Here is info will come in handy when thinking about fills/adjustments. Great information. I have seen this information before and it is really good.

How to Tell When You Are Perfectly Adjusted

You are losing 1-2 pounds per week.

If you are not losing 1-2 pounds per week:

A. You may need an eating adjustment

1. Are you eating 60 grams of Protein a day

2. Are you eating 25 grams of Fiber

3. Are you avoiding all liquid calories

a. Soup can be sign of “soft calorie syndrome”

b. Alcohol contains a lot of calories – 7 calories per gram

(1) It’s also a stomach irritant

c. fruit juice is just sugar Water

4. Are you making healthy food choices from a wide variety of

foods?

a. Are you avoiding soft foods

b. You can’t just eat what’s easy

c. cheese is glorified fat

5. Are you drinking 6-8 glasses of water a day between meals

6. Are you eating too much junk

a. chips, chocolate, nuts, ice cream, Cookies and other highly

processed junk foods are too calorically dense to be regular parts of a

healthy diet. But don’t avoid them completely to the point where you

feel deprived.

b. Stay out of fast food places

7. Are you getting in two servings of Calcium daily

8. Do you always eat the protein first

9. Then the vegetables or fruits

a. Five servings a day

b. Potatoes are NOT a vegetable

10. Is your portion size appropriate?

a. meat or fish

(1) 3 ounces – the size of a deck of cards

b. Vegetables

(1) ½ cup – the size of your fist

c. Starch

(1) If you eat the protein and the vegetables first you don’t need

much

(2) Avoid: rice, potatoes, Pasta

11. You might try avoiding artificial sweeteners

a. Some people think that artificial sweeteners stimulate the

appetite

b. They are HUNDREDS of times sweeter than sugar

c. They teach you to like things too sweet

d. There is no evidence that people who use them are any thinner

than people who don’t

12. Avoid most diet foods

a. Real food usually tastes better

b. Real food is more satisfying than low calorie substitutes

c. When you are only eating a tiny bit the caloric savings is not

that great

(1) Use a teaspoon of real butter instead of a tablespoon of diet

margarine

(2) The body has no way to break down artificial fats

a. They may go into permanent storage

b. Some people think liposuction is the only way to remove

hydrolyzed fats from the body

B. You may need a behavior adjustment

1. Are you eating only when you are hungry?

a. If you’re not sure drink 8 ounces of water and wait.

2. Are you eating three meals a day?

a. With maybe 1 or 2 small Snacks

3. Are you sitting down to eat?

4. Are you eating consciously?

a. No distractions, turn off the TV, put the book or newspaper

away, pay attention to your food and your companions

5. Are you eating slowly?

a. Put the fork down between bites

b. Take 20 to 30 minutes to finish a meal

c. Taking longer might cause the pouch to begin emptying

6. Are you taking small bites?

a. Tiny spoon, chopsticks, cocktail fork

7. Are you chewing well?

8. Are you drinking with your meals or too soon after your meals?

a. Practice water loading between meals

b. You won’t be thirsty if you are well hydrated before the meal

9. Are you stopping at the first sign of fullness?

a. Sometimes it’s a whisper: not hungry, had enough

b. Hard stop versus soft stop

10. Do not eat between meals. Stop grazing.

11. Do not eat when you are not hungry

C. You may need an activity adjustment

1. Are you getting in 30 minutes of physical activity at least 3

times a week?

a. Over and above what you would do in the usual course of your day

b. Could you make it 4 or 5 times a week?

c. Could you make it 45 or 60 minutes?

2. Are you taking advantage of opportunities to increase your

physical activity?

a. Taking the stairs instead of the elevators or escalators

b. Walking on the escalators instead of riding

c. Parking your car further away from the entrance

d. Getting out of the car instead of using the drive through

e. Getting off the bus one stop before your destination

f. Washing you car by hand instead of the car wash

g. Playing with your kids

D. You may need an attitude adjustment

1. Are you committed to your weight loss journey?

2. Are you totally honest with yourself about how much you are

eating and exercising?

a. Log your food and activity on ww.fitday.com for 3 days

3. Are you using food inappropriately to deal with emotional

issues?

a. Have you identified what the emotions are that drive your

eating?

b. Can you think of more appropriate ways to deal with those

emotions?

c. Are you willing to seek help from a qualified counselor?

4. Are you attending and participating in support group meetings?

5. Have you drummed up some support from your family and friends?

6. Have you dealt with saboteurs realistically?

7. Do you have realistic expectations about the weight loss

journey?

