THE FIRST 4 WEEKS

Remember that feeling of lack of hunger and lack of interest in food during the first week. That is the sense of satiety that we are seeking to reproduce. We will be looking to return you to that state of satiety by adjusting the band. If you remember it well, you can guide us. You can say if you are not back to that point or alternatively you can recognize that you have returned to the same level of satiety as in the first week.

Typically, by the end of that 4-week period, you will notice that you are eating too easily, you can eat larger amounts of food than you thought you should be eating and you may be getting hungry between meals. This is normal. These are the signals that you need fluid added. We will start this at 4 weeks. The amount of fluid we add depends upon a number of factors and is really a medical decision. It will depend on the type of band you have, the amount of hunger or satiety you have experienced during the four weeks, the weight loss that has occurred and the approach to the adjustment used. Normally, for the 9.75 cm and the 10 cm LAP-BAND VG series we will add 1.5 mL. For the LAP-BAND AP series we will confirm that the baseline amount of 3 mL is present and then add between 1.0 mL and 1.5 mL to give a total volume of 4.0-4.5 mL.

It is worthwhile being aware of the approximate amount of fluid in the band but please do not focus on this too much. There is nothing magical about any particular volume and there is no reason to believe that the volume your friend has is any better than what you have. The key to the adjustments is to achieve the feeling of satiety, of non-hunger, of disinterest in food. Whatever volume of fluid is needed to achieve this is the correct volume. Increasing the volume beyond is likely to harm, not help. You will be in what we call the “red zone”. Too much fluid and that is where you will be.

In the LAP-BAND world on the Internet, in the discussions across Web sites, there has built up a concept of “the fill” as if this is the be-all and end-all. It is not correct. Correct adjustment is so much more than going to a “fill center” and getting a “fill.” It is a real clinical consultation. It involves sitting down with someone knowledgeable and experienced, usually a physician or a news practitioner, talking about your eating pattern, talking about any difficulties, reviewing for symptoms that something might not be right, looking at the weight loss, giving advice regarding eating , exercise and activity and, after all that, maybe making an adjustment. The adjustment is a part of the clinical consultation; it is not a procedure independent of clinical assessment. With the addition of fluid we are looking to achieve two effects-satiety of the feeling of not being hungry even when you haven’t been eating, and satiation, the feeling of being satisfies after eating. The effectiveness of the band will vary depending on whether we are near the optimal setting for the band or not. Whether you feel a sense of satiety and satiated helps us know if we need to add more fluid at each visit or whether we are near to the optimal setting for the band or not. Whether you feel a sense of satiety and satiated helps us know if we need to add more fluid at each visit or whether we are close to the optimal setting. It is very important that you understand these effects. If you do, you are able to work with the band to get the best result and you can guide us in achieving a correct balance for you.