Wendell Edwards

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.

The thing that helped me with getting fluids in was to get a couple of those HUGE mugs that 7-11, ARCO and Wal*Mart sell. They hold from 48 to 64 ounces, and are insulated and have lids. Every morning I start by filling one of those mugs with a liquid, usually Crystal Lite or Kool-Aid and lots of ice. I make sure that mug is within arms reach for the rest of the day, and I sip constantly from it. That was a learned behavior for me, and I initially used a digital kitchen timer, set to go off every five minutes. Every time the timer beeped, I had to take a drink. After a while, that behavior became integrated, and I no longer had to use the timer to remind me to take a sip.

Surgeons choose band size based on the patient's unique anatomy. The criteria is the closest fit to the patient's stomach, with the least dissection of the fat above the stomach. ALLERGAN specifically warns surgeons about over-dissection of that fat, as stomach perforations could occur when doing so.

ALLERGAN introduced a larger band called the APL last year, It appears that you have that band. You're right, it may take larger fills to obtain restriction in that band.

Although I do not have an answer for you about the gas problem, I do want to caution you about retaining a too-tight fill. Relying on soft food and soups indicates a too-tight band. Keeping a too-tight band will increase your liklihood for an enlarged esophagus or pouch dilatation. I would advise you to consult with your doctor, and consider getting a slight unfill.

Conversely, a person with a smaller band may need multiple fills, while a person with a larger band size, but larger anatomy, may require fewer fills. That is why comparing the amount of fill in any two person's bands is essentially futile. Everyone is different. :smile:

Normal is whatever your unique experience is. Normal weight loss is between one and two pounds per week.

I disagree with the B.M.I. ranges. I use a goal SIZE of a men's XL shirt and 38-inch waist slacks.

I gained weight until fill number 4.

This is very good advice. Wait it out, and don't drink anything.

Most people who are morbidly obese do not like having their picture taken. They avoid the camera because the photographs don't lie. That fact can be put to good use before and during your weight loss. Simply put, the best way to document weight loss is not a scale graph of pounds lost, or a size chart of inches lost. The best way to document weight loss is to take photographs before and during the process. I advise people setting out on this journey to take three initial pictures. The recommendations that I give are these: 1. Take three views, front, side and back (That means you need a automatic timer camera or a friend to help you) 2. Take the pictures in the same place every time. A doorway is a great choice, because it helps put a known quantity into the picture. Other good places are in front of a fireplace or another known point of reference. 3. Take the pictures while wearing form-fitting clothes. A swimsuit is IDEAL. 4. Take the pictures with the same camera, and make sure you are standing the same distance from the camera every time. That's why a doorway helps. You can line yourself up in the doorway and use a measuring tape to find the distance to the camera. 5. Take that same set of pictures every month. Front, back and side views. Wear the same clothes and make sure the distance to the camera is the same. 6. Have the "Before" pictures printed out, and tape them to your refrigerator. 7. Have the latest set of pictures printed out, and tape those next to the "Before" pictures. In doing this, you mind has irrefutable PROOF that what you are doing IS WORKING. People frequently do NOT "See" their weight loss, and they become frustrated, perhaps by a scale weight that is not moving, even though their body size is reducing at an amazing rate. This is a great way to "See" your weight loss. The best way to document weight loss is to take photographs before and during the process.

The very best person to ask that question of is your doctor, because only your doctor is qualified to give you medical advice.

The best source for amounts of food that you should eat is your doctor. Eating very small amounts of food is not what the Lap-Band was designed for. Extremely small amounts of food could lead to very dangerous health conditions, so please consult your doctor or nutritionist for accurate and safe advice.

"It is very important to follow the eating and drinking instructions right from the start after the operation. That’s because you must allow the new stomach structure to heal completely and in the right position. It may take a month or more for this to happen. It is important, especially in the early weeks, not to stretch the small stomach pouch above the band. Vomiting can do this, so it is important not to vomit. Vomiting can increase the chance of stomach tissue slipping up through the band." http://www.allerganandinamed.com/pdf/health/94829-12_LB_Patient_Book.pdf It's on page 10.

Your best source for diet information is your doctor's office. Most Lap-Band patients eat 1 to 1.5 cups of food 3 times per day. If you are onky eating 1/4 cup of food 3 times a day, I doubt that your nutritional needs will be met.

