Re: Reflux - why we must always avoid it - re-post

[Guest guest]

Sandy, Is there a way to determine a leak without fluoro? I was having a

problem with not enough restriction. It went on for a long time. My doc

then thought possibly I might have a leak. We did a fill under fluoro, and

very fortunately, he didn't see a leak. It turns out he needed to be more

aggressive with my fills; it was a significant difference on how much he

should fill. If he hadn't done the fill under fluoro, we wouldn't have

known this. I don't like the idea of radiation, but I could have gone back

and forth for another year to get the restriction right.

My only other comment is that my fills are more accurate with fluoro. Are

some people just like that??

Moles

5/5/03

Reflux - why we must always avoid it - re-post

We should never just cover up symptoms of reflux with medications. We

must find and

correct the REASON for it. Relux before banding is very different

than reflux after banding - different causes, different treatment,

and different problems from it. It is especially dangerous for

bandsters and must NEVER be tolerated.

Reflux - why we must avoid it

What is Reflux?

Reflux (GERD or Gasto-Esophageal Reflux Disease) is caustic stomach

acid that comes back up into the esophagus, where it does not belong.

The stomach has a protective lining that prevents this stomach acid

from causing stomach damage, but no other tissue in the body has this

protection. Any acid that contacts areas other than the stomach

tissues easily causes damage.

Reflux causes ear infections, sinus infections, throat infections,

new or worsening asthma, tooth decay, and if we inhale it at night

when we wake up coughing and choking, it can cause a very bad

aspiration pneumonia. Untreated reflux can also cause esophageal

cancer, which is on the rise in the US.

What causes Reflux (GERD) before banding?

Many obese people have a hiatal hernia which causes reflux before

banding. Most also have a damaged valve at the top of the stomach,

called the LES (Lower Esophageal Sphincter) that is damaged from

abdominal fat back-pressure. The valve does not close correctly,

allowing stomach acid to back up into the esophagus. Many need

surgery to repair the hernia, and/or acid-reducers to try to minimize

the damage. Being very obese and having a hiatal hernia and it's

associated health problems is one of the several conditions that is

considered a " Co-morbidity " and a reason to get Band surgery.(NOT a

reason it cannot be done)

With Band surgery, most of these hiatal hernias need to be

repaired, since the hiatal hernia is just where the band must go.

They are so routinely repared that the Band surgeons sometimes don't

even tell us we had a hernia, but I believe we should know. It can

make recovery bit more painful and lengthy. With known reflux before

sugery, some band surgeons want a pre-op upper GI to evaluate the

size of the hernia so they can better plan surgery.

Of those who had a hiatal hernia causing reflux before band surgery,

about 76% are completely cured with Band Surgery. Another 14% see a

huge improvement. A few see only moderate relief.

What about reflux (GERD) AFTER banding?

Reflux starting AFTER band surgery is another thing entirely, and

with very different causes. Bandster reflux must be avoided., as it

is harmful in a number of ways.

When reflux starts after a new fill, it almost always means the fill

is TOO TIGHT and needs some fill removed. If we get back in very

quicky before swelling and damage occurs, as little as 0.2 cc or so

out will relieve the reflux. It is not enough to simply cover up

reflux symptoms with medication - the CAUSE of the reflux must be

found and fixed.

When new reflux starts that is NOT associated with a new fill, it is

a sign of possible problems that must be checked out if it persists.

First, though, be sure you're following the " Anti-reflux Guidelines

for Bandsters " , below. If new reflux persists despite these

measures, we must consider a Band slip or pouch dilation as the

cause and see our docs quickly for a fluoro and treatment.

ANY Bandster with a new ear infecton, sinus infection, new or

worsening asthma, or pneumonia must consider reflux as the cause and

discuss this possibility with family and band docs. Family docs

often don't know about this connection. We must help them learn.

What are symptoms of reflux?

1. Chest burning or pain

2. Acid laryngitis. This is condition that includes hoarseness, dry

cough, the sensation of having a lump in the throat, and the need to

repeatedly clear the throat.

3. Trouble swallowing (dysphagia). In severe cases, patients may even

choke or food may become trapped in the esophagus, causing severe

chest pain. This may indicate a temporary spasm that narrows the

tube, or it could also be an indication of serious esophageal damage

or abnormalities.

4.Chronic sore throat.

5.Persistent hiccups or burping .

