When to stop getting band filled?

Hi everyone,

This is my first post since surgery almost five months ago, but I have been "lurking" for a while and really appreciate all the great advice I have gotten through reading posts. However, I have several questions related to knowing when to stop getting the band filled that have not seemed to be addressed recently.

I am down about 20 pounds and am at 7 CCs filled after 4 post-op fills. As my band has been filled, I have started noticing some of the results and side effects people mention on this board. After fill #3, I occasionally started feeling pressure when swallowing harder foods or food that wasn't chewed very well. It feels like the food is having trouble getting down my throat or esophagus sometimes, but maybe this is the food trying to get through the band. Does anyone have any advice on how to tell the difference between trouble swallowing (which I have read to be a common side effect) or actual band restriction? The feeling starts just after swallowing, so I keep thinking this is a swallowing side effect and not actual restriction. It sometimes takes 30 seconds to a minute before the pressure/pain stops, but afterwards, I am still quite hungry and I find that I can still very large portions of food as long as I chew very well.

After fill #4, the swallowing pressure is more common, and I had once incident about 5 days after the fill where I ate just a couple bites of rice and chicken that did not stay down. This is the only vomiting I have had since surgery, and my guess is that a small piece of rice or chicken got stuck in the band (possibly due to not chewing well enough or the fact that it was only 5 days after my fill). I have not had any incidents after this point. Other than this incident, I felt satisfied after eating normal servings of food for about a week, but I am back to feeling like I can still go to a buffet and eat a very large quantity of food (not that I will!). How do I know if I have enough restriction? Should I feel full after 4 to 6 ounces of food (I currently do not unless I have trouble swallowing)? What does restriction really feel like (pain, pressure, or satisfaction)? I think what is difficult for me is that I do not really know what restriction should feel like. I would appreciate any advice or experience you have to offer. Currently, I am maintaining but not losing weight, and I feel like I should get another fill, but I'm also worried that my vomiting incident after fill #4 was a sign to stop with the fills for now. Of course, I will consult my physician, but it helps to get advice here first.

One final question- Are there really different sized bands? And do larger bands typically require more fills? At my last fill, the nurse told the doctor "he is currently at 6 CCs and this is his 4th fill, but he has a large band". I didn't really get to ask questions about this, but has this topic come up before? I felt a little relief when I heard that I had a large band because I feel like it helped to explain why the first three fills did little for me.

Thanks in advance for any advice. I am very glad that I found this site because it has been really helpful to hear from other people who have been where I am now.

-Mark

I have to be honest, I don't know how much fluid I have in my band.

To me -- there are 3 levels --- too little, too much and just right.

IF I eat 4 ounces of lean protein and some vegetable, and STOP, then a few minutes later, I realize that I have had enough.  I don't feel full -- I don't feel stuffed --- I could eat more, but I don't.

That is what 'restriction' means to me -- that I can eat a small portion of good/healthy protein and produce and then step away from the food --- and a few minutes later (usually about 15 - 20 minutes) --- I recognize that I am not hungry.

If I eat until I feel full, I have overeaten.

[quote]After fill #3, I occasionally started feeling pressure when swallowing harder foods or food that wasn't chewed very well. It feels like the food is having trouble getting down my throat or esophagus sometimes, but maybe this is the food trying to get through the band. Does anyone have any advice on how to tell the difference between trouble swallowing (which I have read to be a common side effect) or actual band restriction?[/quote]

If you are experiencing any kind of difficulty swallowing or pressure or even slight pain when eating/swallowing, you are probably either 1) too tight or 2) not making your bites small enough or 3) not chewing well enough.

Try making your bites about the size of an english pea or a regular pencil eraser.  Use some sort of "food lube" (low carb ketchup, low cal bbq sauce, mustard.. something like that) and see if that helps.  Avoid meat that is dry.  Chicken breast is a notoriously difficult protein for many bandsters, but if cooked in a way that makes it moist, it can be ok.

[quote] I felt satisfied after eating normal servings of food for about a week, but I am back to feeling like I can still go to a buffet and eat a very large quantity of food (not that I will!). How do I know if I have enough restriction? Should I feel full after 4 to 6 ounces of food (I currently do not unless I have trouble swallowing)? What does restriction really feel like (pain, pressure, or satisfaction)?[/quote]

I don't go by feeling full.  If I eat till I'm full, I've probably overeaten.  My doctor says to eat 3oz of protein and 1/2 cup low carb veggies and stop.  If still hungry after 20 minutes, I'm allowed more veggies (understanding that these aren't veggies loaded with cheese or butter or some other high calorie sauce).

The band really isn't about restriction, although that word is very commonly used.  What you're aiming for is appetite dimming.  Dr. Simpson has an excellent explanation of the mechanism.  Please take time to read the article and discuss this approach with your bariatric team.

http://drsimpson.net/fills/Lap-band-eating/lap-band-not-restriction/lap-band-and-restriction.html

[quote]One final question- Are there really different sized bands? And do larger bands typically require more fills?[/quote]

Yes, there are different sized bands.  Allergan (lapband) has the AP Standard which is 10cc and the AP Large which is 14 cc.  I'm not sure of the sizes of the Realize (Johnson&Johnson ~ I think?), but I'm pretty sure they have an 11cc and a 14cc and maybe one other size.  You can go to the websites for each maker and get more details.

And yes, it's typical for a larger band to need a little more fill for the patient to start feeling appetite suppression.  Doesn't mean it will hold true for everyone, but it's not unusual.

Hope some of this information helps.

ETA: well phooey, formatting didn't work.  sometimes I hate posting on OH.  LOL.. I'm so OCD.  :)

Hi there,

I have a large band too -- the  14cc one and it took several fills to get it adjusted to a good level - -seemed like it would never happen! Since getting it adjusted tight enough, I've noticed the same thing you do  (that tight, uncomfortable feeling right at the back of my throat) if I don't chew very well, or the bite is too big, or I take my bites too close together. It is so weird that you would a feeling right at your throat with too big of a bite. With the band around our stomachs you'd think it would be in that area we would feel the discomfort.
 
Anyway, whenever I start to get this feeling, I take it as a warning sign I need to slow down eating and pay more attention.

Even with good restriction, there are times where I also feel like the band is a little looser and would allow me to eat more food. That's pretty common. The key is to not overindulge when you feel like that.  One of the other commentors put it well: the band works by dimming our appetite.  My surgeon basis the decision to do a fill or not on by how long we stay satisfied between meals. For me I'm good for 4+ hours if I eat protein and veggies and that works well for me.  Others may need a small snack in between meals and that is okay too, so long as you are not ravenously hungry and eating a large portion for a snack.

Good luck to you,