still ahead.

Bright · November 4, 2004

God Alex - what does that mean for you? Can the slight slippage be corrected by the little unfill? That is worrying... I completely agree with you - I have been dreadful for sticking to the "no liquids with meals" rule - I actually became aware today that if I don't have a glass of Water or mug of coffee with my meal, then I can't eat ENOUGH! Aaaarrgghh! No wonder I am plateauing... I guess you mean that we should eat the bandster recommended portion and then stop eating - revolutionary! Why didn't some one tell us this before!!!! I definitely eat too fast - god knows what minor damage I'm doing too - well done Alex for being so vigilant - guess you can never be too careful - monitoring is so important

shellyj · November 4, 2004

the last time i had a fill under flouro the dr said

see the barium sitting in your pouch for a second or two before it goes down...thats restriction...go slow.

i am confused.

leatha_g · November 4, 2004

Sorry to hear this news, Alex. But, I'm glad your doc seems to be on the ball enough to try to prevent any problems. There seems to be some confusion about what they are to be looking for and what they are actually seeing on flouro sometimes. I wished there were some 'cut and dry' rules. I thought I'd repost this post from 'Slipped Bands' on Yahoo Groups. It made a lot of sense to me. I sometimes really think my rebanding might have been unnecessary. Take what you can use and leave the rest.

This is not about ME or Anyone I know. I am reposting from another group board.

*************************************************************

Just wanted to give everyone a quick update on my daughter's band

that we thought had slipped. It's been a while since we've posted,

sorry. Basically, we had just been doing our fills at a

radiologist's office, and he was the one that said the band had

slipped and we should get it taken out (quite a drastic response,

eh?)

Anyway, we decided to take a trip to Mexico to see our surgeon,

assuming she'd need an operation. In the meantime we took out all the

fill and she gained 20-30 pounds. When we got to Mexico, the surgeon

checked her band--xraying while she was standing up. Basically,

there was no slippage, the band had been filled too tight. He says

slippage symptoms are very severe, that what can be diagnosed as a

slipped band can just be a too tight fill. When a band is slipped,

he said the stomach basically bends over on itself and it is

difficult for someone to even swallow their spit--those kind of

symptoms. He thinks a lot of American doctors are looking at the

xxrays of the stomach expand like it is meant to (above the band),

clicking the xray, and assuming the band is has slipped down. SO,

we spent a lot of money to find out that the band was working

properly. SO, I'd be cautious when your doctor says it's

slipped...I'd have them xray it when I was standing up and remember

that the stomach is supposed to expand some above the band, but it

doesn't always mean a slip.

He said that the American doctors who haven't had as much surgical

training on the band often pull away alot of tissue or muscles or

whatever surrounds the stomach leaving quite a bit of room for the

band to move around, but some of the Mexican surgeons use a technique

where they just pull away enough tissue to thread the band around the

stomach in the right position. The remaining tissue that has not

been loosened up makes a channel for the band that makes it very

difficult for the band to move anywhere. He said has never had a

truly slipped band because of this technique.

Our surgeon also said that because our doctor was using only contrast

Fluid to fill the band, it somehow gets thicker and slowly causes

more and more constriction on the band. He says they (mexican

surgeons) have learned that they should use only half contrast and

half saline solution. He also mentioned that the saline slowly and

gradually evaporates or somehow is absorbed into the body and that is

another reason why people with only saline may need another fill from

time to time.

We all know the band is fickle--sometimes seeming tighter than at

other times. He said that people make a mistake by not switching

back to fluids and letting their stomach heal after vomitting or

PBing. There is swelling that occurs from this trama and that to

continue eating as normal only compounds the swelling. If a person

keeps vomitting that leads to more swelling, etc. and sometimes a

slipped band is diagnosed when it really hasn't slipped.

Sorry this is so long, but I thought it was good information and made

a lot of sense to us. He added Fluid back to her band and she has

been doing great. I'm proud of her because I know this has not been

an easy go. It is hard to retrain yourself to eat correctly and chew

right and keep away from sticky foods. She has never been sorry she

got the band, though.

Alexandra · November 4, 2004

It's absolutely true that different doctors see the same things different ways. My doctor didn't say I actually had a slippage, but that what he was seeing might set up a situation that could lead to a slip. There was some barium that stayed in my pouch when it should have been going through; my pouch has enlarged a tiny bit so there is an area created where stuff can collect. It's this that he wants to nip in the bud, because it could get worse.

Shelly, I think your doc is exactly right, as long as the pouch empties in pretty short order (which obviously happens faster with liquids). My pouch wasn't emptying the way he wanted it to. Leatha, that story actually reassures me that my doc is on the right track.

Bright, I'm not worried about my weight because I see no reason to change the *amount* I've been eating (unless I get hungry, which remains to be seen). What I have to change is the WAY I've been eating, and that is so, so hard to do. I'm going to concentrate on putting my utensils DOWN between bites, and staying away from things that tempt me to munch.

DeLarla · November 4, 2004

You use utensils? I need to work on that. Alex, thanks for sharing - I couldn't even finish reading your post, but grabbed the phone and dialed my doctor frantically since I'm still waiting for my Upper GI results from 2 weeks ago. I'll start a new thread now that I have preliminary results. I hope this problem is something the unfill can resolve. This is an excellent reminder to all of us that we (I, ME, NOW) need to eat slow every single time. I've come a long way, but it's a daily battle. Last night I got "golf ball in throat" but waited for it to subside and kept eating. No, no, no. The band is working, yet a lot of us fight it. You have an excellent band-itude.

