How do I talk to my Physician Assistant when I go for a Lap Band fill? (long)

[slm2007 7]

If anyone is paying attention, I've been on here whining a lot lately about how frustrated I am. Quick synopsis, I was banded 4/18 and have had 4.5 cc in my 11 cc band. I'm hungry. Frustrated and hungry. I weigh, measure and walk 4-5 days a week (more than I ever did before). I'm not perfect but I'm so, so much better at my eating than I used to be. I am supposed to keep calories around 1,100 but can't keep it below 1,300 on a really good day and I am not even counting the calories from my Protein Powder, which I just realized when I printed my journal today.

Anyhow, I have to go to dr. on Wednesday for a follow up and I know I haven't lost a single pound in 6 weeks. I'm taking my journal with me, but how do I approach this with her. I always end up just accepting what she tells me and I'm not happy with how I'm feeling. I'm not feeling anything. I'm getting no "help" from this tool. She always has a way of making me feel like I'm wrong. I told her last time that if I wanted to diet I could have done that on my own, but I thought this band was supposed to help me control my eating by making me feel full and satisfied....it's not. She said that band isn't going to help my hunger? What is it supposed to do then? I've read the link about restriction etc. that some people have suggested and it makes sense? Fluid in my band so I'm feeling something happening. I don't want to end up too tight and I'm willing to work with that but right now I can eat anything and as much of anything that I want in one sitting. I am not grazing. I thought that the band was supposed to help me feel "full and satisfied" on a small amount of food....it's not.

Anyhow, I'd like to know how you approached your dr.'s when making sure you got more of a fill? Can I insist on one? What if she doesn't want to do it? She doesn't put me down but I just feel like a failure when I go there. She says that the band isn't going to control my hunger and stop me from eating. I get that it won't stop me from eating that even if I'm full I can still eat as much as I want to....I know that part is up to me to STOP when I'm FULL....my problem is that I"m not getting full until I eat almost a "regular/presurgery " portion. I have to stop myself and then inevitably, I'm hungry ...stomach hungry...in a hour or two.

Suggestions would be appreciated because I have a way of just letting them talk over me and I don't want to do that this time. I'm getting nowhere fast and I want something to start happening. What is the band supposed to make me feel like? And, how do I explain it to her so she listens that NOTHING is happening here.

Thanks everyone...in advance!

Staci

[papoose 48]

My doctors office has a flourscopy machine. So when I had my last fill and he checked to see how much of a fill I needed and he told me that I didn't need a fill. I told him I was very hungry at night. So he gave me .2 and that seemed to help me. I have 5 cc in a 10 cc band and I am at my sweet spot. My last fill was in June. I can go 4-5 hours at a time without eating. Some days I have to make myself eat. Also before I had that fill I was plateauing, I didn't lose any weight for about a month. Once I got the fill I am losing every week. That little bit really helped. You don't want too much of a fill and then you start throwing up your food and then have to go back and have Fluid taken out. Try to eat more Protein or drink more Protein drinks. Good luck.

[Dave_NW 92]

Hi Staci,

I know this is tough for you. It's so easy to ask, "What's going on?" when things aren't working as you'd like. I don't have any specific answers, but I do have a few suggestions to try. This post will ramble a bit, so try to read between the lines of what I'm trying to say.

First thing to find out is if there is a different PA you can use for your fills. Sometimes it's about personality. I changed from one who was as nice a person as you'd ever want to meet, but she was giving me conflicting information. Her knowledge was mainly for managed weight loss non-surgical people and Gastric Bypass patients, and not so much with Band patients. After a few false starts, I decided I needed someone I could relate to better. The new PA I'm seeing is awesome. He "gets it" about banding, and he hasn't steered me wrong since. It made all the difference in the world.

I didn't start feeling restriction until I was at about 7cc in my 14cc band. So if that's roughly 50% of capacity, then I'd think for you, around 5.5cc in your 11cc band should be a similar place. Everyone is different, of course, so you may find that's not enough, or may be too much. I'm currently at 9cc, and I'm at a perfect spot. So the question to ask yourself (that your PA should also be asking) is "Are you feeling hungry between meals? Do you find yourself feeling satisfied with a smaller portion of food for several hours at a time?" If the answer to that is No (and your post above indicates that is the case) then you SHOULD have another fill. When you get closer to your sweet spot, green zone, or restriction, (depending on which words you want to use), you SHOULD find yourself feeling satisfied after eating. Note you should not necessarily feel FULL, as in the "Thanksgiving dinner" kind of "full." But a portion of food should stay with you for more than an hour or two. You should be able to properly eat a normal bandster portion, and walk away from the table. You won't necessarily feel FULL, but your appetite should be gone. That's where the willpower comes in. Within a few minutes, you shouldn't be hungry, or even have a desire to eat. And it should stay that way for several hours. If you slow down while you're eating, your hunger may even turn off before the food portion is gone. For me, if I eat too fast, I get hungrier sooner.