6. Coughing and Respiratory Symptoms. Asthmatic symptoms like

coughing and wheezing may occur. In fact, in one study, GERD alone

accounted for 41.1% of cases of chronic cough in nonsmoking patients.

The incidence was even higher when GERD and asthma were combined.

ANY new or worseing asthma in a Bandster should be very suspicious of

reflux.

7. Chronic Nausea and Vomiting. Nausea that persists for weeks or

even months and is not attributable to a common cause of stomach

upset may be a symptom of acid reflux. In rare cases, vomiting can

occur as often as once a day. All other causes of chronic nausea and

vomiting should be ruled out, including ulcers, stomach cancer,

obstruction, and pancreas or gallbladder disorders.

8. Acid or metallic taste in the mouth

9. Chronic or persistent ear or sunus infections

How can Bandsters prevent Reflux?

There are several standard things Bandsters should always do to

prevent reflux. Since some reflux cannot be felt and the damage is

still occurring, these preventative things should be very routine for

Bandsters. As we get tighter and tighter with fills, the guidelines

will become even more important to heed.

1. never keep a too-tight fill, thinking it will get better in time.

A too-tight fill is the #1 reason for ALL the serious band problems,

including reflux. There is just NEVER any good that results from too-

tight fill.

2. Don't eat solids within 2 hrs of bedtime. Anything in the pouch

or stomach when we lay flat encourages reflux. Some people may not be

able to eat solids within 3 hrs of bedtime.

3. If you nap during the day, use a recliner with your head higher

than your belly. The gravity helps keep stomach acid where it

belongs.

4. Take no meds within an hour of bedtime. Take them one hour before

laying flat, with a full glass of water to wash them completely

through the pouch.

5. ONE hour before bedtime, have a full glass of water (only).,

whether you take " bedtime " meds or not. This rinses out the pouch

and dilutes the night's stomach acid.

6. Stay very well hydrated, so the normal stomach acid is not

concentrated. For Bandsters, this means at least 80-100 oz a day of

no-calorie fluids. Adequate fluids are essential for Bandsters for

many other reasons too, including good weight loss, normal stools,

less variation in restriction, and much more.

7. Some foods/fluids encourage reflux. If you have any reflux,

minimize or avoid them:

Coffee, caffeine, alcohol, chocolate, citrus (including tomatoes,

kiwi, strawberries, pineapple) , mint, greasy/spicy foods, onions,

garlic, all carbonation. A cup or two of normal-strength coffee in

the morning is ok for most people, especially if buffered with milk

or creamer, IF there is no burning or reflux.

8. Avoid clothes that are tight around the waist, as this increases

the stomach back-pressure that encourages reflux.

9.. Those with severe reflux who cannot get in at once for an unfill

should raise the head of their bed 6 inches on blocks or books, or

sleep in a recliner, until they see their docs. This will help

prevent the asoiraton oneumonia comon if acid is inhaled into the

lungs at night. Just adding extra pillows is NOT enough; the head of

the flat bed must be raised.

10. Avoid NSAID use for more than 2-3 days maximum. NSAIDs are known

to alter the protective lining of the stomach after about 3 days,

and then stomach acid can damage the stomach. THis alteration of the

potective lining CANNOT be prevented by simply washing the NSAID

thru the pouch, and is the major damage NSAIDs cause in Bandsters.

Some surgeons feel this is one of the causes of band erosions.

11. Some other medications also increase the risk of reflux. Look up

all meds you are asked to take, and request ones wih the least risk

of reflux and stomach irritation. A good place to look up medications

is www.drugs.com . Take all meds correctly, as per special Bandster

needs.

Acid-reducing Drugs

Some with persistent reflux despite all preventative measures must

take regular acid-reducers like nexium, prilosec, or protonix.

However, These are not without side effects, so should not be taken

routinely, unless really needed. Side-effects include nausea,

constipation,an diarrhea.

Many acid-reducers also interfere with medication and nutrient

absorption, and used longterm, can cause nerve damage and B-12

deficiencies. Some wih kidney disease sould not take these meds (and

many with diabetes have some degree of kidney disease even though

routine tests may not show it)

Others on low-salt diers should also not take some acid-reducers.

As with ALL Bandster problems, PREVENTION of problems

is the key. It's much easier to prevent problems by following good

bandster habits, than to try to pick up the pieces after we are

already having trouble. With a good understanding of reflux and it's

causes in bandsters, it is easy to prevent it and all the many

problems it

causes.

c. Sandy s, BSN, MN

Band Educator

at goal> 5 yrs

------------------------------------

[Guest guest]

Londa, fills are mostly a guessing game, which is why having an

experienced fill person is so important.

