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.

Dr. Watkins,

How many bands have you done?

Colleen

Okay, I have had that happen. That's what started the whole question of whether I have a leak. When you think you are adding Fluid to the port, but it doesn't go in, where in the heck does it go???

Presently, I don't think I do have a leak. It's been over a week now, and I tested it out today at a salad bar. I got stuck pretty quickly. Not stuck enough to pb, but I immediately quit eating. I really do wonder though, where the saline goes when you get a fill, and it doesn't go into the port like you stated above.

Thank you so much, Denise

Dr. Watkins,

How many bands have you done?

Colleen

Over 1,000 as primary surgeon and many, many more assisting and teaching other surgeons.

Okay, I have had that happen. That's what started the whole question of whether I have a leak. When you think you are adding Fluid to the port, but it doesn't go in, where in the heck does it go???

Presently, I don't think I do have a leak. It's been over a week now, and I tested it out today at a salad bar. I got stuck pretty quickly. Not stuck enough to pb, but I immediately quit eating. I really do wonder though, where the saline goes when you get a fill, and it doesn't go into the port like you stated above.

Thank you so much, Denise

If the saline is injected into the surrounding tissues the body simply absorbs it and uses it.

The majority of our blood is saline and interestingly it has the same salt content as the ocean.

If you go into the emergency room dehydrated they will pump thousands of milliliters of saline into you (I.V. fluid). If a fill misses the port you get 0.5 to 4 milliliters (whatever the volume of the fill).

I wish I lived in your city, I would definately want to go to you. You seen to make people feel at ease and aren't condesending like so doctors could be.

What city are you near?

I have lots of great band surgeon friends.

:party:Still jumping for joy about my last fill working so well. For so long the scale stood still. I lost another pound today. I've been losing at the rate of a pound a day this last week. ( I know they are not all true pounds as some are water.)

Xmas dinner is going to be tough for all of us. I'm spending mine with family, who would totaly freak out if I started PBing.

Thank you for the concise description of what happens.

Hi again Dr. Watkins,

I live in a surburb of Chicago, guess what happened today? I have hmo bcbc of il. I did all the requirements they had me do 12 mths. supervised diet seeinf a dietition, never missed an appt. finished up 12-12 07 . Just today got the denial letter from the hmo dept. they said i didnt loose enough weight in the 12 months. I'm so sad right now. because we can't afford to be a self pay. Now I will have to start fighting with them. I also forgot to mention I broke my tibia Oct.31 lost weight with cast on and they denied me I'm so fustrated at this point.

Hi again Dr. Watkins,

I live in a surburb of Chicago, guess what happened today? I have hmo bcbc of il. I did all the requirements they had me do 12 mths. supervised diet seeinf a dietition, never missed an appt. finished up 12-12 07 . Just today got the denial letter from the hmo dept. they said i didnt loose enough weight in the 12 months. I'm so sad right now. because we can't afford to be a self pay. Now I will have to start fighting with them. I also forgot to mention I broke my tibia Oct.31 lost weight with cast on and they denied me I'm so fustrated at this point.

Insurance companies don't specialize in your health.

They specialize in denying things.

They collect money every month in insurance premiums.

Their business is figuring out ways to keep as much of the money as possible.

They do this by denying things for stupid reasons and ratcheting down payments to doctors and hospitals.

Don't torture yourself thinking insurance companies make sense.

There are thousands of ways (other than evil insurance companies) that people have band surgery.

Never give up hope.

thanks every one for the tips and info.. does anyone experience what i have.. banded in may,, 3 fills under fluoro, and i have been told the band is totally full up. and my restriction isn't very much.. its seems that if teh band is full up.. that it !! the band has nothing left to offer me

regards

paula

I am in your boat and I don't know what to do either. I have had 4 fills and am totyally full. I never felt the first restriction until the fourth fill. I feel like to have enough restriction to lose weight properly I would need one more fill and that doesn't exist. My nurse acts like I am the only person that the lap band doesn't work on properly. She tries to find excuses of why it is my fault that it isn't working. I know what restriction is and I don't have enough of it. I had my surgery in Aug. and I have lost a total of 7 pounds.

Pamela

Thanks for the advice Dr. Watkins if I dont get anywhere with my primary dodc I will have to be thinking of going elsewhere, my husband is so mad we pay around 1400.00 a month for that stupid ins. to be denied!!!!!

Colleen

I feel like I just waisted a year for nothing!!!!!!

How Much Weight Have You Lost So Far? What Does Your Doctor Or Nurse Tell You?

What city are you near?

I have lots of great band surgeon friends.

I am not far from you at all, on the Oregon coast. Is Dr. Tersigni

one of your band surgeon friends?

How much do you charge for fills? Do you do blind fills?