Is it fluoroscopy and/or a sonogram that form the basis of a successful Lap-band fill? In this article we look at the elements that really cause a successful fill. Experience is the largest determiner of a quality result when it comes to Lap-band adjustments.
Dr. Terry Simpson does all fills for his Lap-band surgery patients…
…unless he is on vacation. When on vacation, he has a very competent associate physician stand in for him. But it is only when he is on vacation that his patients can possibly get their fills from a doctor other than Terry. Why? Because, Terry knows that the secret of success with the band is accurate fills. Sure the quality of surgery is important, and Terry is among the best Lap-band surgeons. But once the band is in, diet and precise adjustments are the cause of weight loss success.
Experience results in Lap-band patients requiring less fills (adjustments)
We know that no one wants to have a needle pushed into their stomach (although it is not as bad as most people think). Ultrasound only allows the fill technician to find the fill port. Fluoroscopy allows the flow of ingested Barium liquid through the band to be seen. They have nothing to do with the sucessful performance of an adjustment. One goal should be to limit the number of fills a patient might receive. The only way to accomplish this There is no fill center with more experience than oursgoal is through precise adjustments. By precision we mean the precise amount of saline solution is injected into or removed from the band. We have stated that many other practices have medical technicians or nurses doing their adjustments. There is absolutely nothing wrong with fills being done by a technician or nurse as opposed to a medical doctor. As we have explained, there is no imaging tool that can improve the result of a fill or unfill. The only controlling factor for positive results is the experience of the medical staff member doing the adjustment, be they a technician, nurse or even a doctor. Two facets of experience must be considered. First, experience gained by the shear number of fills an individual has done. Like surgery, the more adjustments done by a medical practitioner, the better results become because understanding of the process and process variables is gained with experience over time. Second is knowing and understanding each individual patient.
Understanding individual patient response to Lap-band adjustments
Beyond the simple act of inserting the needle into the port comes the understanding the medical practitioner is able to develop over time about unique reactions to fills each patient may have. Each patient responds differently to a given injection size. The same amount of fluid might be perfect for one patient and may not do a thing for another or may be an overfill for some. Factors such as the type of food eaten, how completely the patient chews, and the size of the lap-band all come into play and are subjective to each individual. On this website can be found many writings about the consistency of different types of foods and how preparation methods of foods affect the ability of food to pass through the band.
Learning how to develop honest communication about a patient’s diet
Almost every overweight person that is not genetically predisposed to obesity has learned to lie to themselves and others about their diet. In fact, we all rationalize eating unhealthy food. Think about this the next time you eat a fatty food or a large rich dessert. Most people say to themselves, “I eat healthy most of the time so this one time won’t hurt me.” Problems arise when your ability to lie to yourself increases. Then frequency of consumption increases as the interval of time between each rationalization gets smaller and smaller. Before you know it, you are eating the stuff all the time while telling yourself you’re not. A good weight loss health professional develops a new method of communication with patients were honesty about what is being eaten does not involve admonishment or embarrassment. The best way to stop eating fattening food is to learn to realize you are doing it without guilt being involved. You must desire to uncover and know the truth without fear and shame.
Good Lap-band fills require a new type of diet assessment
There are some foods we all love that are not compatible with the band…dry chicken is a good example that we talk about all the time. This is another level of honesty about what a patient eats that must exist between the patient and the medical professional that administers Lap-band fills. So we educate patients in our support meetings and websites. We teach them to tell us the truth and communicate in such a way that it doesn’t hurt. We communicate in such a way that the patient desires to tell the truth whether they are able to or intend on stopping eating the offending food. Most of the time we come up with a way to prepare the offending food in such a way that it works with the band…it doesn’t become stuck or slide through too quickly. We want to reinforce that most foods can be eaten with the Lap-band without regard. There are not very many healthy foods that cause problems with the band. But every once in a while we have a patient that just loves something that for some reason doesn’t work, and they really want to eat it. If they tell us about it, we almost always come up with a solution that does not include depravation. With us guiltless truth is king. If the patient feels they are in an atmosphere where the truth can’t be spoken, they keep failing and no solution is forthcoming.
So we make telling the truth and failing…fun
It sounds insane, but if you come to our groups you will get a lot of laughs from stories patients tell about their failures. What does this accomplish? When the patient is honest and not afraid to communicate about their problems…any problem, they begin to see it. They begin to see something that they have buried with lies to themselves for years. Once they begin to see they lie to themselves without guilt, they no longer bury it. They can see it, bring it into the present moment, and begin to end it. Truthfully considering what you eat is critical to successful Lap-band fills. Most patients have few to no problems, but when they do, they need to feel they can, and it is important that they do communicate about it with the person administering their fills. We don’t want to do a fill or removal of fluid if we discover the patient is eating something or preparing food in such a way that causes the problem. We change the behavior rather than do an unnecessary fill. Typically we have already dealt with the problem many times previously with other patients so we can instantly resolve it. In the case where the food is desirable to eat to the patient, we usually have already developed numerous ways to consume it without bad effects. When it is a new problem we haven’t seen before, we work on it and create solutions that, again, do not require deprivation…it’s what we do as professionals.
A chain of honest and fearless communication causes long term success
That’s our secret. We talk about and learn about what each patient eats…and fill accordingly. You cannot do an accurate fill without knowing the patient and what they eat (the food, its consistency, how they chew, etc…). To do that, you must develop a nurturing system built upon fearless truth in communication without consequence. Most of all, you must have procedures that record individual patient’s diet peculiarities in a standard form that causes all practitioners to administer fills consistently, as close to the same way as possible. Further, in the case where more than one practitioner administers fills, a standardized method of communication must exist. One that causes all fill practitioners to have the same understanding about each patient, resulting in the same method being applied to each patient by each individual fill practitioner. How could it be done accurately any other way?
Dr. Terry Simpson administers all fills to each patient in his practice
That’s the sure way to treat each patient with consistent accuracy. The results are that patients may need fewer fills and the likelihood of an overfill is lessened. This saves the patient’s time because the band is stabilized more quickly and it may stay that way lessening the number of fills a patient might need. But it’s more than about accurate fills. This doctor wants to know everything he can to improve his practice for his patients. As we have said, installing the band is the easy part. Supporting the patient after surgery is what causes success. Honest and open communication resulting in accurate fills is a major component to great support. Quality communication does not occur by happenchance. It is acquired by professional understanding and true care for each patient’s outcome.