Too tight (looking at unfill #2)

I had a dilation and complete unfill almost 2 years ago. I didn't go back because aftercare needed my surgeon to okay me to resume and at first I didn't have the copay money in the budget and then I just didn't get around to going back. I tried Medifast, lost 50 lbs, went off it and then gained the weight all back. I'm still 40 lbs down from my pre-surgery weight, so it hasn't been a complete failure.

I had a barium swallow last Friday. Looked good. Went to my surgeon on Tuesday for the okay. He said I was fine and gave me a fill right there, 3 cc. Water went down okay in the office but Tuesday night I got tight! Liquids wouldn't go down, acid reflux, the whole nine yards. Went back Wednesday and had him take 1 cc ou****er went down okay in the office and I had some protein shake last night. Today I'm tight again. I've been able to get half a cup of hot tea down but not any protein shake. At first I hoped it was just morning tightness but now I'm feeling super frustrated and defeated.

I looked back on some old journals and I guess being tight after fills is a recurring nightmare for me. I don't really remember all the details over the years but I don't want to get dilated again (twice in 7 years). Maybe my band is just unusually sensitive? I try not to focus on the numbers, but going forward I'm tempted to ask the clinicians to think of what they want to put in and then put half of that in.

I'm trying some soup for lunch. I'm starting to get a little worried that I'm not taking in enough calories or protein. At least the tea went down, so I'm not worried about dehydration so much. I hate how its hard to tell if food is going down but I'm eating too fast/too much or if I'm just still too tight.

The trouble is that I really don't have the time today to take off from work to go in again, especially with the hours I still need to make up from my 2 trips so far this week. I have to go to aftercare if I need more taken out today, which does not have work-friendly hours. I won't even think about the copays for all of these visits yet since I have a new insurance provider and I'm not sure what they're charging.

I think I'm still too tight. Soup did not go down well. So now I have to decide to go in today or try for Friday morning? Either way I have to take more time off of work. *sigh*

Anyone else who's been at this point?

That is a pretty common problem especially the farther out you get. The longer we have the band the more scar tissue builds up underneath it, causing it to be tighter. So many docs don't even realize or accept this but it is proven over and over when bands are removed that there is a tremendous amount of scar tissue. I paid for 2 partial unfills and decided enough is enough and had mine completely emptied to hopefully avoid further damage until I can get insurance to remove it. Thank God I haven't had any further issues in the 2 yrs since I had it emptied and actually I can now eat healthier foods so haven't gained any further weight, altho I never lost a whole lot to begin with. So you may just need to go very light on fills or just stay empty. You may be ok with just fluids till tomorrow but do get some out as soon as possible, you don't want to push your luck.

I feel your frustration!  I seem to be either very hungry or too tight.  I have had a .1 fill bring me from hungry all the time to not being able to tolerate protein shakes.  I wouldn't hesitate to get an unfill.  I know I suffered needlessly because I thought maybe it was just swelling from the fill.  Never turned out to be the case. I say go in ASAP.  Sorry you have to miss work and I know the copays stink.

I was always fill sensitive.  At the fullest if I got .5  cc I would have to go back and get .25 cc back out.  I was totally unfilled at 1 year out and two years out.  The last 18 months with the band I never had over 6.5 cc (I had 8.75 in a 10 cc band at one year out). They spent the last 9 months removing fill ever months as the band was getting tighter and tighter untill totally unfilled for the third time and than removed.

That is what I  had to deal with on my last 2 fills. I was at 6cc from 4/09 to 1/12 ( not by choice) I left the state that my surgeon was in, got a new surgeon and Only 1 fill of 1cc. and came back  a year later,no insurance so gradually trying to increase restriction. Once I got to 8cc I was too tight, but had to wait and entire month before seeing my surgeon. (because his staff was terrible at scheduling, or would tell me to go to the ER or he was not in the office (typical response) So after being tortured for a month. only eating 500 calories a month. I finally got to see the surgeon and got a slight unfill and an RX for a PPI. A month later same thing happened, too tight. reflux UGH. But by this time i was experiencing severe Left shoulder Pain and gave up getting fills.

And yes Scar tissue builds up, but the doctors seem to ignore it, sorry your going through this I Hope you find a resolution.