If a leak is suspected, it can only be seen for sure with a dye test

under fluoro. We can have a strong suspicion , but cannot " see " it

without a fluoro. Still, some tiny leaks are never seen.

If the technician gets most of the previous fill back, when

withdawing it, there is no leak. A fluoro and it;s radiation are not

needed.

Yes, the theory is that fills can be more accurate under fluoro, but

all a fluoro tells is that the fill is ok right then in the office,

and you are not completely closed off. It tells nothing at all about

how the fill will be in a few hours, after the normal swelling, or a

few days.

It's always between the patient and doctor to decide whether the

risks of a fluoro are worth th advantage, They surely have their

place.

My thoughts, at least...

Sandy

>

> Sandy, Is there a way to determine a leak without fluoro? I was

having a

> problem with not enough restriction. It went on for a long time.

My doc

> then thought possibly I might have a leak. We did a fill under

fluoro, and

> very fortunately, he didn't see a leak. It turns out he needed to

be more

> aggressive with my fills; it was a significant difference on how

much he

> should fill. If he hadn't done the fill under fluoro, we wouldn't

have

> known this. I don't like the idea of radiation, but I could have

gone back

> and forth for another year to get the restriction right.

> My only other comment is that my fills are more accurate with

fluoro. Are

> some people just like that??

>

> Moles

> 5/5/03

>

>

> Reflux - why we must always avoid it -

re-post

>

> We should never just cover up symptoms of reflux with medications.

We

> must find and

> correct the REASON for it. Relux before banding is very different

> than reflux after banding - different causes, different treatment,

> and different problems from it. It is especially dangerous for

> bandsters and must NEVER be tolerated.

>

> Reflux - why we must avoid it

>

>

> What is Reflux?

>

> Reflux (GERD or Gasto-Esophageal Reflux Disease) is caustic stomach

> acid that comes back up into the esophagus, where it does not

belong.

> The stomach has a protective lining that prevents this stomach acid

> from causing stomach damage, but no other tissue in the body has

this

> protection. Any acid that contacts areas other than the stomach

> tissues easily causes damage.

>

> Reflux causes ear infections, sinus infections, throat infections,

> new or worsening asthma, tooth decay, and if we inhale it at night

> when we wake up coughing and choking, it can cause a very bad

> aspiration pneumonia. Untreated reflux can also cause esophageal

> cancer, which is on the rise in the US.

>

>

>

> What causes Reflux (GERD) before banding?

>

> Many obese people have a hiatal hernia which causes reflux before

> banding. Most also have a damaged valve at the top of the stomach,

> called the LES (Lower Esophageal Sphincter) that is damaged from

> abdominal fat back-pressure. The valve does not close correctly,

> allowing stomach acid to back up into the esophagus. Many need

> surgery to repair the hernia, and/or acid-reducers to try to

minimize

> the damage. Being very obese and having a hiatal hernia and it's

> associated health problems is one of the several conditions that is

> considered a " Co-morbidity " and a reason to get Band surgery.(NOT a

> reason it cannot be done)

>

> With Band surgery, most of these hiatal hernias need to be

> repaired, since the hiatal hernia is just where the band must go.

> They are so routinely repared that the Band surgeons sometimes don't

> even tell us we had a hernia, but I believe we should know. It can

> make recovery bit more painful and lengthy. With known reflux before

> sugery, some band surgeons want a pre-op upper GI to evaluate the

> size of the hernia so they can better plan surgery.

>

> Of those who had a hiatal hernia causing reflux before band surgery,

> about 76% are completely cured with Band Surgery. Another 14% see a

> huge improvement. A few see only moderate relief.

>

>

>

> What about reflux (GERD) AFTER banding?

>

> Reflux starting AFTER band surgery is another thing entirely, and

> with very different causes. Bandster reflux must be avoided., as it

> is harmful in a number of ways.

>

> When reflux starts after a new fill, it almost always means the fill

> is TOO TIGHT and needs some fill removed. If we get back in very

> quicky before swelling and damage occurs, as little as 0.2 cc or so

> out will relieve the reflux. It is not enough to simply cover up

> reflux symptoms with medication - the CAUSE of the reflux must be

> found and fixed.

