This may help you in understanding the restrictive mechanism of a Lap-Band.

The ALLERGAN protocol for Lap-Band fills calls for a six-week delay after surgery, prior to any fills. The purpose for the six-week delay is for the patient’s stomach to heal from the surgery, as well as allowing time for the Lap-Band to “Seat” or “Nestle” into the fat pad between the stomach wall and the interior wall of the Lap-Band.

Prior to receiving an EFFECTIVE fill, it is VERY uncommon to have any restriction from a Lap-Band. Some patients will NOT lose weight, or may even GAIN weight until they have received an effective fill in their Lap-Band.

Normal weight loss with a properly restricted Lap-Band is between 1 and 2 pounds per week.

The normal cycle of fills, restriction and weight loss is as follows:

1. The patient's Lap-Band constricts when the patient receives a fill. Swelling for a few days after receiving a fill is very common. Many doctors require a patient to go on a liquid diet for a day or two after receiving a fill. A fill may have a “Delayed Action” of up to 4 weeks. A “Delayed-Action” means that the fill may not become effective for up to 4 weeks after the fill. That is why the ALLERGAN protocol states that fills should not be performed on patients who will not have access to medical care for at least two weeks after a fill.

2. The patient's stomach capacity is lessened as a result of the restriction caused by the Lap-Band.

3. The patient loses weight because they cannot eat as much food.

4. The residual fat-pad between the inside of the Lap-Band and the outside of the patient's stomach reduces in size because of the overall weight loss in the patient.

5. The reduction of the residual fat-pad causes the Lap-Band to become loose again.

6. At that point, the patient needs another fill, because the Lap-Band is loose, and the patient has a loss of restriction, which allows the patient to eat larger amounts of food.

7. The patient receives another fill and the process starts all over again.

Most Lap-Band patients receive several fills to adjust the Lap-Band as their weight loss progresses, and there is less and less residual fat-pad between the inside of the Lap-Band and the exterior of the stomach wall. Once a patient has lost all of their residual fat-pad, fills become less common. As the Lap-Band patient progresses in their weight loss, the effect of very tiny fills (Less than .2ccs) becomes greater and greater.

It is not uncommon for a late-stage Lap-Band patient to experience a significant difference in restriction with as little as .05cc of fill.

I was afraid Dr. Watkins wouldn't be back!

Dr. Watkins, How is it possible when you get a fill, and it's supposed to be a certain amount, then when you get your next fill, part of it is missing.

I was supposed to be at 2.75, but then at my next fill, he was only able to pull out 2.0. Yet he says I don't have a leak. I have heard different theories, like air bubbles taking up space.

Is it possible when giving a fill that part of it doesn't get into the band? This whole thing confuses me!:cry

Thank you in advance!;)

I was afraid Dr. Watkins wouldn't be back!

Dr. Watkins, How is it possible when you get a fill, and it's supposed to be a certain amount, then when you get your next fill, part of it is missing.

I was supposed to be at 2.75, but then at my next fill, he was only able to pull out 2.0. Yet he says I don't have a leak. I have heard different theories, like air bubbles taking up space.

Is it possible when giving a fill that part of it doesn't get into the band? This whole thing confuses me!:cry

Thank you in advance!

As long as there is some saline in the band I wouldn't worry about the total volume. Any amount of saline means you don't have a leak and what matters most is that you are able to reach perfect restriction.

As we do fills and add up the amounts in your chart you get a total number but over time the band rarely has that number remaining. The balloon is a permeable membrane and does lose tiny amounts of saline over time. Dr. John Dixon (Australia) did a bench study and came up with mathematical formulas for how much saline the band loses over time. The higher the volume and the smaller the band the more saline the band would lose over time.

Also, with the newer bigger bands, it is hard to withdraw 100% of the saline so the Fluid check volumes are less meaningful.

If, on multiple occasions, you have a fluid check and it's always zero despite having saline replaced each time, that means you have a leak and likely need a new port.

If you are able to reach perfect restriction and it lasts a while then you're good and my advice is to ignore the number.

Perfect restriction is when you are full on small meals, aren't hungry all the time, don't feel like you're on a diet, you use words like "sweet spot" and "ah, I get it now", you think your surgeon is a genius, you easily lose 1-2 pounds per week during weight loss or easily maintain your goal weight.

If the band is too loose, you will feel like it's not working, you will feel like you're on a diet, it will be hard to lose weight, you will be able to eat a lot. Since the stomach tissue slims down with you, the band must be tightened during weight loss. Many patients get a perfect fill and when the stomach shrinks away and the band "quits working" they get all discouraged when all they need to do is to get another fill.

If the band is too tight, you will have heartburn and everything you eat will get stuck and you will likely see it again soon, the only thing that wants to go down is bad stuff like ice cream and Cheetos. Leaving the band too tight is not good practice because this is what causes "slips".

If your band isn't perfect, you should get it adjusted.

