Or more properly, an adjustment. The beauty of the Adjustable Gastric Band (AGB) surgery is that it is adjustable. Through the fill port, the Doctor, using an hypodermic can inject fluids into the fill port. The fill port is connected by a small tube to the actual band thereby changing the amount of pressure that is exerted on the stomach walls. This in turn, changes the size of the stoma. Which in turn varies the amount of restriction that you will feel. The reason this procedure is called an adjustment is because the change can be either positive or negative. In my case, I have had two adjustments to tighten the band (Week 8, week 14). Then had fluid removed (Week 33) to decrease the tightness of my band.
When the band is installed, it is generally installed empty. Or the surgeon may opt to make a minor fill at that time. In my case, The band was installed in me with no fill fluid present.
The general advice about the first, second and third fill is quite simple. Wait until the weight loss is stabilized for at least 3-4 weeks. Then it is time for a fill.
Another reason for the wait is the stomach needs to heal. Those sutures need time to heal and to form a healthy layer of scar tissue. This does not occur overnight. Even though, the pain goes away in a week, doesn't mean the stomach has completely healed. Remember, you have literally been stabbed in the abdomen don't let your impatience with weight loss cause you to lose sight of the long term weight loss and ultimate health.
NOTE: During the time prior to the first, second or third fill, you may not feel any restriction to eating at all. This is quite normal. In my case, I did not feel any restriction at all until my first fill. I got my first fill at 8 weeks. During that first 8 weeks, I could eat anything and everything. There was no apparent impediment to eating. But, during that time, I lost a bit of weight. At about 5-6 weeks, my weight leveled out and I stayed at 285 # for the next 3-4 weeks.
I may be the only person on the planet suggesting this, but I view a fill as somewhat of a minor operation. I feel, that the stomach is one organ that does not like to be moved, shoved, disturbed in any way. If it is, it gets upset and in general don't like it. So, what to do? What I have done prior to the fill process is to consume only water for the 12 hours prior to the fill.
REASON: To flush the stoma, remove any food that may get trapped in the folds of the stomach. In general: to remove any reason for a complication.
One of the most controversial parts of the adjustment discussion. So here goes. Every one of us are different. The location of our particular bands, the placement of the device, the thickness of our individual stomach walls, the type of band, your shoe size. All are different. Keeping this in mind, all adjustments are totally independent, individual and unique to each of us.
WARNING: Do not compare your fill numbers with anybody, these numbers are unique to you and to you only. For Example: If You have a fill of 3.0 cc and I have a fill of 3.2 cc. Comparing those numbers means absolutely nothing. My internal geometry, band, stomach etc. could be way different than yours. Due to that, the amount of tightness is individual and cannot be compared person to person. Well, enough of beating that horse to death. Now back to the main question.
HOW MUCH TO FILL: When you first get the band, the band is installed with none or a minimum amount of fill fluid. In time, you will lose a bit if weigh. Now, to put things into scope, the walls of the stomach contain fat. This fat contributes to the thickness of the stomach wall. As you lose weight, the stomach loses fat and the thickness of the stomach wall gets thinner. Consequently, the band gets looser and looser. The restriction that we all wants diminishes, and you are able to consume more. The weight loss slows down. What do we do? Get a fill.
In general, the first few fills are just to "take up the slack". Not necessarily to provide any true resistance or restriction. So how much to fill? Lets admit it, most Doctors are practical and efficient. They have found that most of the patients need a certain amount for the first and second fills. So they pump you with that amount for the first and second adjustment and don't really think about it. Nothing wrong with that procedure, but beware of an over fill.
WARNING: In retrospect, my second fill was a bit aggressive. If I had to do it again knowing what I know now, I would have advised the Doctor to be less aggressive, taken a bit less for the second fill and waited a bit longer for the weight to come off.
So What is wrong with an overfill? The newly banded person somehow perceives that more fill is better fill. That a fill of 2.8cc is better than 2.5cc. Nothing could be further from the truth. There are many dangers with an over fill. The absolute worst thing that an overfill can do is KILL. Huh? Well let me explain. If the pressure inside the band is greater than the blood pressure of the stomach, the pressure of the band can cut off the blood supply to the stomach walls just under the band. When the blood supply is cut off, the tissues of the stomach cannot get blood, oxygen and all that. And the tissues die. The solution, don't overfill the band. The band is designed to operate with time. Give it time.
Subsequent fills: So the first few fills are just to "take up the slack". What about further downstream? Here is the artistic side of band maintenance, adjustments, and all that. So what do I mean? When you have had 2-3 fills, the fills after that are going to be a bit to artistic trial and success. The adjustments are going to be minor. Perhaps as small as 0.1 cc. And the effect will be great. Keep in mind this will be changes on a band that has been in place for quite a while. The stomach walls have shrunk quite a bit. There is not a lot of room to maneuver. So the strategy here is add some, take out half, add a quarter. Divide and conquer.
So - How to tell you have a proper fill? For the first few fills, you may feel nothing different at all. There will be a bit more restriction, but nothing too bad. When you get to the proper fill level, you should be able to swallow your own spit, sip water. If the fill is getting close to optimum, you might be able to "gurgle" as you drink. This is perfectly normal. How to explain it? Imagine turning a water bottle upside down. Notice how as the water escapes, that air has to "gurgle" into the bottle to displace the water leaving. In this same manner, as you drink, the air in your stomach escapes up though your esophagus and make a cute gurgling sound. This has provided me with interesting sounds in the middle of the night.
Treat your stomach as if it just had minor surgery. It is not used to being moved, squished, prodded, etc. You have just shoved it around, squeezed it a bit and it will get upset. It might make you feel nauseous for a few hours, it might swell up for a while. In general, it might act like a spoiled child.
WHAT TO DO: Well, it appears the best thing to do is give into it. Go back to fluids for 24 hours. Let the stomach do it's thing. Let the stomach get used to it's new collar, new tightness, new control. It will come around. In general: Treat your just filled stomach as if it was a new surgery. Liquids for 24 hours.
A whole bunch. The bottom line. Do not overfill. Overfilling causes many avoidable side effects that can be avoided by not overfilling. Encourage your Doctor to under fill you. Particularly the first and second fills. Time is on your side. The band demands time. Use time to your advantage. Keep in mind, the tightness of the band is just one part of the whole equation. The other parts are equally important: Exercise, Protein and Water.
Yes, I have a few. To get one, the price is $20.00 US$. Cache, Cheque or first born Son. For the mailing address: Send request to: mailto:wsmith_AT_waynesmith_DOT_net (Remove the underscores]
NOTICE: All opinions expressed herein are the author's own. None of this is to be construed as to being medical advice.