8. Are you still obsessing about food, weight, dieting, eating?

a. Obsessive – compulsive thoughts

(1) Obsess about something else

b. Perfectionism

(1) All or none, black and white thinking

c. Patience with the pace of healthy weight loss

9. Are you acknowledging your successes with non-food rewards?

10. Have you learned how to take a compliment?

11. Are you giving up diet mentality?

a. Stop weighing yourself several times a day or every day

b. Stop dieting

c. Stop depriving yourself

d. Stop defining food as “good” and “bad”

e. Stop rewarding and punishing yourself with food

12. How do you feel about all the changes taking place?

E. You may need a band adjustment

1. You feel like you are making healthy food choices in appropriate

portion sizes but getting hungry between meals?

2. You can still eat white bread, fibrous vegetables and large

portions.

3. You are having to struggle to lose

4. You are gaining weight in spite of eating right, exercising and

having a good mind set.

F. You may need your band loosened

1. There are times when you can’t get fluids down

2. You are vomiting too much

a. How much is too much?

3. Do you have frequent reflux or heartburn at night?

a. Do not lie flat or bend over soon after eating

b. Do not eat late at night or just before bedtime

c. Rinse your pouch with a glass or water an hour before bedtime

d. Certain foods or drinks are more likely to cause reflux:

(1) Rich, spicy, fatty and fried foods

(2) Chocolate

(3) Caffeine

(4) Alcohol

(5) Some fruits and vegetables

a. Oranges, lemons, tomatoes, peppers

(6) Peppermint

a. Baking soda toothpaste

(7) Carbonated drinks

e. Eat slowly and do not eat big meals

f. If you smoke, quit smoking

g. Reduce stress

h. Exercise promotes digestion

i. Raise the head of your bed

j. Wear loose fitting clothing around your waist

k. Stress increases reflux

l. Take estrogen containing medications in the morning

m. Avoid aspirin, Aleve and ibuprofen at bedtime

(1) Tylenol is OK

n. Take an antacid (Pepcid complete) before retiring

o. Try other over-the-counter heartburn medications

p. See your health care provider

4. See your health care provider immediately (or call 911) if

a. You have a squeezing, tightness or heaviness in your chest,

especially if the discomfort spreads to your shoulder, arm or jaw or is

accompanied by shortness of breath, sweating, irregular or fast

heartbeat or nausea. These could be symptoms of a heart attack.

b. If your symptoms are triggered by exercise.

c. If your pain localizes to your right side, especially if you

also have nausea or fever

d. If you throw up vomit that looks like black sand or coffee

grounds. Or if your stool is black, deep red or looks like it has tar

in it. These are symptoms of bleeding and need immediate attention.

(Note: Pepto-Bismol or other medications with bismuth will turn your

stool black. Iron supplements can also make the stool tarry.)

e. If your pain is severe

To me, a good fill is when you can eat (chew chew chew) and not feel like it is going to come back up. It sounds like you might be a little tight with this fill.

I had my second fill on 4/26/08 and am at 2.7 in a 10 cc band. At first I didn't think it was tight enough....but....yesterday I had my first PBing episode. So I guess it is tight enough!!!! Today, I am eating a lot slower and a lot less!!! Yea!!!!

I got my band 3/11/08 from Dr. Michael Wood From ABMI at detroit medical center. I was going to get my first fill today 6 weeks post op and my Dr called and told me he has a new policy and will only be doing fills once a month and so don't come in till may 31. I will be 10 weeks post op this dosn't sound right. I've lost 38 pounds since I was banded but I'm getting hungry and eating more. I called my Dr. and he told me to have will power:cursing::party::cursing:. My surgury was $27000.00 since he got paid I feel he is blowing me off what should I do. I don't want to take a step backward

Hi Medge,

I can understand how frustrated you are. Do you live in Michigan? I live in Grand Rapids but I had my surgery done in Mex. It sounds like your Dr. is not going to budge so be kind to yourself. Even if you gain a pound or two, this is something we are doing for a lifetime, all is well. When I went to Mex I met a lady who had her surgery in November and didn't get her first fill till April and she had lost 40 pounds. The end of the month will be here before you know it :-)

Sally

My doctor follows the recommend guidelines from the manufacturer which is 6 weeks between fills. He will adjust the schedule based on individual needs of the patient. My fills have been every 6 weeks apart so far. My doctor did say this time after my fill, that if I needed to return early to just call the office. He did ask that I give this new fill 2-3 weeks to work. So if I need another fill, I will be going back early. Otherwise, my next fill will be in 6 weeks, which is June 12th.

The following is information provided by my surgeon during my pre-op class concerning adjustments:

The adjust-ability of the Lap-Band is one of the great advantages of the Lap-Band over the gastric bypass or duodenal switch. The Vertical Band Gastroplasty or VBG, is a restrictive operation but is not adjustable. After a period of 6 weeks following Lap-Band placement, a patient may require an adjustment known as a "fill"

Three main factors are used to determine whether or not to add Fluid to the Lap-Band: 1. weight loss, 2. level of hunger, 3. degree of restriction.