>

> When new reflux starts that is NOT associated with a new fill, it is

> a sign of possible problems that must be checked out if it persists.

> First, though, be sure you're following the " Anti-reflux Guidelines

> for Bandsters " , below. If new reflux persists despite these

> measures, we must consider a Band slip or pouch dilation as the

> cause and see our docs quickly for a fluoro and treatment.

>

> ANY Bandster with a new ear infecton, sinus infection, new or

> worsening asthma, or pneumonia must consider reflux as the cause and

> discuss this possibility with family and band docs. Family docs

> often don't know about this connection. We must help them learn.

>

>

> What are symptoms of reflux?

>

> 1. Chest burning or pain

>

> 2. Acid laryngitis. This is condition that includes hoarseness, dry

> cough, the sensation of having a lump in the throat, and the need to

> repeatedly clear the throat.

>

> 3. Trouble swallowing (dysphagia). In severe cases, patients may

even

> choke or food may become trapped in the esophagus, causing severe

> chest pain. This may indicate a temporary spasm that narrows the

> tube, or it could also be an indication of serious esophageal damage

> or abnormalities.

>

> 4.Chronic sore throat.

>

> 5.Persistent hiccups or burping .

>

> 6. Coughing and Respiratory Symptoms. Asthmatic symptoms like

> coughing and wheezing may occur. In fact, in one study, GERD alone

> accounted for 41.1% of cases of chronic cough in nonsmoking

patients.

> The incidence was even higher when GERD and asthma were combined.

> ANY new or worseing asthma in a Bandster should be very suspicious

of

> reflux.

>

> 7. Chronic Nausea and Vomiting. Nausea that persists for weeks or

> even months and is not attributable to a common cause of stomach

> upset may be a symptom of acid reflux. In rare cases, vomiting can

> occur as often as once a day. All other causes of chronic nausea and

> vomiting should be ruled out, including ulcers, stomach cancer,

> obstruction, and pancreas or gallbladder disorders.

>

> 8. Acid or metallic taste in the mouth

>

> 9. Chronic or persistent ear or sunus infections

>

>

> How can Bandsters prevent Reflux?

>

> There are several standard things Bandsters should always do to

> prevent reflux. Since some reflux cannot be felt and the damage is

> still occurring, these preventative things should be very routine

for

> Bandsters. As we get tighter and tighter with fills, the guidelines

> will become even more important to heed.

>

> 1. never keep a too-tight fill, thinking it will get better in time.

> A too-tight fill is the #1 reason for ALL the serious band problems,

> including reflux. There is just NEVER any good that results from

too-

> tight fill.

>

> 2. Don't eat solids within 2 hrs of bedtime. Anything in the pouch

> or stomach when we lay flat encourages reflux. Some people may not

be

> able to eat solids within 3 hrs of bedtime.

>

> 3. If you nap during the day, use a recliner with your head higher

> than your belly. The gravity helps keep stomach acid where it

> belongs.

>

> 4. Take no meds within an hour of bedtime. Take them one hour before

> laying flat, with a full glass of water to wash them completely

> through the pouch.

>

> 5. ONE hour before bedtime, have a full glass of water (only).,

> whether you take " bedtime " meds or not. This rinses out the pouch

> and dilutes the night's stomach acid.

>

> 6. Stay very well hydrated, so the normal stomach acid is not

> concentrated. For Bandsters, this means at least 80-100 oz a day of

> no-calorie fluids. Adequate fluids are essential for Bandsters for

> many other reasons too, including good weight loss, normal stools,

> less variation in restriction, and much more.

>

> 7. Some foods/fluids encourage reflux. If you have any reflux,

> minimize or avoid them:

> Coffee, caffeine, alcohol, chocolate, citrus (including tomatoes,

> kiwi, strawberries, pineapple) , mint, greasy/spicy foods, onions,

> garlic, all carbonation. A cup or two of normal-strength coffee in

> the morning is ok for most people, especially if buffered with milk

> or creamer, IF there is no burning or reflux.

>

> 8. Avoid clothes that are tight around the waist, as this increases

> the stomach back-pressure that encourages reflux.

>

> 9.. Those with severe reflux who cannot get in at once for an unfill

> should raise the head of their bed 6 inches on blocks or books, or

> sleep in a recliner, until they see their docs. This will help

> prevent the asoiraton oneumonia comon if acid is inhaled into the

> lungs at night. Just adding extra pillows is NOT enough; the head of

> the flat bed must be raised.