Having said that it is usually not that simple. Many things affect restriction at a given moment, i.e. tighter in the morning, tighter after a commercial flight, tighter on menstrual period, tighter after high salt intake. Also, some patients have esophageal spasm that makes the restriction change every 15 minutes - one day you can eat everything, the next you can eat nothing. For spasm I use nifedipine to calm the spasm and this sometimes helps.

hope that helps

Thank you for your reply. That is good advice. I tried that this time and it just kept happening so I did have .5 taken out and am feeling better.

Hoping that the problem will resolve its self

I think I am having trouble with the spasms. One day i am fine and the next day i am throwing up spit. They watched it under xray yesterday and the barium went down fine until the last part then it tightened up. All they did was take out .4cc's. Now I feel no restriction.

I think I am having trouble with the spasms. One day i am fine and the next day i am throwing up spit. They watched it under xray yesterday and the barium went down fine until the last part then it tightened up. All they did was take out .4cc's. Now I feel no restriction.

That sounds like spasm.

I use a medication called "nifedipine" or brand name "Procardia".

It is a blood pressure medication that relaxes spastic smooth muscle cells.

Arteries have smooth muscle in the wall and so does the esophagus. They have extended release nifedipine that lasts all day. It works great in some patients and has no effect in others. Worth a try. Obviously talk to your doctor about it.

Disclaimer: This is not medical advice. Message boards can never replace a physician evaluation.

Thank you Dr. Watkins. You are so helpful and all of us here really appreciate it!

Your advise has kept me from flippng out on more than one occassion.!!

I had my fluro with a barium swallow last Monday and my band is FINE. The Doc. pushed another 2 cc's into my band. He attempted to withdraw all saline from my band and could not get it all... (just like you said in your prev. post) but the good news was that the Fluid that was in the syringe was CRYSTAL CLEAR... which means it is looking more favorable that I don't have a leak....

Also for others who may have to swallow barium, It dosn't taste bad, I liken it to minty toothpaste just kinda watered down a bit. Was not unpleasant at alll.... and I have a very well developed GAG reflex. No problems at all.

The Barium also didn't set off any allergic reation either. This had been a worry to me as I am allergic to Iodine and I.V.P. dye.

Good day everyone!

I'm 4 months post op and my hair is falling out. I have thick hair so it's not noticeable, but I have to cover it or pin it up to keep hairs from falling into food while I cook.... UGGGGGGGGG

I' ve read a lot about this happening at 4 months post op. Wonder if it is lack of Protein in diet???????????????

what's a sticky?

Cmeyer

I had my first fill the other day the doctor put in 10cc. It has been three days and I have no restriction. Should I have another fill or am I not waiting long enough for it to work? Also when I say no restriction I can eat anything and it just goes right through, I am getting frustrated also I want to eat small but the band is not working!!!!!

I am totally full and the band isn't working for me either. The food just passes through.

I haven't figured out what causes the hair loss. A lot of people have had blood tests taken and their Protein levels were just fine. I have

taken every Vitamin known to man that is supposed to help this. Mine has slowed down, but I am still losing more than normal.

I hate it. There is always hair all over the bathroom floor, my car, etc.

I'm 4 months post op and my hair is falling out. I have thick hair so it's not noticeable, but I have to cover it or pin it up to keep hairs from falling into food while I cook.... UGGGGGGGGG

I' ve read a lot about this happening at 4 months post op. Wonder if it is lack of Protein in diet???????????????

Weight loss is a major metabolic change where your body is using stored fat as a primary energy source. The hair follicles hate this.

Hair thinning is very common during massive weight loss and tends to grow back to its original state at goal weight. At goal your body uses food as a primary fuel source instead of stored fat and the hair follicles are happy again. Protein is important but most band patients are not protein malnourished like the malabsorptive operations (gastric bypass, biliopancreatic diversion).

So called "hair vitamins" do not tend to have much of an affect on hair thinning because the problem isn't a Vitamin deficiency.

I tell patients to expect more hair in the shower drain and on the brush during weight loss but not to freak or panic because it will restore itself to its original grandeur at goal and then you should go and buy yourself a nice present because you deserve it.

All that hair on the bathroom floor is a sign that your are making positive changes in your life and it therefore is to be celebrated and not feared.

Thank you Dr. Watkins. You are such a wealth of information to us.

I always thought it had to do with rapid weight loss and really not anything else. I would supposed I have a set back with this because I lost 22 lbs the first month, and 15 lbs the 9th month. :wink:

Hi everyone, I had my band done in MX and have since had 2 fills done there. I can't go to MX again because of finances. So my concern is having a fill without a flouroscope. How can they possibly position the needle correctly without being able to see the port? At my first fill the Dr. had problems even with the flouroscope as the port was sideways.

The second fill went a little faster but he still relied on the flouroscope to find the port hole. Any information anyone?

I am totally full and the band isn't working for me either. The food just passes through.

I would be afraid of possible band slippage. They say that is what happens when the band slips.