If the patient is not losing adequate weight (less than 1-2 lbs. per week), is ravenous, and seems to be able to eat more with meals, then it is time to do a fill.

Most adjustments can be done in the office in less than 15 minutes. Fluoroscope or X-ray is only necessary if the adjustment port cannot be accessed in the office. My doctor uses the Fluoroscope over at X-ray for each fill, which makes a fill take less than 2 minutes. It takes longer to get on the table and the prep than the actual fill. It is so cool to watch your fill on the Fluoroscope. The 1st adjustment is done no sooner than 6 weeks post-operatively and is a 1cc volume fill. My 1st fill was a standard amount of 2cc. Subsequent adjustments are done at 4-6 week intervals based on the aforementioned criteria. The second and third fills may measure 0.5 cc to 3-4cc. My second fill was 2cc. I now have 4cc in my 14cc band.

It is important to look out for negative symptoms after an adjustment. Symptoms of chest pain after eating and drinking, nausea, vomiting, and reflux can mean the Lap-Band is overly tight. More subtle signs can be night time coughing and choking, and inability to eat a range of foods. It is important that patients remember that weight loss is to be gentle and gradual. Patients must resist the temptation to be too tight too fast. This can lead to dysfunctional eating habits, in which the patients convert their diet to liquids calories. If obstructive symptoms are present, then fluid should be removed from the band.

I just thought I would share this information with you. Each doctor is different in how he/she proceeds with your fill schedule and the amount of fill. Just remember to work with your doctor, you are a team working together to help you meet your goal!

I am so glad that I found this site. I learned so much from everyone. I just had my 5th fill Monday and feel pretty restricted. Food gets stuck, I get chest pain and have reflux or regurgitation. I will give it 2-3 weeks to see if the band loosens up and then see my doctor for an unfil if needed. I'd rather be able to eat food than protein drinks which I did today to get protein in. But I will heed what everyone says about fututre problems. Thanks to much and good luck to everyone here having lapband issues.

Good Morning To all. I just want to share with everyone something I just learned. I like hot and spicy foods. Last month for several weeks I couldn't get enough of hot and spicy foods. This went on for several weeks. Until it took it's toll on me. As the weeks went on my PBing kept getting worse and worse, giving me the impression that my band was to tight/restriction to tight.

When I read on this site or another site about inflammed/ senstitive/ irritated stomach/stoma interferring with digestion and eatng of my food. With each meal there was more pain and pbing than before. Which sometimes I couldn't finish my meal till 30min to 1 hour later. It got to the point that I was afraid to eat. So I decided to let up on eating too often and taking to dring Protein drinks and broth or Soup. In doing this I cut back on the spicy foods.

I began taking the Papaya Enzyme pills and drinking warm liquids prior to my morning meal and sometimes lunch. Along with eating something to help with digestion. After a week or more of not eating spicy foods, the irratition stop and my stomach/stoma began to heal itself. When I did get back to regular eating the problem stopped and I am now able to eat my meals without too much problems.

Say that to say this, if you eat hot spicy foods beware of what happens the next day or several days after. You may not have tight restriction, but may have irritated your digestive system, stomach or stoma. Remember the stoma only holds but so much food before it passes the band into the stomach. Which of course has to pass the esphogus first.

Hope this bit of info has helped someone. This Site is great for learning things.

anyone know someone in Tucson-Phoenix AZ area I can get fills from. I was banded in TJ

Go to fillcentersusa.com and it will help centers close to your home. I had my surgery in Mexico and I get my fills in Las Vegas, Nevada.

did anyone answer you on this question? I want to know the same thing.

OK, anyone know of a place in Reno or Carson City Nevada for fills. I am moving there and I was banded originally in TJ. fillcentersusa.com was expensive and last choice

please let me know if you get an answer. I've checked out fill centers too. I'm in austin Texas.

I was initially banded 3/20/08. My surgeon had me wait the full 6 weeks before the first fill. My surgeon also waits 4 weeks between fills, but I had my 1st fill, wasn't restricted enough, and went again after 2 weeks, and now I feel VERY filled. I get my fill at Beaumont Hospital(Royal Oak) and the surgeon will give a fill when it is necessary with symptoms dictated by the patient. You may want to try Dr. Krause at Beaumont.

cc

were you banded in Mexico or in the US?

Thanks for the info. I had my first fill yesterday - 4 cc in a AP large. The nurse said that the 4 added to 2 already in made it 6 cc. I feel pretty good, not too tight.

is there a place to go that tells if the fills hurt and how they are done?