>

> 10. Avoid NSAID use for more than 2-3 days maximum. NSAIDs are known

> to alter the protective lining of the stomach after about 3 days,

> and then stomach acid can damage the stomach. THis alteration of the

> potective lining CANNOT be prevented by simply washing the NSAID

> thru the pouch, and is the major damage NSAIDs cause in Bandsters.

> Some surgeons feel this is one of the causes of band erosions.

>

> 11. Some other medications also increase the risk of reflux. Look up

> all meds you are asked to take, and request ones wih the least risk

> of reflux and stomach irritation. A good place to look up

medications

> is www.drugs.com . Take all meds correctly, as per special Bandster

> needs.

>

>

> Acid-reducing Drugs

>

> Some with persistent reflux despite all preventative measures must

> take regular acid-reducers like nexium, prilosec, or protonix.

> However, These are not without side effects, so should not be taken

> routinely, unless really needed. Side-effects include nausea,

> constipation,an diarrhea.

>

> Many acid-reducers also interfere with medication and nutrient

> absorption, and used longterm, can cause nerve damage and B-12

> deficiencies. Some wih kidney disease sould not take these meds (and

> many with diabetes have some degree of kidney disease even though

> routine tests may not show it)

>

> Others on low-salt diers should also not take some acid-reducers.

>

> As with ALL Bandster problems, PREVENTION of problems

> is the key. It's much easier to prevent problems by following good

> bandster habits, than to try to pick up the pieces after we are

> already having trouble. With a good understanding of reflux and it's

> causes in bandsters, it is easy to prevent it and all the many

> problems it

> causes.

>

> c. Sandy s, BSN, MN

> Band Educator

> at goal> 5 yrs

>

>

>

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

Thanks, Sandy. I had great restriction after my doctor did my fill Friday

and now it's loosened up already. Although the fluoro didn't show a leak, I

think I still may have a tiny leak and it's just not showing up. What's a

person to do then?

Reflux - why we must always avoid it -

re-post

>

> We should never just cover up symptoms of reflux with medications.

We

> must find and

> correct the REASON for it. Relux before banding is very different

> than reflux after banding - different causes, different treatment,

> and different problems from it. It is especially dangerous for

> bandsters and must NEVER be tolerated.

>

> Reflux - why we must avoid it

>

>

> What is Reflux?

>

> Reflux (GERD or Gasto-Esophageal Reflux Disease) is caustic stomach

> acid that comes back up into the esophagus, where it does not

belong.

> The stomach has a protective lining that prevents this stomach acid

> from causing stomach damage, but no other tissue in the body has

this

> protection. Any acid that contacts areas other than the stomach

> tissues easily causes damage.

>

> Reflux causes ear infections, sinus infections, throat infections,

> new or worsening asthma, tooth decay, and if we inhale it at night

> when we wake up coughing and choking, it can cause a very bad

> aspiration pneumonia. Untreated reflux can also cause esophageal

> cancer, which is on the rise in the US.

>

>

>

> What causes Reflux (GERD) before banding?

>

> Many obese people have a hiatal hernia which causes reflux before

> banding. Most also have a damaged valve at the top of the stomach,

> called the LES (Lower Esophageal Sphincter) that is damaged from

> abdominal fat back-pressure. The valve does not close correctly,

> allowing stomach acid to back up into the esophagus. Many need

> surgery to repair the hernia, and/or acid-reducers to try to

minimize

> the damage. Being very obese and having a hiatal hernia and it's

> associated health problems is one of the several conditions that is

> considered a " Co-morbidity " and a reason to get Band surgery.(NOT a

> reason it cannot be done)

>

> With Band surgery, most of these hiatal hernias need to be

> repaired, since the hiatal hernia is just where the band must go.

> They are so routinely repared that the Band surgeons sometimes don't

> even tell us we had a hernia, but I believe we should know. It can

> make recovery bit more painful and lengthy. With known reflux before

> sugery, some band surgeons want a pre-op upper GI to evaluate the

> size of the hernia so they can better plan surgery.

>

> Of those who had a hiatal hernia causing reflux before band surgery,

> about 76% are completely cured with Band Surgery. Another 14% see a

> huge improvement. A few see only moderate relief.

>

>

>

> What about reflux (GERD) AFTER banding?

