What is a good fill? (Re-post)

I'm seeing an awful lot of people here with signs of a too-tight fill. It's essential that we understand that the #1 reason for ALL the major and monor ban trouble, including those leading to stomach damage, band loss, and even esophgeal cancer from ongoing reflux - is trying to keep a too-tight fill.
I'm afraid that not many docs are educating well on the signs and symptoms of a too-tight fill, or the definition of a GOOD fill. we are NEVER meant to be trying to tolerate the largest, tightest fill possible. We want AS LITTLE fill as possible, to still give us some help.
I hope this education document that i have posted here regularly over the last 5-6 years, will help. It was developed for and approved by the major surgeon I worked for for several years as a Patient Educator. 

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

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 US docs rarely use a fluoro with routine fills. They consider it unneeded
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 other  cir****tances - assessing possible band/pouch problems, for instance. IMO, we all need one every 6-12 months, to try to catch any problems starting to arise. 

I personally chose to get only one fluoro a year, to check band
position, pouch size, etc - never with every fill. 

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 time of the new fill, 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 will never meet nutrition needs for health
or safe loss. we are never trying to at as little as possible. 
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. this means 1-2x a month, max, imo
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/or 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 wide variety of foods
5. Struggling to meet fluid needs
6. ANY REFLUX. this means ANY! :-)  (See the "reflux" document) 
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. WE need these daily. 
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
extra after all previous diet attempts.

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
banded March, 2003
At normal BMI goal 6+ years 

nicely said.  I am also a long-term member of this banded living community, in my 4th year and maintaining a normal BMI.  Thanks for posting this!

Gloria, you've done great!

Dr Billy is excellent, and I have sent a number of patients to him for banding, and many Kuri bandsters to him to get much better aftecare and to get help for trouble. He's the best, in my book !  You're very fortunate to have him. sure wish every doc had his team of people following up and educating their patients.

sandy r

Thanks Sandy,
I couldn't be happier with Dr. Billy and his aftercare program or my decision to get my band.  I'm a new person and I love banded living.  I'd appreciate your help.  I recently started a blog as a way of paying it forward.  It's a retrospective blof of my decision process and my journey aimed and providing support, education and inspiration.  I'd really appreciate if you would have a look and give me some feedback.  Here is an excerpt from a recent post about the "rules" of the band with a link to my blog:
 

I recently started a thread on one of the Lap Band message boards about the rules of the band.  It turned into a passionate debate, and a huge source of inspiration for me.  The manufacturers of the bands have “rules" or “tips" posted on their sites.  What I learned from my fellow members of the Banded Living community is that  1) a lot of us don’t like “rules" because we’ve tried them before and frankly they didn’t work as a way of life and 2) we are all different, and we need to work hard to find what works “for me."

So here I am, in my fourth year, and maintaining a normal healthy weight and in the best shape of my life. I devote a lot of time and energy to paying it forward.  I mentor lots of folks, some of who are frustrated or struggling and trying to figure out how to get the most out of their tool.

My doctor, my head coach on this Banded Living journey reminds me over and over again, that it’s a tool, and I need to work it.  I shouldn’t expect “it" to do anything.  (A screwdriver can’t remove a screw unless you turn it.)  I have to work it to get the results I want – and for me that was more than the average 5o% Excess Weight Loss.  My band helps me with portion control, controls my hunger and leaves me with a feeling of satiety when I work it. 

Here are the 10 things I learned about how to use my tool: 

1. I stay close to my surgeon and have a whole team of people to help me on my journey.  It starts with my surgeon who is my head coach.  I also surround myself with other successful members of the Banded Living community. www.gloriasbandedliving.com/transforming-003-maintaining-004 -getting-the-most-from-my-lap-band%c2%ae-how-i-learned-to-us e-my-tool/

I'd like to keep in touch.  Like you I am very committed to paying it forward!