Wendell Edwards

This may help you in understanding the restrictive mechanism of a Lap-Band. The INAMED 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 two weeks. A “Delayed-Action” means that the fill may not become effective for up to two weeks after the fill. That is why the INAMED 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. Neal requires 2 days of full fluids after any fill or PB, in order to allow stoma swelling to reduce before food is slowly re-introduced. If I had a PB like you did, I would go on full fluids for at least 2 days to allow the swelling to go down, otherwise I could re-irritate my stoma, causing a total obstruction.

It sounds to me that you are losing a lot of the residual fat-pad around the stomach, which would account for the loose band. This may help you in understanding the restrictive mechanism of a Lap-Band. The INAMED 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 two weeks. A “Delayed-Action” means that the fill may not become effective for up to two weeks after the fill. That is why the INAMED 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.

Well, there are some possibilities: 1. Damage to the Lap-Band system. That could be any one of the following: a. A leak in the band liner, tubing, port or the fittings from the port to the tube or tube to the band. b. A tubing puncture that happened during this last fill. 2. He "Rocked the needle in the septum" and when that happened, Fluid in the port squirted out. And that's about the only way you could have lost restriction so fast, unless you have a band slip. Verification of band patentcy is done under fluoroscope, as is checking for a slipped band.

Not me; I know every day that I have one.

Success with any weight loss surgery is determined by the patient's willingness to modify their lifestyle. I know MANY people who are within BMI <25 range.

Hi Essence, While nobody can tell you for sure what WILL happen, it's what MIGHT happen that should concern you. I made the following post a loing time ago, because this question gets asked all the time, but the answer remains the same: "DON'T DO IT!" "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 resistant 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 its 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. One more thing: I strongly recommend that you NOT follow the advice given to you by ANYONE who is not YOUR DOCTOR.

*MY* "Saw" cost $23,000!

Hi, Eating before you are supposed to is NOT a good idea. I have answered this one quite a few times, and I have the following saved as a word document on my computer: "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 resistant 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 its 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.

I know that for me it was the weight from my GP's office when he gave me the referral. Personally, I would do whatever I had to in order to have this life-saving surgery. I would eat a lot of ham, drink fluids, wear lead underwear.... Whatever it takes!

I have 4 scars that are less than one-inch long, and one that is between three and four inches long. I consider them "Medals for saving my life".

I gained 33 pounds before I obtained effective restriction on fill number four. I received that fourth fill 24 weeks after the operation. Before I received my fourth fill, I had absolutely no restriction.

Hi, while I sympathize with your nervousness, I do not recommend having a "Last Supper". In my opinion, there really is not a need for one, because the premise is that the patient's life is going to change so drastically, and that they will be denied and deprived of their favorite foods. THAT HAS NOT BEEN MY EXPERIENCE WITH LAP-BAND, EXCEPT THE IMMEDIATE POST-SURGERY TIME FOR HEALING. So, if a person still will be able to enjoy their favorite foods (In moderation, with some exceptions) then in my mind, the reason for a "Last Supper" is false. And if you were wondering, no, I did not have one.

Hi Susan! Restriction means that the band has enough saline fill in it to restrict the amount of food that you can eat. In essence, that is what makes the Lap-Band work, enough saline fill to provide restriction. I call this "Effective restriction". Many people use the term "The sweet spot" to describe effective restriction. The problem is that some people expect "The Sweet Spot" to last, it doesn't, and neither does "Effective Restriction". Not until the entire residual fat-pad on the outside of the stomach muscle is melted off, and that takes TIME. (And usually MULTIPLE FILLS)

This is a very good post. My full signal is usually one tiny hiccup. Just one. Woe be unto me if I choose to ignore that tiny little hiccup! I can usually take one more bite after the hiccup, but if I take two, instant pain occurs, usually accompanied by sliming.

You're very welcome!

A study I saw stated that without drinking after meals, the food stayed substancially longer in the pouch than 30 minutes to an hour.

Hi, the difference between an effective fill and a non-effective fill is night & day. An effective fill is what we are all looking for. It makes the Lap-Band restrict the amount of food that we can eat, and provides the sensation of "Full", although your new "Full" feeling may not feel like your old "Full" feeling. Some people use the term "Sweet Spot" to describe what I call "Effective Restriction". The reason I do not use the term "Sweet Spot" is that it is easy to mistake a "Sweet Spot" for something that will last indefinitely, and an effective fill will usually NOT last indefinitely, due to the inevitable reduction of the residual fat-pad that lies between the band and the stomach wall. 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 three weeks. A “Delayed-Action” means that the fill may not become effective for up to three 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.

Scale weight repeatedly stalls during the weight loss process. Common reasons include the following: (A) Patient is eating more than they think they are. ( Patient is retaining Fluid for some reason, like salt intake or menstrual cycle © Patient's body is dehydrated, and is retaining fluid for that reason (D) Patient's body weight has increased due to muscle tissue increasing due to increased exercise (E) Unknown. The best way to not go insane about scale weight is simple: Stop weighing obsessively. Weigh in not more than once a week, because momentary weight fluctuations of as little as 1% of your body weight will wipe out a full week's weight loss. Take measurements before being banded so that when the scale weight stops, you can re-measure to see if your body size is shrinking while the scale stalls. EXPECT the scale loss to stall once in a while, this is NORMAL. Weight loss is a "Staircase, not a curve" that is, its stop, then drop, stop, and then drop.

The pain level is that of any injection. I have had many fills, only one ever hurt, and that was a mild discomfort.

Not only will you feel horrible, you will also start losing valuable lean muscle, because if your body doesn't get in enough protein, it starts to "eat" muscle tissue. Less muscle tissue means you get tired faster, and you lose LESS WEIGHT, because that muscle tissue burns calories just to exist. Lose the muscle tissue due to protein insufficiency, and your weight loss will take quite a bit longer to achieve.

No, it sounds like you are too tight. 3 Ounces of protein is only 21 grams, and that's not nearly enough protein. Plus, you might dehydrate at this rate. I would advise you to get a slight unfill, as little as .2CC will make the band a lot more comfortable.

You're very welcome!

scale weight repeatedly stalls during the weight loss process. Common reasons include the following: (A) Patient is eating more than they think they are. ( Patient is retaining Fluid for some reason, like salt intake or menstrual cycle © Patient's body is dehydrated, and is retaining fluid for that reason (D) Patient's body weight has increased due to muscle tissue increasing due to increased exercise (E) Unknown. The best way to not go insane about scale weight is simple: Stop weighing obsessively. Weigh in not more than once a week, because momentary weight fluctuations of as little as 1% of your body weight will wipe out a full week's weight loss. Take measurements before being banded so that when the scale weight stops, you can re-measure to see if your body size is shrinking while the scale stalls. EXPECT the scale loss to stall once in a while, this is NORMAL. Weight loss is a "Staircase, not a curve" that is, its stop, then drop, stop, and then drop.

You're very welcome!