What is a good fill ?? why isn't a fluoro the answer?

What is a GOOD fill vs a fill that is too much and dangerous ?
Education Module

It's important to know that, even with a fluoro, a good fill can be
very elusive. A fill that "looks perfect" on a fluoro can still turn
out to be way too tight in a hour, a day, a week. The usual swelling
that is common after a fill occurs in the next few-24 hrs, not
immediately. The only thing that matters in the end is how well and
safely you can EAT, not what the x-ray "shows." It also takes some
fills 1-2 weeks to "settle in", and we cannot tell how a fill really 
is until then. this is why at least 4 weeks between fills is very
important, and this is addressed by the band manufacturer in the
professional literature they provide surgeons.

This is why many docs rarely use a fluoro.They consider it uneeded
radiation (to the ovary area in women) that does not tell enough to
justify it's use. a fluoro DOES have it's good place, though, in 
certain
cir****tances - assessing possible band/pouch problems, for instance.


Since a fluoro is only a clue to a good fill, WE must therefore be
responsible for knowing what a good fill is, and never trying to keep
a too-tight one. Way too many people think that if the doc says "this
fluoro looks great" and sends you home, that the fill IS always good,
and they must put up with any pain or problems. Just not so! I wish
it were that clear-cut.

With a GOOD fill, we can:

1. easily drink fluids from the start, and get the minimum 80-100 oz
a day in
2. be able to eat 1-1.5 cups of good bandster food per meal most of
the time. Less than this very often will never meet nutrition needs for health
or safe loss. we are never trying to at as little as possible (as tempting as that is, 
since w still mistakenly think is is the way to lose) . 
3. with good bandster choices, we can meet the daily (on average)
protein, fiber, calcium, good carb, and omega 3 oil needs
4. we never have pain when eating, unless we forget a rule
5. we rarely have vomiting, pb's, or sliming
6. With a good band meal, we feel satisfied (not FULL - there is an
important difference) for 3-4 hrs
7. we will be losing, averaged over a month or two, about 1-2# a 
week, as long as we are being reasonable in food choices, exercise, 
and fluid needs. we have to do our part too - the band is not a magic 
cure.

A TOO-TIGHT and UNSAFE fill is:

1. being unable to swallow your own saliva, and having painful burping
2. being able to eat only a few bites per meal
3. being scared and worried when we eat
4. not being able to eat a variety of foods
5. Struggling to meet fluid needs
6. ANY REFLUX
7. ANY regular pain or trouble, including pb's, sliming, barfing
8. Being unable to eat the solid meat/chicken/ fish that is the basis
of most good bandster meals.
9. Having to rely on soft foods and liquid foods like protein drinks,
soups, ice cream , etc to get enough to eat and feel satisfied (This
applies only after we are back on regular foods, of course, not in
the post-op diet phases)
10. a too-tight fill is harmful to the stomach, and the #1 reason for
ALL the major band problems, some requiring more expensive surgery and
even band removal. We have to take very good care of our stomachs if
we want the band to stay safe and last inside us.

One of the hardest things we have to change is the thought that the
less we eat, the more we will lose and the better we will do. this is
very untrue, and very unsafe. when our bodies are deprived of
adequate calories, they refuses to lose well - if at all. When our
calories are too low, the metabolism "Set point" is way too low, and
we VERY easily regain. This is a big reason why we all regained plus
then some after all previous diet.

The "starvation mode", when we are eating too little for safety and
stop losing as a protective mechanism, is VERY real. We must eat
ENOUGH calories, but still just a bit less than we need, to lose
safely and in a way that will STAY the heck OFF this time!!

We have all lost weight before, and sometimes a lot of weight, but we
did it in an unsafe way that caused deprivation and poor health, and
all the weight plus more just came right back again.

THIS time, we need to learn and follow better ways to be successful
with the Band, maintain lost weight long term, and regain our health.

c. Sandy Richards, BSN, MN
band educator
at goal 5+ yrs
[email protected] - email to request free education documents

Sandy,

I agree - a fluoro is just a "snapshot" and is no guarantee of a comfortable fill.

I have had fills take 2 weeks to kick in.  I asked Dr. Curry about it and he said it's very common in his practice.  But, I'm curious about WHY restriction can be delayed.  Can you shed any light on that?  Does it take a while for the fill to work its way through the tubing and into the band, or what?

Thanks,
Jean

Hi, you!

I'm not sure anyone knows!  There are just some things that "are" with the band we have to accept on faith.  I used to never believe this, until i experienced it myself. It's also covered in the Inamed written materials for docs, but without any explantion as to WHY.

My guess is that it has something to do with the fill distributing itself thru all the nooks and crannies of the band system, and equalizing the osmotic pressure inside the band.

I also think this is why it is SO important to maintain excellent hydration with the band - 80-100 oz a day - to minimize restriction variations. Since the band is a semi-permeable membrane, it loses or gains a bit of fluid  depending on levels of hydration in the body.

the band is just a quirky, weird, unpredictable thing sometimes....   (but still a wonderful life-saver)

Sandy.

I've had the delayed fill reaction too-so I can testify that it does exist...but can't explain why either.

Sandy, Thank you so much for posting that information. My surgeon does not do fills with flouro, and it seemed to me to be the way to go. Your explination makes me feel much better...plus thank goodness I wont have to drink that yucky barium every time!

I only had to do the flouro right after the surgery.

Jeane

I have had about 14 fills and a few unfills in the last 3 1/2 years, and I have NEVER had a fill to kick in right away, so a fluro fill would not do me any good anyway, my doc has always done fills without flouro, I never had a flouro fill, he does Upper GIs when we suspect something is going on with our bands, we, my band doc depends on his patients to be HONEST regarding restriction and he keeps that chart of the different fill level zones, the yellow zone, meaning need more saline, green zone, optimal restriction, small meals keep you satisfied and the RED ZONE -- too tight with reflux, heartburn and frequent vomiting and this minimize band slips and complications.

But if you read these board MOST FOLKS STAY IN THE RED ZONE of vomiting and REFLUX frequently and get SUPRISED when they get pouch dilation and band slips --I think most of these folks DON'T CARE as long as the scales are moving...THEY WILL just ride it out until they slip and then want sympathy and prayers or what their options are....which is not much after the band has slipped and replacement surgery is not a guarantee.

Well, I'm probably the odd duck here.  My doctor does all of his fill with fluoro.  Fortunately, I'm comfortable with him and his ways of after care.

There are way too many conflicting ideas from people's doctor's on this board, which is why I was so confused early on.  I have to choose to not look at what these other doctors are doing and trust that my doctor knows what's best for me.

My doc wanted a fluoro with every fill too. But as  long time health care provider,  I know that the rsdiation exposure is not usually worth the very small amount of info a fluoro provides with routine fills.  I found most docs agree wih this, especially for young women still in child-bearing age. the LESS radiation exsposure, the better.
. 
I chose to get a fluoro only yearly, to assess my band/pouch/esophagus. - and have done just fine. got to goal in a year, and have stayed at goal for more than 5 yrs now - with vigilance.

We are a TEAM with our docs and have the responsibility to do our own research, gather our own info, and ask lots of questions.

It's surely true that band knowledge is continually evolving - thi is why we need to consider all information, imo.

Sandy

I choose to let my doctor be my team leader.  If he says he needs to do the flouro, then I trust what he says.  I am an educated individual, with several degrees, but I certainly did not go to medical school.  My doctor did, so I'm fairly certain he knows more than I do when it comes to medicine, imo.