>

> Reflux starting AFTER band surgery is another thing entirely, and

> with very different causes. Bandster reflux must be avoided., as it

> is harmful in a number of ways.

>

> When reflux starts after a new fill, it almost always means the fill

> is TOO TIGHT and needs some fill removed. If we get back in very

> quicky before swelling and damage occurs, as little as 0.2 cc or so

> out will relieve the reflux. It is not enough to simply cover up

> reflux symptoms with medication - the CAUSE of the reflux must be

> found and fixed.

>

> When new reflux starts that is NOT associated with a new fill, it is

> a sign of possible problems that must be checked out if it persists.

> First, though, be sure you're following the " Anti-reflux Guidelines

> for Bandsters " , below. If new reflux persists despite these

> measures, we must consider a Band slip or pouch dilation as the

> cause and see our docs quickly for a fluoro and treatment.

>

> ANY Bandster with a new ear infecton, sinus infection, new or

> worsening asthma, or pneumonia must consider reflux as the cause and

> discuss this possibility with family and band docs. Family docs

> often don't know about this connection. We must help them learn.

>

>

> What are symptoms of reflux?

>

> 1. Chest burning or pain

>

> 2. Acid laryngitis. This is condition that includes hoarseness, dry

> cough, the sensation of having a lump in the throat, and the need to

> repeatedly clear the throat.

>

> 3. Trouble swallowing (dysphagia). In severe cases, patients may

even

> choke or food may become trapped in the esophagus, causing severe

> chest pain. This may indicate a temporary spasm that narrows the

> tube, or it could also be an indication of serious esophageal damage

> or abnormalities.

>

> 4.Chronic sore throat.

>

> 5.Persistent hiccups or burping .

>

> 6. Coughing and Respiratory Symptoms. Asthmatic symptoms like

> coughing and wheezing may occur. In fact, in one study, GERD alone

> accounted for 41.1% of cases of chronic cough in nonsmoking

patients.

> The incidence was even higher when GERD and asthma were combined.

> ANY new or worseing asthma in a Bandster should be very suspicious

of

> reflux.

>

> 7. Chronic Nausea and Vomiting. Nausea that persists for weeks or

> even months and is not attributable to a common cause of stomach

> upset may be a symptom of acid reflux. In rare cases, vomiting can

> occur as often as once a day. All other causes of chronic nausea and

> vomiting should be ruled out, including ulcers, stomach cancer,

> obstruction, and pancreas or gallbladder disorders.

>

> 8. Acid or metallic taste in the mouth

>

> 9. Chronic or persistent ear or sunus infections

>

>

> How can Bandsters prevent Reflux?

>

> There are several standard things Bandsters should always do to

> prevent reflux. Since some reflux cannot be felt and the damage is

> still occurring, these preventative things should be very routine

for

> Bandsters. As we get tighter and tighter with fills, the guidelines

> will become even more important to heed.

>

> 1. never keep a too-tight fill, thinking it will get better in time.

> A too-tight fill is the #1 reason for ALL the serious band problems,

> including reflux. There is just NEVER any good that results from

too-

> tight fill.

>

> 2. Don't eat solids within 2 hrs of bedtime. Anything in the pouch

> or stomach when we lay flat encourages reflux. Some people may not

be

> able to eat solids within 3 hrs of bedtime.

>

> 3. If you nap during the day, use a recliner with your head higher

> than your belly. The gravity helps keep stomach acid where it

> belongs.

>

> 4. Take no meds within an hour of bedtime. Take them one hour before

> laying flat, with a full glass of water to wash them completely

> through the pouch.

>

> 5. ONE hour before bedtime, have a full glass of water (only).,

> whether you take " bedtime " meds or not. This rinses out the pouch

> and dilutes the night's stomach acid.

>

> 6. Stay very well hydrated, so the normal stomach acid is not

> concentrated. For Bandsters, this means at least 80-100 oz a day of

> no-calorie fluids. Adequate fluids are essential for Bandsters for

> many other reasons too, including good weight loss, normal stools,

> less variation in restriction, and much more.

>

> 7. Some foods/fluids encourage reflux. If you have any reflux,

> minimize or avoid them:

> Coffee, caffeine, alcohol, chocolate, citrus (including tomatoes,

> kiwi, strawberries, pineapple) , mint, greasy/spicy foods, onions,

> garlic, all carbonation. A cup or two of normal-strength coffee in

> the morning is ok for most people, especially if buffered with milk

> or creamer, IF there is no burning or reflux.

