Back and Forth with fills, but never Just right ??

[Guest guest]

Back and forth with fills, but never " just right " ?

A number of people have emailed me in the last week or so, having great trouble

with fills. I thought I'd address this, for those interested, with the

techniques I use and strongly recommend.

In my 6+ years as a Bandster, and 5+ years as a band educator, this is a very

common problem.

IMO, many if not most, surgeons and fill people are far too aggressive with

fills, and then also too aggressive with the then-needed Unfills. This means we

end up going back and forth between too much and too little, and never get to a

GOOD amount. This is also very costly and frustrating for both patient and fill

personnel.

We need to creep up slowly on fills. This helps avoid overfills, which always

brings trouble – sooner or later. The #1 reason for all the big and small band

problems is getting and trying to keep a too-tight fill. Few docs, however, ever

tell us or give us written guidelines about WHAT TOO MUCH FILL IS !

That means we ourselves must accept the responsibility of KNOWING what a good

fill is, what a BAD fill is, and never trying to keep a too-tight fill.

It still takes 3-5 or so fills to slowly get to a good level. The new AP bands

are no different. As we get closer to a good fill, the fills must be smaller and

smaller. This means FILLS OF 01. TO 0.2 CC OR SO as we get closer and closet to

" just right. " .

These tiny fills are easily given, with the correct technique. Don't let your

fill provider say they are not possible. " Good technique " means, imo, using a

1-cc TB syringe, and a one-way STOPCOCK. Tiny fills are not possible without

these, and an attempt will likely allow a good bit of fill to leak out, and you

will end up with even less fill rather than just a touch more. ly, a

stop-cock is always wise to use, as it greatly increases the accuracy of ALL

fills. It does cost the surgeon a few dollars more for the stopcock, so some do

not want to use them.

I use a stopcock with fills 100% of the time, and was taught to do so by my own

early fill person, Dr. Fitzpatrick.

It is also NOT necessary to withdraw with every fill. Doing so only causes extra

trauma and swelling, which must be avoided when we are trying to fine-tune a

fill with tiny additions or subtractions.

If we need just a tiny bit more, do not allow a withdrawal first. Just give the

small addition ! We want to mess with fills as little as possible. Jessie Ahroni

taught me this and it's what she does.

Also, of course, allow only a special Huber-type needle to be used. These are

the only ones allowed by the Band manufacturer. All others carve out a tiny

piece of the port membrane and can lead to port failure which requires another

surgery to put in a new port and tubing. Just don't take chances, unless you

need an emergency unfill from a place that does not have Huber's readily

available.

I can't emphasize how important it is to choose only a highly-experienced BAND

surgeon and fill personnel . Avoid those who do mostly bypasses, and only a few

bands and fills. It takes a lot of experience with fills, and all stages of

fills and unfills, to assess with you if you need more or less fill, give a good

fill, instruct the essential issues about fills, and help you do well.

I also want to add that many of us still think there is such a thing as a

" perfect fill. " There is NOT. No fill is ever good all the time. There are way

too many individual variables – the state of our hydration , the time of day

(never get a fill early in the morning when we are usually tightest), our bowel

status, WHAT we choose to eat (no fill will restrict liquid or soft foods), and

much more.

The best we can hope for is " pretty good most of the time " .

The purpose of a good fill is to DIM hunger between meals, not to MAKE us stop

eating. We need to stop when we are satisfied (not FULL –a big difference), or

at 1-1.5 cups of food – whichever comes first - whether or not the band MAKES us

stop.

Sandy s, BA, BSN, MN

Band Educator

banded March 2003

at normal BMI since 1-1-04

Moonshadow.Sandy@...