Thank you for the feedback on the scar tissue - I was NOT aware of that issue. Another issue I just became aware of this week is the permeability of the band. I had no idea that fluid can migrate in/out through the band.

I went through Thursday able to drink hot tea, but not anything thicker like a protein shake. So I made an appointment this morning. Another barium swallow revealed dilation. Wow! I was shocked it happened so fast, especially since I was trying to take tiny sips to determine whether or not they were going down. The PA told me not to stress out about it because she's even seen it happen overnight before.

So out the fluid came, 2.5cc when there was only supposed to be 2cc in there. That's when I realized another thing my doctor doesn't do that aftercare does. Before they add fluid, they remove it all so they know for sure how much goes in. So there could have been fluid in the band already when my doctor put all of that in! I don't think I want him giving me fills anymore.

I'm not sure if she left .5cc or emptied it because we discussed both, but I have 3-4 weeks to heal before I get fills started again. Liquids for 3-6 days then mushy for 3-6 days and liquids 3 days before my next appointment. And another barium swallow before I see my surgeon in 4 weeks. I think I'm going to let aftercare do my fills and we're going to go super slow this time!

Even if I don't have great restriction, it looks like I'm going to lose some weight on this liquid diet regardless. I'm down 7 lbs since Tuesday, but what a miserable way to lose it!  I'm struggling today to get back to equilibrium - I was able to get a Slimfast down but I still almost passed out a short while ago after standing for 5 minutes. Thank god for desk jobs! I'm probably dehydrated too, so I'm trying to get lots of water in. I need to make up time from my doctor appointment to save the amount of sick time I have to use, but I'm feeling terrible today.

When I had the problems at one year they took out all the fluid and I was left unfilled 6 weeks.  The second time at two years I was left unfilled for 8 weeks. 

Good luck with your fills, baby fills does it.

I would get a slight un fill. It's terrible that you have to take off work, but this band takes a lot of aftercare! I wouldn't get a lot taken out though, maybe .50. Then see how you do. Good luck.

If you had a dilated pouch that long and still having issues, you need to look into repairing your pouch/removing the band or revising, instead of the unfill/refill game, you are wasting your time on this. Some dilations can be fixed by totally emptying the band (which you mentioned you already did). If the pouch gets too big and the band stays too tight too long your chances are slim in getting your band to work again properly.

Any time you get an adjustment and the band is very tight and you experience ANY reflux, at THAT point it is wise to remove saline, but if you were very tight for long periods of time and the reflux got worse over time, and you started vomiting in your sleep, frothing at the mouth and the band got tighter and tighter to the point were you could not drink liquids....AT THIS POINT, the band gets damaged beyond getting it filled anymore without issues.

If you can't get a revision now, but still want to use your band, never get a big fill, with a dilated pouch, you have to be very careful with fills, you can't get big fills like someone with a healthy band, you have to go small, yes this may cause more money, but that is the only way you may be able to get some restriction without being too tight, 3cc was a BIG fill even without dilation, you made a mistake there, refilling a band with a dilated pouch must be done in carefully and smaller increments, IF you are able to remove saline 'safely' you may want to remove another .5ccs since you've already removed some, remember when your pouch is dilated you have to be EXTRA careful with everything, eating, vomiting and getting it filled.

Living with a dilated pouch is only a band-aid approach to a damaged band, you really need to be looking into getting your band fixed, removed or revised, it's just only time before you start having issues with it.

This has been happening to lap banders for years and very common (WHICH CAUSE BAND REMOVAL)  this is why Allergan has that warning Chart of fill levels, if a new lap bander ever start experiencing the symptoms below they need to remove saline immediately...sometimes removing only .1cc will get them out of the red zone...if they do not remove saline immediately this will cause the pouch to dilate and damage the lap band system, I've had friends over the years never removed saline when their bands were too tight and they took PPi's, slept in recliners, slept on a pile of pillows until the reflux got unbearable.

 

The goal is obviously to stay in the green zone.  This zone optimizes weight loss and comfort and minimizes side effects.

 

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I have a 4 cc band and have never been able to get above 1.5cc. Because I have never reached full restriction my doctor has recommended a revision. Last week I had my band emptied because at 1cc. I was too tight. I still feel my band was a success because I kept off 60 out of my 80 lb. loss!