>

> 8. Avoid clothes that are tight around the waist, as this increases

> the stomach back-pressure that encourages reflux.

>

> 9.. Those with severe reflux who cannot get in at once for an unfill

> should raise the head of their bed 6 inches on blocks or books, or

> sleep in a recliner, until they see their docs. This will help

> prevent the asoiraton oneumonia comon if acid is inhaled into the

> lungs at night. Just adding extra pillows is NOT enough; the head of

> the flat bed must be raised.

>

> 10. Avoid NSAID use for more than 2-3 days maximum. NSAIDs are known

> to alter the protective lining of the stomach after about 3 days,

> and then stomach acid can damage the stomach. THis alteration of the

> potective lining CANNOT be prevented by simply washing the NSAID

> thru the pouch, and is the major damage NSAIDs cause in Bandsters.

> Some surgeons feel this is one of the causes of band erosions.

>

> 11. Some other medications also increase the risk of reflux. Look up

> all meds you are asked to take, and request ones wih the least risk

> of reflux and stomach irritation. A good place to look up

medications

> is www.drugs.com . Take all meds correctly, as per special Bandster

> needs.

>

>

> Acid-reducing Drugs

>

> Some with persistent reflux despite all preventative measures must

> take regular acid-reducers like nexium, prilosec, or protonix.

> However, These are not without side effects, so should not be taken

> routinely, unless really needed. Side-effects include nausea,

> constipation,an diarrhea.

>

> Many acid-reducers also interfere with medication and nutrient

> absorption, and used longterm, can cause nerve damage and B-12

> deficiencies. Some wih kidney disease sould not take these meds (and

> many with diabetes have some degree of kidney disease even though

> routine tests may not show it)

>

> Others on low-salt diers should also not take some acid-reducers.

>

> As with ALL Bandster problems, PREVENTION of problems

> is the key. It's much easier to prevent problems by following good

> bandster habits, than to try to pick up the pieces after we are

> already having trouble. With a good understanding of reflux and it's

> causes in bandsters, it is easy to prevent it and all the many

> problems it

> causes.

>

> c. Sandy s, BSN, MN

> Band Educator

> at goal> 5 yrs

>

>

>

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

, this is very likely the common false " restriction " from the

normal swelling with fills. the stoma is very sensitive and swells

with any fill manipulation, especially if the docs withdraws and re -

inserts the fill several times. once is plenty. When tweaking the

fill only a tiny bit - like 01. - 0.2 cc - it's best not to withdraw

at all. The swellingmakes it seem as if the band is tighter. That is

why we need to be on fluids for 24 hrs (some docs want longer) to

allow the stoma to rest and heal from the fll. I hope your doc is

going over all this type of thing with you...

Once the intial swelling after all fills resoloves in a few days,

then we can tell more about the fill over the next couple of weeks.

it takes some fills 1-2 weeks to settle in, and then it takes another

1-2 weeks to adjust and refine our eating to be able o evaluate the

fill. that's why fills can only be safely given every 4 weeks or more.

Please tell us a lot more about your fill history - when, how much,

as much as you remember (it's good for us to keep our own records for

times like this). then we can see if it sounds like a leak.

If there is consistently a lot of fill " missing " (assuming the fill

person is very experienced and is not losing fill whe withdrawing the

needle - using a stopcock is ideal, but few docs do) then the dye

test is indicated. A special safe dye is inserted into the port, and

can be seen on a fluoro leaking out of the closed band system. Big

leaks are eaasily seen. little tiny leaks are not, so then one has to

go by other evidence and make an educated guess.

Sandy

>

> Thanks, Sandy. I had great restriction after my doctor did my fill

Friday

> and now it's loosened up already. Although the fluoro didn't show

a leak, I

> think I still may have a tiny leak and it's just not showing up.

What's a

> person to do then?

>

>

[Guest guest]

I meant to also say that a normal fluoro will not show a leak. the

special dye test is needed, and then sometimes several fluoros hours

and days apart to find the leak. i know a couple cases where it took

daily fluoros for 6-7 days to finally see a tiny leak.

Sandy

>

> Thanks, Sandy. I had great restriction after my doctor did my fill

Friday

> and now it's loosened up already. Although the fluoro didn't show a

leak, I

> think I still may have a tiny leak and it's just not showing up.

What's a

> person to do then?

>