All else being equal, you may want to evaluate what types of foods you're eating. For me, if I eat too many carbs, they don't stay with me very long, and I find myself actually getting stomach rumbling hungry within a few hours after eating. But if I eat some dense Protein every three to four hours, I rarely feel hunger pangs. So you may want to adjust your balance of Protein vs. carbs. And since protein tends to be lower calories than carbs, you may find yourself able to stay within your limits more easily.

Going off the record here, let me offer this: If you find that despite everything you're doing, you just aren't able to manage it by the numbers, then boost the numbers. My daily intake is around 1200 calories, sometimes more, sometimes less, and I shoot for 10% of that number to be protein grams. (So with 1200 calories eaten, I try for 120g of protein.) But I go with how I feel about the foods I'm eating. By focusing my meals on higher protein and lower glycemic carbs, and eating properly (small bites, eaten slowly, chewed well, and giving my system a chance to recognize that I'm feeding it), I can usually stop eating after a suitable portion of food, and I'm good for several hours. (Again, if I eat more carbs, I get hungrier sooner.)

And then there are two aspects of this whole process that are underrated: Water and sleep. If I don't drink enough fluids every day, I tend to stall on my weight loss. If I up the fluids a bit more, I find the scale moves more. And sleep is vital. For me, weight loss happens when I sleep. So getting better/more sleep tends to help me out.

I'm by no means an expert, but that sort of thing is what helps me the best.

Now, as to how to talk to your PA, explain to her that you don't want to be made to feel like you're the one who is always doing wrong. Tell her you've done everything you were taught, but that you're still not at your sweet spot. She will know that term. Tell her you're still getting hungry between meals, and you want a fill. Ask her to confirm the amount of Fluid in your band. They do that by extracting all the Fluid out of your band during the fill process, then they put it back in, plus the new fill amount. It's one way to know exactly how much is in your band. You may not have as much in your band as you think. And if she gives you attitude about it, then ask her point blank if there is someone else you can talk to about this.

Wishing you only good luck with things!

Dave

[Melissannde 41]

Dave's comments/suggestions are right on the mark.

If you have an 11 cc band, it's probably a realize band? And I think I read somewhere that the AVERAGE amount of Fluid to achieve good appetite suppression with those is about 6 or 7 cc's.

I weigh and measure my food (3oz Protein, 1/2 cup veggies) eat that and get up from the table. If 20 minutes later I'm still hungry, I eat more veggies. Usually I'm fine after the 20 minutes. If you're eating till you feel full.. that's part of the problem. I'd suggest using some sort of Portion Control for a while and see if that helps.

Best of luck.

[slm2007 7]

THANKS everyone. You guys rock. Yes, I do have a Realize band but I found this site before I was banded and figured Lap, Realize, it doesn't really matter, we are all bandsters, right?

I wonder if it is possible to just tell her to shoot me up to 5.5cc and see how I do. I can't imagine going through this for another 6 weeks until I get to 5.5. She said she only gives .5cc' which is the high-end of a fill? So if I'm at 4.5 cc's now, I get a .5 cc fill on Wednesday, I'm going to have to wait another 6 weeks for another .5 cc's.....I'm going to go insane! I'd like her just to try a full 1 cc on Wednesday.

This was a really good post for me to write. Dave, that was awesome advice and suggestions. Thanks so much. I know I really need to start listening to my body. I measure and try to watch but I still think to myself "this can't be enough food to fill me up." I guess my eyes are still in the old mind set?? I need to listen to my body and once in awhile I'll get that soft-stop and a little sigh will happen but most of the time I finish my "bandster portion" and I sit and wait, drink and wait, yep, still hungry. I just want to be "full" on my bandster portion, I'm still working on the head hunger and boredom hunger, but that is why I say I'm good most of the time. I know I'm not perfect and I'm not expecting perfect results. I follow the rules 90% of the time which is awesome compared to how I used to be and I'm changing my ways so I'm not expecting miracles just something for my effort and some help from my "tool."

I do Portion Control and eat off an 8" square plate. I do not overfill and have my portion control spoons and even those give you a lot of food...too much for my little plate. Maybe I'm just carbing it too much? I'll have to pay attention to that more.

Thanks again, you guys are awesome.

[Dave_NW 92]

I wonder if it is possible to just tell her to shoot me up to 5.5cc and see how I do. I can't imagine going through this for another 6 weeks until I get to 5.5. She said she only gives .5cc' which is the high-end of a fill? So if I'm at 4.5 cc's now, I get a .5 cc fill on Wednesday, I'm going to have to wait another 6 weeks for another .5 cc's.....I'm going to go insane! I'd like her just to try a full 1 cc on Wednesday.

I do Portion Control and eat off an 8" square plate. I do not overfill and have my portion control spoons and even those give you a lot of food...too much for my little plate. Maybe I'm just carbing it too much? I'll have to pay attention to that more.

Thanks again, you guys are awesome.

I have an Allergan lap band, so I'm not sure if it gets managed differently than the Realize bands, but I've had as much as 2.5cc added in a fill. So if yours can be done the same, then a 1cc addition shouldn't be a problem. But I'd insist they confirm your band amount before doing that. You need to know for sure how much is in your band.

As to portion control - I find it's tedious to weigh and measure every little thing. I go for average (bandster) portion sizes, served on regular plates, and eaten with regular utensils. I try to eat slowly and chew well, and when the food is gone, I'm done eating. Depending on what it is, sometimes I'm done eating before the food is gone. My soft stop is gentle burps and hiccups, and if I get to that point, I know I'm done eating for now. Eating past that point makes me feel overly full. And as Melissa mentions, getting up and leaving the table at that point is good - after 20 minutes if you're still hungry, eat some more. Chances are great you won't need to do that. The big thing is to get away from the kitchen, and more food. Sitting there only encourages you to eat more.

I do find listening to my system has been the best way for me to manage my band. My NUT had all these hairbrained ideas for me at first, very few of which have worked out. I've done what I think is best for me, and adjusted my behavior, exercise, and diet methods to suit what's working for me, in my life. And I'm doing great. So something must be paying attention -- oh yeah, it's ME!

Glad to help. Good luck!

Dave

[vickyd 24]

Dave has a lot of good points. For me, the biggest one is that "full" for me means something different than it used to. Now, "full" means I am no longer hungry (it used to mean if I eat one more bite, I might explode ).

You might want to try writing eveything you want to say down on a piece of paper and taking that paper with you to your appointment. That way, you have a "script" to go by so you don't get flustered when dealing with the PA. I also agree with Dave that you shouldn't be afraid to request another PA if the person you are dealing with isn't meeting your needs. This journey takes time and you need to be dealing with someone that you are comfortable with and who meets your needs as a healthcare provider.

Good Luck!

[honk 780]

Now, "full" means I am no longer hungry. I agree with this statement. I did not get restriction until 10.8 in a 11 CC band.

Did you have sessions with a psychologist presurgery to discuss eating "issues". I found these sessions really helpful. You need to recognize what foods you eat to excess. Over half of this battle is mental. Developing a new relationship with food is critical. Are you focusing on 3 oz of solid Protein every meal? Personally I get my carbs from veggies and fruit. I don't eat crackers/cookies/ice cream/pasta. I don't have problems eatin certain foods; I just chose not to eat them (breads).

[Melissannde 41]

THANKS everyone. You guys rock. Yes, I do have a Realize band but I found this site before I was banded and figured Lap, Realize, it doesn't really matter, we are all bandsters, right?

I wonder if it is possible to just tell her to shoot me up to 5.5cc and see how I do. I can't imagine going through this for another 6 weeks until I get to 5.5. She said she only gives .5cc' which is the high-end of a fill? So if I'm at 4.5 cc's now, I get a .5 cc fill on Wednesday, I'm going to have to wait another 6 weeks for another .5 cc's.....I'm going to go insane! I'd like her just to try a full 1 cc on Wednesday.

This was a really good post for me to write. Dave, that was awesome advice and suggestions. Thanks so much. I know I really need to start listening to my body. I measure and try to watch but I still think to myself "this can't be enough food to fill me up." I guess my eyes are still in the old mind set?? I need to listen to my body and once in awhile I'll get that soft-stop and a little sigh will happen but most of the time I finish my "bandster portion" and I sit and wait, drink and wait, yep, still hungry. I just want to be "full" on my bandster portion, I'm still working on the head hunger and boredom hunger, but that is why I say I'm good most of the time. I know I'm not perfect and I'm not expecting perfect results. I follow the rules 90% of the time which is awesome compared to how I used to be and I'm changing my ways so I'm not expecting miracles just something for my effort and some help from my "tool."

I do Portion Control and eat off an 8" square plate. I do not overfill and have my portion control spoons and even those give you a lot of food...too much for my little plate. Maybe I'm just carbing it too much? I'll have to pay attention to that more.

Thanks again, you guys are awesome.

Absolutely no problem at all on you posting on the lapband board. The reason I was asking if you had a realize band is that they are known for usually taking a bit more Fluid to reach "the green zone" than the lap band. That was the sole reason.

Regarding the "carbing too much" that you mention above.. if you're still eating white carbs (bread, rice, Pasta, potatoes, etc.) yes, that can be an issue that causes hunger when your blood sugar drops again. Those foods tend to spike our bld sugar, making us feel good temporarily, but when it drops again.. here comes that hunger again. And getting off of them for one meal isn't enough, takes about 2 or 3 days.

Hang in there.. and hope you get a good response this time.

[slm2007 7]

Well, went for my fill today...gained 2 pounds...SERIOUSLY!

Anyhow, yes, she made me cry but that is not unusual when I'm frustrated. She explained that I need to get off the carb bandwagon. I thought I was doing so well and following the rules for the most part because I was getting the Protein in. I was really, really trying to watch my calories and make sure I got good Protein, however, my carbs were apparently too high for her liking. I admit that I was rarely below or at 1,100 calories but never above 1,500 (and that was on two super bad days). But as I said, I'm hungry and she said it is the carbs fault...okay I get it. She said if I lay off the carbs I should be much better. I again expressed to her that I'm frustrated because I feel like I'm on a diet and I don't want to live on chicken, salad, eggs and tuna! I want to feel fullness/satisfied with two bites of a hamburger patty (no bun). I want to feel something is happening and nothing is happening....again she blamed it on the carbs. Maybe she is right? I have been proud of myself for the huge changes I've made, i.e. going from probably 3,000+ calories a day to 1,300-1,500 per day, and walking 45 minutes a day but apparently that isn't good enough.

She told me there is no such thing as a "sweet spot" and that is not what the band is about? I dont' get it? What is the band for then? If it isn't stopping me from eating (you know what I mean, I know I can eat as much as I want) but if it isn't helping control my hunger, why did I get surgery? What is the purpose? I know I have to work it but honestly, I could have starved myself with 1,100 calories, been hungry and walked without a band being put in place? If she tells me there is no sweet spot that people talk about, why is the band even done? I'm so mad right now. She gave me .5cc' fill and I'm so freaking sore right now and I have a huge black and blue mark on my stomach.

I just don't get the purpose of this band and why the recommend it if it is all up to you? She says I'm not willing to sacrifice? Seriously? I've done a lot of changes in my life but you are telling me that I have to live on chicken, fish, eggs and veggies....sorry. I'm going to end this rant now because I have a feeling I'm just going to start rambling and making no sense.

Thanks for listening. Really, no sweet spot? Then ALL these people must be wrong? I don't understand what the purpose of this surgery was anymore.....I just don't get it.

[lakegirl88 13]

I dont evan know how to respond to this. I feel so badly for you. If it was me I would find a new place for your fills. I love my Dr so much that I fly to Denver to get my fills. He never treats me that way. Yes it took me a looooong time to get to my SWEET SPOT. Yet once there it really WORKED for me. I am a slow looser and that gets frustrating, but I dont gain much if any back. I am going to get another fill soon as I am getting hungry sooner as well as eating a bit more.

Please consider another fill person. This person seems to make you feel like C@@@@p .

Good luck and keep us informed on your journey.

[Dave_NW 92]

I just don't get the purpose of this band and why the recommend it if it is all up to you? She says I'm not willing to sacrifice? Seriously? I've done a lot of changes in my life but you are telling me that I have to live on chicken, fish, eggs and veggies....sorry. I'm going to end this rant now because I have a feeling I'm just going to start rambling and making no sense.

Thanks for listening. Really, no sweet spot? Then ALL these people must be wrong? I don't understand what the purpose of this surgery was anymore.....I just don't get it.

You need to find someone else to do your fills. She's giving you conflicting information that is not helping you, and you're not getting the right kind of support. it's one thing to show/tell you how to do things better, but it's quite another when you're stressed out and crying after your meeting. And if you're black and blue after a fill, somebody isn't doing things right. Find another person to give you your fills.