Vera · November 4, 2004

This is very Interesting Alexandra, I hope the best for you…I also have to change the way I’m eating. I need a new band-itude…. I eat way to fast.

Leatha, Thanks for forwarding this post, It couldn’t have came at a better time. I’m scheduled for a fluoroscopy on the 11th and was discussing weather we were checking for leaks or just going for a fill. During my last 2 fills, done blind. My doc couldn’t get any saline out from previous fills. So what this Mexican doctor is saying about saline dissipating is very interesting yet as I have read, Inamed only recommends saline (even thou I have a Swedish band) and this is the first time I’ve heard of this contrast solution used for a fill not just for checking for leaks??

paula · November 4, 2004

This is wonderful information, from both of you (Alex and Leatha). It definately puts MY mind a little more at ease...

Thank you thank you!

shellyj · November 4, 2004

thanks leatha for that very intersting post.

i am actually going for an upper gi on next week because i think i am to tight. i have been on liquids since monday. i cant afford to wait for something to wrong because if i go to the er my ins wont pay. i am getting the upper gi to 'diagnos' reflux but i am taking the x-ray films to my band dr. as soon as they will give them to me.

alexandra- please keep us updated. i know you will.

blossom · November 4, 2004

Wow, Alex! It's a good thing you kept that appointment. I hope the unfill puts everything back in place. Good Luck!

Great info, Leatha!

jenniferh · November 4, 2004

I think Alex has a big point with the mind thing. I can't understand why some days there is more restriction than others. Today I felt like I could really pack it in there, but then there are nights at the dinner table when I am lucky if I can get a couple of tablespoons in. I just had my first fill on 10/28/04. Exactly how much food is the pouch supposed to hold at a time? I am feeling a little discouraged because my weight has not budged since last week.

leatha_g · November 4, 2004

During my last 2 fills, done blind. My doc couldn’t get any saline out from previous fills. So what this Mexican doctor is saying about saline dissipating is very interesting yet as I have read, Inamed only recommends saline (even thou I have a Swedish band) and this is the first time I’ve heard of this contrast solution used for a fill not just for checking for leaks??

I've heard it said on some other groups that some have better luck with the Fluid not disipating by using a percentage of contrast solution and a percentage of saline with the swedish band. Some folks bring it home with them from France, Belgium, etc.

Alexandra · November 4, 2004

Jennifer, the general consensus seems to be that the pouch capacity is somewhere about the size of a child's fist. But it's not a concrete thing; depending on the consistency of what you're putting in, some food may be passed through the stoma before you're done eating, making the "capacity" seem larger. So depending on your restriction, it may be possible to eat considerably more than that small amount.

If you just had your first fill on the 28th, it's not at all impossible that you're not even really feeling it yet. Give it a couple of more weeks, but be cautious in the meantime. Getting surprised by new restriction is not pleasant. Your weight will start to move downward, I promise! (BTW, have you come to any support group meetings? Have we met? Forgive me if I should know you!)

As far as eating fast and taking big bites--I'm sure you'll all agree with this: If we take a big bite of something it seems like a lot less food than if we nibble it to death. This is a big challenge, because there's something so viscerally pleasing about taking a big bite! (Understatement of the year, I know.) One or two big bites of something is probably all we really need in terms of quantity, but in no way does it seem like enough food to our mouths. For me at least, thanks to my band, it's often really is enough food for my stomach.

So now somehow I have to make the two parts communicate and share the love. MUST. LEARN. TO. NIBBLE.

Alexandra · November 4, 2004

Jennifer, the general consensus seems to be that the pouch capacity is somewhere about the size of a child's fist. But it's not a concrete thing; depending on the consistency of what you're putting in, some food may be passed through the stoma before you're done eating, making the "capacity" seem larger. So depending on your restriction, it may be possible to eat considerably more than that small amount.

If you just had your first fill on the 28th, it's not at all impossible that you're not even really feeling it yet. Give it a couple of more weeks, but be cautious in the meantime. Getting surprised by new restriction is not pleasant. Your weight will start to move downward, I promise! (BTW, have you come to any support group meetings? Have we met? Forgive me if I should know you!)

As far as eating fast and taking big bites--I'm sure you'll all agree with this: If we take a big bite of something it seems like a lot less food than if we nibble it to death. This is a big challenge, because there's something so viscerally pleasing about taking a big bite! (Understatement of the year, I know.) One or two big bites of something is probably all we really need in terms of quantity, but in no way does it seem like enough food to our mouths. For me at least, thanks to my band, it's often really is enough food for my stomach.

So now somehow I have to make the two parts communicate and share the love. MUST. LEARN. TO. NIBBLE.

DeLarla · November 4, 2004

Alex, I posted about my Upper GI results. Penni responded that the "relatively mild limitation of gastric distension at EG junction" probably means that I've stretched a little from eating too much. Other than that my Upper GI was normal, so I really need to eat tiny. It's very freaky thinking I have to eat less than I already do because my mouth and head want more, more, more. I used more self-control at lunch today, but dinner is the hard part. Hey, maybe we're just drinking too much water! A girl's gotta dream.