When do I need more fill? (Education document, re-post)

When do I need another fill?

First, let’s review what a GOOD fill is, and then we can discuss when another fill might be needed.


These are the things that together  help tell you that you have a good fill:

1.You are losing about 1-2 # a week or more, averaged over a month’s time or longer. Don’t panic if you have not lost weight for only a couple weeks – our weight loss will never be steady or predictable. The body needs regular rest periods to “compact". Still, try to never go beyond 4 weeks without losing – ask for help. 
2.You find your hunger is dimmed, and you don’t get very hungry between meals. This is assuming you are eating good band foods and following the eating guidelines like no fluids for an hour after eating. 
3.You aren’t thinking about food all the time. 
4.You are having no reflux and are only rarely having PB’s or getting “stuck,." Or having other problems.
5.You’re able to get the minimal calories in  -at least 1200-1500 a day, for women, and at least 1800 or so for normally-active men. Those starting heavier, or doing better than average exercise need more calories and more protein. Most docs now want everyone to have 90-100 gm a day of ptotein , to preserve muscle mass. 
6.We can eat  at least 2 small meals , and ideally 3, of solid protein and good carbs a day. (Some people are too tight to eat solids in the morning, and this is another issue to  cover another time)
7.You’re meeting the nutrition goals – the protein, fiber, calcium, omega oils, good carbs, etc. 



So, OK,  how do I know when I might need another fill??

1.Your weight loss has stopped for 3-4 week or more weeks IN A ROW, and you KNOW you’ve been doing pretty well with food choices, liquids, exercise, and the other things. . 
2.You are getting honestly  hungry again between meals and thinking about food a lot
3.You ARE NOT  having any regular  trouble with the last  fill. 
4.You find you can eat a lot more than you could before, even of good band foods. 
5.You’re honestly not satisfied with 1-1.5 cup meals – but  this only applies if you are choosing good BAND FOODS for that meal. 
6.It’s been at least a month since your last fill, and really see no improvement in food quantities or less between-meal hunger’. 
7.You are not relying on protein drinks, any other liquid calories, or soft foods  to get enough nutrition.


Before I go for another fill, what else should I check, to be sure?

1.I’m still eating pretty well – protein and veggies, mostly. 
2.I’m still getting about the same amount of exercise
3.I’m doing pretty well with getting fluid in
4.There really haven’t been any big changes in my life that are producing extra stress
5.I know the difference between “Head and Heart" hunger and real, physiological hunger. 



Why not just always go for more fill?

It’s always best to have as small a fill as you can have to still lose well. Fewer problems occur with smaller fills, but – still – you need ENOUGH to do well. It can be a fine line, so you have to be patient and flexible sometimes. WE should never run for more fill the second our loss slows or stops. 

Be sure you’re getting regular fluoros. Sometimes, if we find we can eat more and more and more, when we have had a fill that was TOO tight before, we might have a pouch dilation. This requires an UNFILL for safety. It would be dangerous to get still more fill if we have a pouch dilation.  A dilation can be seen only with a fluoro exam. 

These are signs of having TOO MUCH FILL:

1.ANY persistent reflux, especially at night
2.Any new or worsening asthma, new ear infections, new dental problems especially in the lower back teeth – these are all the subtle signs of reflux. , 
3. Unable to eat at least 2, and preferably 3, meals a day of mostly solid protein.
4. Depending on liquid calories, protein drinks, or soft foods to get in needed calories and nutrition. 
                
5. ANY regular trouble with sliming, pb’ing, barfing.  
6. Any persistent pain in the chest, a lump in the throat, persistent left shoulder pain (only after we have started with fills, not in the post-op period) 

Please never try to keep a “too-tight" fill –that is the biggest reason people have slips, erosions, and other very serious band problems. 



Sandy Richards, BSN, MN
Patient Educator 
updated August, 2009

Remember these are rules of thumb.  For some of us, like me, I just went to see my doctor thinking since I'm getting more hungry more often (real hunger) and still eating my high protein diet that I needed a fill.  He stated to me that because I do high intensive exercise that it is okay to eat when hungry making sure I eat protein snacks.  The best thing is to consult your physician.  But a great guide!