Wendell Edwards

This link from Allergan has information on fills on page 12: http://www.allerganandinamed.com/pdf/health/94163_04_LB_Product_Data_Sheet.pdf

"Should I tell my family and friends?" It's up to you. in an ideal world, everyone would love you and support your decision to have life-saving surgery. But this is the REAL WORLD, where some people just can't keep themselves from making nasty, hurtful, ignorant and insensitive comments to people. If you don't want those comments, or are not strong enough to NOT CARE what other people think, DON'T TELL THEM!

Many doctors believe that caffeine, because it is a stimulant, may stimulate a patient's appetite. Caffeine may also be a gastric irritant, which could be a contributor to GERD, acid reflux or eventual band erosion. As far as I know, there are no limits on how much Fluid may be consumed at one time, as pain will eventually stop the patient from drinking too much.

I would do it a few weeks apart, so that one can help the other one immediately post-op.

Unless the surgeon flushes the band during implantation, there will be air in the band, which will eventually be replaced with saline.

Every doctor follows what they feel is best. The INAMED/Allergan instructions for fills is on page 12 on this link: http://www.allerganandinamed.com/pdf/health/94163_04_LB_Product_Data_Sheet.pdf

Well, I think you are too tight and need a slight unfill, maybe only .1CC.

It takes me more than three weeks to schedule a fill, and my doctor's office does fills five days a week.

Some doctors will not give a fill if the patient is losing weight within the 1-2 pounds per week expectation. They are following the INAMED instructions: 3. Where the average weight loss between visits has been greater than 2 lbs per week, normally no additional Fluid would be added. http://www.allerganandinamed.com/pdf/health/94163_04_LB_Product_Data_Sheet.pdf

That's good to hear. Most patients take between 3 and 5 fills to obtain effective restriction.

Every time I get a fill, I have to re-learn what I can tolerate.

It's normal. Your band is getting looser because the fat-pad between the band and the stomach is shrinking, which results in the stoma becoming larger, with less restriction.

This is directly from Allergan/INAMED: The following are general guidelines for BioEnterics LAP-BAND System adjustments: 1. The initial adjustment postoperatively should occur at six weeks or more after operation and usually 1-2 cc of normal saline would be added for the 9.75 and 10 cm LAP-BANDs. The initial adjustment for the 11cm and Vanguard Bands is usually 4cc 2. The patient should be reviewed regularly (4-6 weekly) and weight and clinical status measured. If the weight loss has averaged less than 1lb per week over the period and the patient indicates there is not excessive restriction to eating, a further increment of Fluid should be added (usually 0.3 – 0.5 ml). 3. Where the average weight loss between visits has been greater than 2 lbs per week, normally no additional fluid would be added. 4. If the weight loss averaged between 1 and 2 lbs per week, additional fluid would be indicated if the patient felt he/she could eat too freely or found difficulty in complying with the dietary rules. 5. Fluid would be removed from the system if there were symptoms of excessive restriction or obstruction, including excessive sense of fullness, heartburn, regurgitation and vomiting. If symptoms are not relieved by removal of the fluid, barium meal should be used to evaluate the anatomy. Prior to doing an adjustment to decrease the stoma, review the patient’s chart for total band volume and recent adjustments. If recent adjustments have not been effective in increasing restriction and the patient has been compliant with nutritional guidelines, the patient may have a leaking band system, or may have pouch enlargement or esophageal dilatation due to stomal obstruction, band slippage or over-restriction. http://www.allerganandinamed.com/pdf/health/94163_04_LB_Product_Data_Sheet.pdf It's on page 12.

I was still capable of being surprised back in 2004, which is when I asked them that question. :bounce:

I talked to Inamed about how many CCs in a Lap-Band made for a "Good fill". Their answer surprised me: "It really doesn't MATTER how many ccs are in the band. The only thing that matters is whether or not that CC amount provides EFFECTIVE RESTRICTION" (Emphasis added) So the trick then is NOT how many CCs are in the Lap-Band, it's whether or not the band works well at that level of fill. One more thing... "The Sweet Spot" is just another way of saying "Effective Restriction". The problem is that 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.

Hi there! Lap-Band patients have a unique vocabulary to describe different things. Here's a LINK to a great post about the different language that is used: http://www.lapbandtalk.com/f73/abbreviations-what-they-mean-7959/ To answer your question directly, a "PB" is a "Productive Burp", which is a small amount of vomit.

I didn't have the surgery done but I know someone that did. I'm wondering about fills and when you have to pay for them. Do you have to pay for every fill and defill? That depends on the surgeon's policies and the insurance company. Some surgeons provide lifetime fills at no cost, some provide a limited amount, some charge for every fill and unfill. Some insurance companies pay foir fills, some don't. That's why it's important to ask about this BEFORE having surgery. I see this person that I love paying so much money after getting sugery on fills and adjustments. It just doesn't seem right to me. Personally, I believe that lifetime maintainence on my car should be supplied as part of the cost of the car, but it doesn't work that way. If you get a fill and it doesn't seem to have any effect and you tell the doctor and they schedule you for another fill do you pay twice? That depends on the surgeon's policy. It seems like they didn't do it right the first time to me. Maybe I don't understand. I'm trying to be supportive but it's hard to see her take this financial hit at the same time. Also, if you get a fill and it's too tight do you have to pay for the defill too? That depends on the surgeon's policy. Fnially, I read about someone losing their fill completely over time which required them to get filled again. A person who "Loses their fill completely over time" has a leak in the port, tubing or band. The Lap-Band is a sealed system. Would you think this person should have to pay for the refill? To me this seems like something that shouldn't happen and fixing it should not have a charge assocaited with it. It doesn't matter what I think, it only matters what the surgeon's policy is, and that is why it is so important to know this in advance.

My first fill was 4.0 and no restriction until fill number 4 with 8.4CCs in the VG band.

When Inamed (Allergan now) issued the guidelines that most surgeons use, they recommended the initial fill be done at 6 weeks. Doctors use different guidelines to determine fills.

Getting a proper fill level is always a combination of skill and luck in my experience. You have only had three fills so far, and many people require that and more fills to obtain proper restriction. My doctor does all fills under a fluoroscope to verify the fill level. One advantage of having fills under fluoroscope is that the port is easily identified under fluoroscope. Is fluoroscope a possibility for you? You may want to ask your doctor if it is available.

Some people get this type of port pain. Just to be sure it's not something bad, you will want to talk to your doctor about this.

It's called Omnipaque. Here is a link to the manufacturer and the previous thread: Omnipaque (iohexol) http://www.lapbandtalk.com/f13/omnipaque-what-44159/

Dr. Neal requires me to be on liquids for 8 hours before a fill, and for 2 days after a fill, in order for the post-fill swelling to reduce.

In terms of how they work, all the Allergan (Inamed) Lap-Bands are the same. The differences are in the size of the band and the capacity of saline. There are major differences between the older bands and the newer "AP" series of bands. You might want to contact Allergan directly, but in all likelihood they are going to refer you to your doctor.

Really good info here! :clap2: