By: Gloria Samuels

As lap band patients we need to work with our doctors to assess if we are too loose, too tight or just right.  No other weight loss surgery is adjustable.  Fills are unique to lap band surgery.  Common questions include:

1. How do I know when I have a good fill?
2. What will it feel like?
3. How many fills does it take?
4. What fill volume should I have?
5. Am I too tight?
6. Am I too loose?

 I'm convinced that a good fill is as much of an art as it is a science.  I also know that we are all so different when it comes to fills.

 This is one patient's perspective:

"It took me many fills to get to just the right place, where I'm satisfied with a small amount of good quality food, and not obsessing about my next "fix" between meals.  Conversely, my mentor never needed a fill at all during her entire first year after surgery.

When it comes to assessing where I am, I've also found that I need to remember that it's the trend that matters.  What I mean by that is that some days, I feel looser, and some days I feel tighter, and some days I feel just right!  I've come to accept those variations as normal, and I can usually adjust my food choices accordingly.  I've also learned that if I have an episode of being stuck, I can be irritated for days.  If I don't go back to liquids and give myself a chance to allow any irritation to subside, I can get irritated and swollen and end up feeling too tight.  That can take days to resolve; it can also require a small "un-fill", but after having that experience, more than once I might add, I've learned to catch it early and try to avoid the cycle of un-fill, feeling too loose then re-fill.

Believe it or not I don't know exactly how much fluid I have in my band; I stopped focusing on that a long time ago!"

As a patient you can be your own advocate by being able to clearly describe what you feel to your doctor.  Here are four things that you may want to discuss with your doctor if you think you may need an adjustment:

1. Volume
   How much plain dense protein can you comfortably eat in one twenty minute sitting (without food lube)? Patients often feel best and have good weight loss when we can comfortably eat ½ cup to 1 cup of dense protein like chicken or fish, without food lube in a twenty to thirty minute sitting.


2. Satiety
   Did you feel satisfied after eating? Note we did not say Do you feel stuffed or uncomfortable? Satisfied is a more subtle cue, like you've had enough and you can push away from the table and stop thinking about food. This is not the absence of emotional or head hunger. But finally feeling satisfied, on a small amount of food, can help you to recognize the difference between physical and emotional hunger. Understanding and recognizing these cues may take some practice.


3. Hunger Between Meals
   Are you hungry between meals? What is the intensity of your hunger between meals? How long does the absence of hunger last? With a properly adjusted band most patients say they're not hungry for at least three to four hours after a meal. That can help you to be comfortable and in control of your choices; it should not require unnatural acts of willpower to wait for your next meal next meal.


4. Problems, Difficulties and Changes in Your Medical Status
   Are you experiencing vomiting or reflux? What foods give you trouble? Are there any changes to your medical status that may be relevant, such as an illness or pregnancy? It is very important to be honest and communicate any concerns, discomfort or changes with your doctor.

Your doctor will have other criteria that he/she considers.  For example, are you losing weight?  Where are you on your weight loss journey?  What is your history?  What is the practice's protocol?  That being said, it is helpful to be able to clearly and honestly describe what you are feeling to your doctor so that you can work together as a well informed team. 

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