That's normal. When a patient is newly banded, swelling of the stomach tissues often provide temporary restriction. When the swelling subsides, effective restriction is removed and the patient's hunger returns. Head hunger seems to be the worst at that time also. While few patients experience effective restriction on receiving their first fill, eventually effective restriction does happen, at which time most patients experience a dramatic lessening in hunger.

Hi Amy, INAMED had quite a few pages of information for patients and doctors on their website before ALLERGAN took them over. Some of the best, most accurate information that I have seen was on those pages.

I understand your frustration. You have lost an average of one pound per week, and that is within the normal weight loss range for a Lap-Band patient, congratulations! The normal range of weight loss with a Lap-Band is one to two pounds per week. Any weight loss that is over 2 pounds per week is outside of the normal range.

I think you might want to re-focus on the basics of eating according to the post-op diet at this time. Getting a fill isn't always the answer.

:whoo:You GO!!!!:whoo: :biggrin1:

Head-hunger is ALWAYS an issue for me. When my band is properly adjusted, it's less of a problem. It took 4 fills for me to even KNOW that I had a Lap-Band, but once the proper level of fill was given, and effective restriction kicked in, physical hunger ceased to be a problem.

I remember the shock that I felt the first time I realized that every time I got a fill I was going to have to start over again and re-learn my eating limitations. Every fill results in a smaller stoma diameter, and what USED to be a food that wouldn't cause a problem SUDDENLY WAS! :faint:

"How Important Is The Post-Op Diet?" It is critical. Most doctors prescribe a post-op diet of weeks of clear fluids, followed by weeks of full fluids followed by weeks of mushy food. My doctor said 2 weeks clear Fluid, 2 weeks full fluids and 2 weeks of mushy food. The time following the operation is for your stomach to heal. The Lap-Band needs to form a groove on your stomach. That groove makes the Lap-Band resistent to slipping. Eating food during the post-op period before you are supposed to be eating food could cause the Lap-Band to slip, or increase the risk of a future slippage. Food causes the stomach muscle to "Work" to digest the food. The "Work" could cause the band to not seat properly on the stomach. Weight loss is NOT to be expected during the recovery time after the operation. If you lose weight, wonderful, but don't expect it. The time between the operation and getting an EFFECTIVE fill that causes restriction is called "Bandster Hell" for a good reason. Without an EFFECTIVE fill, our hunger is just as strong, but the band does not work to help us. Getting an EFFECTIVE fill sometimes takes multiple fills, it is not unusual for it to take 3-5 or even MORE fills to obtain restriction. Because the band has to seat into the groove to hold it's position, and every time the band is filled the fill adds extra pressure on the band, most doctors choose to let time pass between fills. Most doctors will not fill a band before 4 weeks after the operation, 6 weeks is common and 8-12 weeks of healing time is not unheard of.

<p><p> </p> <p> </p> <p> </p> <p>I use a target of 1.25 grams per Kilogram of lean body weight. </p> <p> </p> <p>I calculate lean body weight by assuming a body fat percentage of 15% at goal weight.</p> <p> </p> <p>So:</p> <p> </p> <p>225 X 85% = 191.25 / 2.2 = 86.9316 X 1.25 = 108.66 grams of Protein per day.</p></p> <p> </p> <p>Adding a note, protien is roughly 7 grams per ounce of solid protein food, so I can tell how many ounces of protien I need to eat by dividing the protien gram goal by 7.</p> <p> </p> <p>Thus, 108.66 / 7 = 15.52 ounces of solid protien per day.</p>

"Is it possible to stretch out the small stomach, or "Pouch"?" The pouch seldom enlarges, because it is created in an area that is very resistent to enlargement. The esophagus above the pouch will usually stretch before the pouch itself does. That is almost always caused by repeatedly over-eating, AKA "Stuffing the pouch". Not very many people do this, but if they do, it can result in "Esophageal Dilatation" or stretching of the esophagus, which can be a very serious thing. The usual remedy for esophageal dilatation is to completely unfill the band for a period of time, in the hope that the esophagus will shrink back to it's original size. In some instances, where the patient refuses to stop "Stuffing The Pouch" band removal is necessary. The only way to tell if this condition is present is to have a doctor order a fluoroscopic examination with a barium swallow.