The "sweet spot" is one term for the optimum amount of fill in your band. See this link for a chart that shows what it's about. (My surgeon has this chart on the wall of every exam room at his clinic.) http://all-about-lapband.com/post-op/fill-chart.html

She is right, too many carbs can sabotage your weight loss. if you want to eat a lot of carbs, you're going to have to make changes in other parts of your diet. It's the BALANCE of Protein vs. carbs that help with your weight loss, and you DO have to make adjustments to your diet to get the results you want. Just walking for 45 minutes may not be enough exercise to burn enough calories to offset the diet you're eating. You may have to get into the gym and actively burn off more calories than that.

You shouldn't be chasing a "two bites of a hamburger patty" meal and expecting it to be enough to satisfy you for several horus. It may be fine for awhile, but you'll find yourself getting hungry within a short time. And if your meals are carb-loaded, you'll feel hungry even sooner. So in that regard, you do have to "diet" (in the sense of planning what to eat), but you shouldn't have to feel deprived.

I said this before, and it bears repeating: All the band does is help dim your appetite. You need to use your willpower and common sesne to control what you eat, and when you eat it. The band is not magic, nor will it do the hard work for you. it only gives you control over your appetite. Nothing more. And the rest is up to you.

One thing I use that helps me tremendously, is the Bodymedia.com FIT armband. It's made by the same people who make the Bodybugg, worn by contestants on The Biggest Loser. This gadget measures your activity, helps track your calories eaten, shows calories buned off, and even traacks your sleep quality. I especially like that it shows the nutritional breakdown of foods I've eaten. Over time, you can see trends in your weight loss, and learn how to best manage your plan. I've worn mine daily for over six months, and I won't be without it. www.bodymedia.com. You can learn about it there, but if you get it, shop around. costco.com and BestBuy.com sell them for less.

Good luck!

Dave

[slm2007 7]

You need to find someone else to do your fills. She's giving you conflicting information that is not helping you, and you're not getting the right kind of support. it's one thing to show/tell you how to do things better, but it's quite another when you're stressed out and crying after your meeting. And if you're black and blue after a fill, somebody isn't doing things right. Find another person to give you your fills.

The "sweet spot" is one term for the optimum amount of fill in your band. See this link for a chart that shows what it's about. (My surgeon has this chart on the wall of every exam room at his clinic.) http://all-about-lap...fill-chart.html

She is right, too many carbs can sabotage your weight loss. if you want to eat a lot of carbs, you're going to have to make changes in other parts of your diet. It's the BALANCE of Protein vs. carbs that help with your weight loss, and you DO have to make adjustments to your diet to get the results you want. Just walking for 45 minutes may not be enough exercise to burn enough calories to offset the diet you're eating. You may have to get into the gym and actively burn off more calories than that.

You shouldn't be chasing a "two bites of a hamburger patty" meal and expecting it to be enough to satisfy you for several horus. It may be fine for awhile, but you'll find yourself getting hungry within a short time. And if your meals are carb-loaded, you'll feel hungry even sooner. So in that regard, you do have to "diet" (in the sense of planning what to eat), but you shouldn't have to feel deprived.

I said this before, and it bears repeating: All the band does is help dim your appetite. You need to use your willpower and common sesne to control what you eat, and when you eat it. The band is not magic, nor will it do the hard work for you. it only gives you control over your appetite. Nothing more. And the rest is up to you.

One thing I use that helps me tremendously, is the Bodymedia.com FIT armband. It's made by the same people who make the Bodybugg, worn by contestants on The Biggest Loser. This gadget measures your activity, helps track your calories eaten, shows calories buned off, and even traacks your sleep quality. I especially like that it shows the nutritional breakdown of foods I've eaten. Over time, you can see trends in your weight loss, and learn how to best manage your plan. I've worn mine daily for over six months, and I won't be without it. www.bodymedia.com. You can learn about it there, but if you get it, shop around. costco.com and BestBuy.com sell them for less.

Good luck!

Dave

Thanks Dave:

Yes, I do realize now that I'm carb heavy. I think I was concentrating so hard on getting Protein and calories correct, that I didn't pay attention to the carbs I was eating. I'm going to work on that!

I know the band won't do the magic for me....I'm willing to work with it and maybe once I get the carbs under control it will start to fall into place because like I said, right now, I feel like it is ALL up to me and there is no appetite dimming at all

Back to the drawing board and THANK YOU everyone for the words of encouragement.....I really need it right now.

:thankyou: