Journal of an OCC bandster

[BSN]

I wouldn't consider it higher than a 3 star hotel AT THE MOST, lol

Don't you think Mexico's version of 5***** is a little different from the US version of 5*****? I have never been to the TJ Lucerna but I have another Lucerna. From what I can see the *service* is five star, the facilities are not. But they are quite good.

[Donna34]

Yes, I have to agree here. It was nice, it wasn't elaborate. Certainly wasn't the Opryland Hotel. I have traveled A LOT, even though I haven't flown, and we have stayed at countless resorts, in over 24 states and had some of the most luxurious accommodations. I would say the Lucerna is a normal nice Hotel. It's benefits are the restaurant, so you don't have to leave the hotel to eat, the pool is nice, and it's pretty. Not glamorous, but pretty. I thought the Italian Restaurant, was very good, atleast my selection on that particular day was. Of course this too, was after FASTING, so a rubber tire, may have been as delicious! LOL

The fact is, if you are going to TJ, you are not LOOKING for the most fabulous accommodations, or atleast I wasn't. Most people are going here for the price. So, if you want something, more elaborate, and fancy, I guess you will have to go elsewhere, and pay the higher price.

Donna

[FurEllie]

Don't you think Mexico's version of 5***** is a little different from the US version of 5*****? I have never been to the TJ Lucerna but I have another Lucerna. From what I can see the *service* is five star, the facilities are not. But they are quite good.

Yeah, that's true Don't get me wrong, I love the Lucerna. The workers there - I want to take them home! But I just never thought of it as a "5 Star Hotel" in my little picky mind

[dreamhappy07]

Yeah, that's true Don't get me wrong, I love the Lucerna. The workers there - I want to take them home! But I just never thought of it as a "5 Star Hotel" in my little picky mind

Hello,

I was reading the posts about the Lucerna and I must admit that I have not travelled much in my life, but have stayed in many hotels. To me, the Lucerna probably wasn't a 5 star hotel to many in the US, but in Tijuana, it definitely is one. When comparing what all of Tijuana was like. the Lucerna stood out like a castle. But, that is my opinion. I felt so important and special when I stayed there. Don't get that feeling much in the US. Hope this makes sense. Their ratings on excellence are probably different than here.

Judy

[phx-justin]

I am about to have surgery at OCC on Thursday. I think I have set realistic goals and have a realistic outcome. I didn't do nearly as much research, but the conclusion that I came to is really the same as No worry did--there are a couple of very good options and Dr. Ortiz is exceptionally well qualified. Here the reality, I am choosing a surgeon first and the creature comforts second. I want sterile, comfortable, convenient, and experienced. I keep looking for "I had major complications" or "I died" or some kind of horror story. If the worst I get is "the van driver was late and looked scruffy" and "Mrs. Ortiz wasn't as communicative as she could be" then I have made the right decision. I just don't want to have any major complications. I can deal with all kinds of logistical problems and with this entire process as long as I have good information and come home and get good results (lose weight, don't die). I am a little concerned that the immediate post-op diet instructions are not super detailed, but I can find that info on the Internet. My wife isn't a big fan of spending a night alone in Mexico, but the info about the hotel makes me feel more comfortable.

As far as the surgeon decision, I am very pleased to hear about the good experience. I am also glad to hear that the facility is clean, comfortable, and has a good support staff (with occasional warts). And I am also glad to hear that you are having good results. The posts were extremely helpful for me. I don't want to hear rose colored assessments about stuff that isn't up to par simply because you are happy with the overall results or with other parts of the process. Don't tell me I am staying at the Ritz just because the the surgeon is great. These are two different things. You take warts and all. If I am prepared for the warts, then they don't even bother me because I am prepared. When they are unexpected and controlable, it bothers me.

I am prepared for minor logistical problems now and this just confirms that the medical proceedure and doctor choice are the right ones.

[FurEllie]

I am about to have surgery at OCC on Thursday. I think I have set realistic goals and have a realistic outcome. I didn't do nearly as much research, but the conclusion that I came to is really the same as No worry did--there are a couple of very good options and Dr. Ortiz is exceptionally well qualified. Here the reality, I am choosing a surgeon first and the creature comforts second. I want sterile, comfortable, convenient, and experienced. I keep looking for "I had major complications" or "I died" or some kind of horror story. If the worst I get is "the van driver was late and looked scruffy" and "Mrs. Ortiz wasn't as communicative as she could be" then I have made the right decision. I just don't want to have any major complications. I can deal with all kinds of logistical problems and with this entire process as long as I have good information and come home and get good results (lose weight, don't die). I am a little concerned that the immediate post-op diet instructions are not super detailed, but I can find that info on the Internet. My wife isn't a big fan of spending a night alone in Mexico, but the info about the hotel makes me feel more comfortable.

As far as the surgeon decision, I am very pleased to hear about the good experience. I am also glad to hear that the facility is clean, comfortable, and has a good support staff (with occasional warts). And I am also glad to hear that you are having good results. The posts were extremely helpful for me. I don't want to hear rose colored assessments about stuff that isn't up to par simply because you are happy with the overall results or with other parts of the process. Don't tell me I am staying at the Ritz just because the the surgeon is great. These are two different things. You take warts and all. If I am prepared for the warts, then they don't even bother me because I am prepared. When they are unexpected and controlable, it bothers me.

I am prepared for minor logistical problems now and this just confirms that the medical proceedure and doctor choice are the right ones.

LOL, if someone posts "I died" we ALL need to worry

I've stayed at the hotel each trip by myself - it is VERY safe. I've walked around outside during the day but probably wouldn't do it at night. She will be quite safe

[phx-justin]

I promise that if I die, I will post about it.

Somehow my wife thinks Tijuana is a completely different culture and radical change from Phoenix. Just like Phoenix, you stay away from bad areas and stay in at night. And just like Phoenix, if you get lost, speaking Spanish is a plus.

[Cauleen]

You don't need a band--you need a LIFE!

Step 12: Heading home

The next morning, I bathe and pack my stuff. I check out and settle up the 50 cents I owe for the call to the Clinic. I

[titancupcake]

You don't need a band--you need a LIFE!

I was thrilled to see the minute by minute account of a bandster's experience with OCC. My surgery was June 11 and my friend's was June 12. We live in San Diego, have been to Tijuana before, and have traveled extensively. But knowing what to expect the day before your surgery is priceless.

The transportation has some issues. Mrs. Ortiz, while pleasant, came to pick up me, my friend (the 2 patients) and our husbands at the border in her 4 door Volvo. As soon as she saw us, she said she couldn't fit us all in with our bags, we would bottom her car out. So, we ended up waiting at the the parking lot for about 30 minutes for another van. A little irritating, especially when you know that 2 of the 4 people you are picking up are patients and are probably not skinny!

The same thing happened EVERY time our group and the other patients for the day had to be transported to the clinic or back to the hotel or when we left. She showed up with the volvo and said we couldn't fit, we had to wait. She has the list of pickups, so I just didn't get that. It seemed to be an easy fix--get another van for her to use. With all our group on June 11, we just volunteered to get a cab everytime, so all of us could go and not wait another 45 minutes. Today when we left, we were told to be downstairs at 7am to be taken to the border. We got down there, and were told there wasn't room for us!! So, we started to get a cab. This time it was Francisco with his van, he said someone else didn't show up and we could hop in and he would take us to the border. I feel bad for whoever was supposed to be there.

On the Lucerna The five star is MX rating. I give it 3 star American. The tortilla soup is great. The pool area is beautiful. If you drink Diet coke, and have never been to MX before, don't bother with their version "Coca Cola Lite". It tastes nothing like diet coke. Not even worth drinking it for your last soda!!!

Just the odds and ends to prepare for.

My surgery went well and so did my friends. But, it is nice to know about EVERYTHING to expect.

[NoWorry]

I was thrilled to see the minute by minute account of a bandster's experience with OCC.

I'm delighted that my journal helped you with your expectations. Congratulations on your successful surgery!

.

[BSN]

You don't need a band--you need a LIFE!

And you need some manners. Your point?

NoWorry... thanks for posting this. There are lots of newbies that not only want to know what to expect step by step but they are also looking for the kind of honesty you write.

Ignore those without manners and keep on writing exactly the way you do.

[NoWorry]

Ignore those without manners and keep on writing exactly the way you do.

Thanks, BSN. I appreciate the support.

[NoWorry]

I am a little concerned that the immediate post-op diet instructions are not super detailed, but I can find that info on the Internet.

This is definitely a huge weakness. I'm 5 weeks post-op now and it's been difficult getting accurate instructions. This forum is a good source of information, but because it's posted by patients, there is a fair amount of contradiction and misinformation, too. I have been continuing with my journal, but I'm not convinced that posting it here is such a good idea.

On the subject of post-op diet instructions, my major source of information was "WLS for Dummies." There is some contradiction between the information there and Dr. Miranda's (scant) instructions. Quite frankly, I simply trusted the book more.

What have you found?

[NoWorry]

The liquid diet

According to OCC's (scant) post-op diet instructions, I am required to be on clear liquids for the first four days. After that, I go to full liquids. In this phase, I'm allowed protein shakes, soups (without lumps) and pretty much anything that will pass through a straw (although I'm not supposed to use a straw, and I suppose I get to choose whether the straw is a McDonald's milkshake straw, or a coffee stir stick straw). Some of the soups I'm craving have a few lumps but I take care of that by sticking the whole thing into a blender and getting it all mushed to liquid.

For me, the first week is really easy to get through (one surgeon has called it a "honeymoon period" - the stomach is swollen from the surgery and not capable of feeling physical hunger). But as the stomach begins to heal, the hunger returns. My biggest weapon against this is protein. I drink three Atkins Advantage shakes each day (160 calories, only 3g of sugar) along with an occasional Kellog's K20 protein drink and lots and lots of water and diet Iced Tea.

And this brings some fairly unpleasant surprises that I had not read of in any of my pre-surgery research. Constipation. Diarrhea. Yes, they're exactly opposite from each other, but they take turns making appearances. No solids, so constipation isn't so surprising. And lots of liquids, so I guess that diarrhea shouldn't be too surprising, either. But I am surprised and they are both extremely unpleasant. Whenever I go out and my belly starts gurgling and sloshing about, I have no choice but to pop an Imodium or make sure I never venture more than 5 minutes from a restroom.

The OCC diet has no 'mushies' phase, although almost every other post-op bandster diet has at least some stage of mushies, and the book "Weight Loss Surgery for Dummies" describes three seperate stages of mushies. One OCC bandster reports that Dr. Miranda, the OCC nutritionist, has eliminated mushies from the post-op diet because she believes that patients will abuse this stage and max out on carbs. I wonder if it wouldn't be better to treat us like adults and simply tell us to avoid carbs and offer sensible alternatives.

I remind myself that, as much as I respect doctors and nutritionists, I am ultimately responsible for my own health. After I have taken the diarrhea for as long as I can stand (about 1 week), I decide to add some mushies to my diet.

To this end, I discover the Magic Bullet. It's a small personal blender that they sell on infomercials on TV, and it's an amazing weapon for anyone on a liquid diet. I find frozen strawberries and frozen mangoes at my local supermarket. I take a fistful of either, add a cup of non-fat milk, a scoop of protein powder and put them into my Bullet. Five seconds later, I have a totally yummy smoothie. The protein, once again, tackles the hunger and the thicker consistency of the drink, plus the fibre from the fruit, takes care of the diarrhea.

I explore some of the other recipes in "WLS for Dummies" and I'm delighted with the middle ground I have found. After this, week three becomes a breeze and I discern no noticeable negative effects.

[NoWorry]

Exercise

All my pre-surgery research has shown an inescapable connection between exercise and gas pains. It is clear to me that those who exercise report the least discomfort from gas.

On Day 2 following my return home from surgery, I hit the gym. I'm cleared only for walking, so I pick the treadmill, set it at 2.5 mph and go for 30 minutes. I am paying attention to any physical discomfort during the exercise, but I feel none.

This becomes part of my regular routine and I do not miss a single day for 2 weeks. During this entire time, I never once experience the shoulder pains that many bandsters complain about. Twice, I briefly have a slight back ache that I attribute to gas, based on the comments of other bandsters, and sure enough two Gas-X strips take care of the pain in about 20 minutes.

At the end of Week 2, I am cleared for general exercise (except abdominal exercises), and I start increasing both the duration and the intensity of my workouts. By the end of week 3, I am up to 45 minutes at 3.0 mph and an incline of 3.0 and by the end of week 4, I finally hit my goal of 60 minutes. Thanks to LifeFitness technology, I monitor my heart rate continuously and keep it in my target range of 115 bpm. I am pleased to see that I am burning around 500 calories per day after my hour of exercise.

I am glad that I have made a committment to take all the time and effort necessary for making this major event a success. Otherwise, if I had returned to my regular schedule immediately following my surgery, I am fairly certain I would not have been able to find the time to go to the gym each day. As it is, on two occasions, I only get there at the very end of the day and finish my workout just as they are getting ready to close up.

[NoWorry]

Back to solids

On Day 22, my post-op diet instructions tell me that I'm allowed to return to solid food. There is a list of accompanying instructions that tell me, in part, to take small bites, chew each bite 30 times before swallowing, and not drink liquids starting an hour before a meal until an hour after the meal.

I fix myself a small plate of food, follow the instructions exactly, and am pleased when everything goes down smoothly and the meal is done.

But by the third meal, my curiosity can take it no longer. For months I have been reading about and anticipating the concept of 'restriction.' I want to know what this means!

I get a big burger, an order of fries and a side of onion rings. No pop, because I'm not allowed liquids before, during or after a meal. I take small bites, I chew a lot and I swallow carefully. And I keep waiting for this magical 'restriction' to kick in. Twenty minutes later, the entire meal is gone and it feels no different than before I had surgery.

I'm not entirely surprised, but still a little disappointed. I've read many reports that although some bandsters do feel varying degrees of restriction before their first fill/adjustment, the vast majority feel no restriction at all. In addition, I have the Vanguard (VG) band which is bigger than the 'standard' band and is less likely to be restrictive prior to a fill.

It's almost a month after my surgery and I feel like I'm right back to square one. I can eat whatever I want, and as much as I want. No matter how hard I try and stay on track, I can see the old habits creeping back. I've lost over 25 lbs as a result of my pre-op and post-op liquid diets and now the scale is beginning to creep back up again.

I look for solutions and there don't seem to be much. A few experienced bandsters refer to this period as "Bandster Hell" and the name is very appropriate. I really and truly wish I had known about this before my surgery. I might have been better prepared. And even if I had not found any solutions, I might be psychologically less inclined to beat myself up for giving in to all my old cravings and desires.

And the 'last chance' syndrome is back. I had originally believed that the period before my pre-op diet was my last chance to have all my favorite meals. So of course I had every one of them. On the last day I was making lists of all the things I hadn't had during the last chance period and trying to decided what I most didn't want to miss. But it turns out that that wasn't my last chance. Here it is again. Between now and my first fill, I have yet one more last chance. And my mind is going crazy making lists of all the things I want to have before this last chance comes to an end on fill day. There is a limit to how much temptation a person can resist.

Due to conflicts on my calendar, I am unable to schedule a fill at the end of week 6 as recommended by the OCC materials. I had known about this prior to my surgery and had found an opening at the end of week 8 and had decided that I had no option but to wait until then.

Not anymore. After the daily struggle with my old eating demons returns in full force, I want that fill as quickly as possible. I have a window at Day 38 which is 4 days before the end of my 6 weeks. The Patient Care Coordinator tells me that I must wait until the end of 6 weeks. I ask her to escalate my request given that it's only 4 days off. I don't mention yet that Inamed's LapBand manual green lights a fill as early as 4 weeks after surgery. I figure I can use this later, if the need arises.

To my relief, the Fills Coordinator approves me for a fill on the day that I've requested. Now all I have to do is battle the food demons for another week before my LapBand superhero ally can be activated and stand beside me in battle. In the meantime, there's leftover pizza in the fridge loudly shouting my name!

[FurEllie]

One thing to be careful about with The Magic Bullet - I had both of the blades go bad when the small plastic ring fell partially out and got caught in the blades Just make sure before you start it up that it's VERY SECURE inside the ring.

[GregNE]

Back to solids

It's almost a month after my surgery and I feel like I'm right back to square one. I can eat whatever I want, and as much as I want. No matter how hard I try and stay on track, I can see the old habits creeping back. I've lost over 25 lbs as a result of my pre-op and post-op liquid diets and now the scale is beginning to creep back up again.

I had a lack of restriction as well, but what the band seemed to help me do was to not gain weight back. Holding steady was much better than gaining.

I look for solutions and there don't seem to be much. A few experienced bandsters refer to this period as "Bandster Hell" and the name is very appropriate. I really and truly wish I had known about this before my surgery. I might have been better prepared. And even if I had not found any solutions, I might be psychologically less inclined to beat myself up for giving in to all my old cravings and desires.

Several of us have posted about the great difficulty in keeping the pre-op weight off with the VG band. I knew before my surgery that this difficult time would be coming. One male bandster even decided before surgery that he would stay on only liquids until his first fill, and he did.

And the 'last chance' syndrome is back. I had originally believed that the period before my pre-op diet was my last chance to have all my favorite meals. So of course I had every one of them. On the last day I was making lists of all the things I hadn't had during the last chance period and trying to decided what I most didn't want to miss. But it turns out that that wasn't my last chance. Here it is again. Between now and my first fill, I have yet one more last chance. And my mind is going crazy making lists of all the things I want to have before this last chance comes to an end on fill day. There is a limit to how much temptation a person can resist.

I had some 'last chance syndrome' pre-op, but believe me, with the VG you will have endless opportunities to eat your favorite meals. The first fill in a VG will offer a little restriction, but by dinner time, if you chew very well, you will be able to eat anything. You will most likely be able to enjoy your favorite foods for the forseeable future. And even with restriction, you can eat almost all your favorites....just much smaller amounts.

To my relief, the Fills Coordinator approves me for a fill on the day that I've requested. Now all I have to do is battle the food demons for another week before my LapBand superhero ally can be activated and stand beside me in battle. In the meantime, there's leftover pizza in the fridge loudly shouting my name!

Fill #1 is really going to be almost a non-event. Do not make the mistake of thinking your first fill will offer any restriction. With the VG band, look towards your third or fourth fill as your turning point. I wish you had read some of my old posts. There is more frustration coming your way before your band really gets jump started. Be patient....very patient.

[NoWorry]

I wish you had read some of my old posts.

Are your old posts still accessible?

[NoWorry]

Do not make the mistake of thinking your first fill will offer any restriction. With the VG band, look towards your third or fourth fill as your turning point.

Why is this? I see that on your third fill you went up to 7.6 cc. What prevented the fill doctor from filling you to 7.6 cc on your first visit?

Did Dr. Romero do all your fills? I see many of his VG patients whose first fills were in the 6 - 7 cc range.

Until I have evidence to the contrary, I am going to continue to believe Dr. O's comments in his book: in the first year, 1/3 of all patients need 1 fill, 1/3 need 2 and 1/3 need 3 or more. And of course I'm hoping I fall in the first 1/3.

[BSN]

No Worry...

Any updates? How are you doing? We are all waiting, wanting to know DETAILS!

[NoWorry]

First Fill

I fly back to San Diego on June 23rd for my first fill. This time I'm taking care of my own travel and logistics and I'm pleased that things run very smoothly. I fly in, pick up my rental and drive to the border. I park at the first parking lot I find and it's $9 for the day. (On my way back I discover a parking lot near the USA exit which is $4 and make a mental note for the next time - turn left after the freeway exit to the parking area.)

I walk across the border without incident. I have plenty of time and since I haven't done my treadmill today, I decide to walk. My walking instructions to the clinic are vague at best, but I'm armed with a map of Tijuana that is a bit of help. The key is to stay to my right after I cross over and pass the taxi stand. In the distance I can see an arch similar to the St. Louis arch and I remember seeing it on my last trip to Revolution Ave and it makes an excellent visual landmark to get me over the bridge across the sewage canal.

I need to consult my map a number of times before I stumble onto the only visual reference that I have - the Costco store. From there, finding the clinic is a breeze. I arrive at OCC almost exactly on time, but a little sweaty from the walk in the hot sun.

Only minutes after filling the paperwork and forking over my $100 fee, Dr. Romero comes out to escort me to the fill room. It is supposed to be Dr. Acosta's turn in the rotation to do fills this week, but I have requested that Dr. Romero do it, since - with over 6000 fills - he has far more experience.

Dr. Martinez comes in for a brief examination. He looks over the scars and tells me that they are healing well. The swelling around the main incision is still a little pronounced, but only about half the size it was the day after surgery and he tells me that it will be gone in another month or two.

After Dr. M leaves, Dr. R makes me comfortable on the bed, and turns on the fluorscope. The image is grey and muddy and I can't make out a thing. Dr. R points out my pouch, the band and my stomach, but it's all a visual blur to my eyes. He hands me a styrofoam cup of barium and I sip it through a straw. He points out the barium going down on the monitor but I can still barely make it out.

He locates the port, and injects the needle into my stomach. It's a brief sting, only mildly painful and then another slight sensation as he inserts the needle into the port. He drapes the needle with a piece of gauze so that I can't see the needle where it enters my skin and then adjusts the bed to a semi-reclining position. The long syringe wavew wildly with every movement.

While Dr. R is flushing the air from my band, I feel a very unpleasant sensation of gas building in my chest, most likely from sipping the barium through the straw. Now comes into play the one problem I've been dreading - I've never learned to burp. I can feel the gas uncomfortably bloating my esophagus, but I can't get it out. My situation might not be as unique as I think it is, because Dr. R takes it in stride.

He injects saline into my band and closes it off my stoma completely. He hands me a bottle of water and instructs me to drink a few sips rapidly. The congestion in my chest is extremely uncomfortable now. Dr. R nods approvingly and eases off the band and settles on a 4 cc fill. He removes the syringe, wipes the disinfectant off my stomach and I am done. The entire procedure has taken around 15 minutes and much later I wonder if Dr. R rushed a little since it was not his turn on the rotation. But I have no way of knowing. What I do observe later is that Dr. Acosta never takes less than 30 minutes with each patient, but that might be explained by levels of experience. Still, I have a nagging feeling that I shouldn't have asked for Dr. R.

I am supposed to stay on liquids for three days, but I'm not heading back until I know that the band is working. I head over to the restaurant around the corner and order lunch. Some fish, rice and salad. But the discomfort of the gas in my chest is so pronounced that I can't feel anything else. I eat about a third of my lunch and I think I feel full, but I really can't tell where the sensation of gas ends and the feeling of fullness begins. I reluctantly accept that I have to assume that all is well and I walk back to the border.

The lineup at US Immigration seems very long. There is a young man in the line directly in front of me and he tells me that it only looks bad, and we should be through in about 30 minutes. It's closer to 50, but I'm in no rush and the time passes uneventfully. Immigration waves me through and I am back in the US only a little more than 2 hours after I left.

It's a bit of a maze on the US side and I need to walk around a little before I get my bearings and find the parking lot where I parked my car. I pay the fee and hit the highway back to San Diego.

At Dr. Martinez's suggestion - made at the time of my surgery - I'm staying overnight in the area so that I can test out my fill and be close to the clinic if any adjustments are needed. I'm booked at the Holiday Inn and it's pleasant enough. My room is on the 10th floor with a lovely view of the ocean. I unpack, make a few phone calls and decide to take a nap. When I wake up, thankfully the discomfort from the gas is almost gone. I had originally planned to spend the evening exploring the city, but I'm simply not in the mood and a part of me wishes that I hadn't scheduled an overnight stay.

That evening, I stock up on protein drinks for the next day, but then decide to test out my fill. I'm looking for something soft and mushy that doesn't require a lot of chewing, but substantial enough to be restricted by the band. I settle on a chicken and rice bowl at El Pollo Loco. It has been recommended that I eat the meal in private in the event of any unexpected results so I carry the meal back to my hotel room.

I start on the bowl, eating slowly and methodically, chewing my food well before swallowing. I keep waiting for this feeling of 'restriction' I've heard so much about but have never yet experienced and it never comes. I finish the entire bowl and have discerned no feeling different from before. Fearful of just such an event, I have also ordered a few extras but my chicken quesadilla and then a pollo taco carbonara also go down without any fuss. This is pretty much what I used to have for dinner before being banded and on some level I'm simply destroyed that, after two months of anticipation, I'm back at square one.

[NoWorry]

First Fill (Part II)

The next morning, I call Claudia at OCC and inform her that I'm heading back for another adjustment. I'm not much in the mood for walking this time, so I call the car rental company and purchase insurance for driving in Mexico. It costs $26, but subtract the $9 for parking and the $5 for a cab each way and it feels perfectly reasonable.

I drive to the border again and, this time, just drive across. It takes only a few minutes to get to OCC. I drive into the underground parking garage and ask the security guard where I can park. She tells me that there is no guest parking, but then asks how long I'm going to be. I guess that I'll be there for about half an hour and she graciously allows me to park.

Claudia has already informed me that Dr. Romero is off that day, and my appointment is with Dr. Acosta. The waiting room is already quite crowded and most of the patients are there for fills or consultations, since there are no surgeries on Saturdays. Around 10 minutes after I arrive, Dr. Acosta comes out and takes me into the fill room. He goes through his procedures and turns on the fluoroscope. This time, the image is clearly defined and I can easily make out all the organs and the band. As far as I can tell, Dr. Romero prefers to keep the fluoro on continuously at a low intensity, while Dr. Acosta prefers a much sharper intensity, but turns on the fluoro for only brief periods of time.

This time I pass on the straw and sip the barium directly from the cup. I can see the barium going down clearly this time and although it creates the hurricane image passing through the stoma, it flows through fairly quickly. Dr. A plays with the adjustment while I drink water and then adjusts me to 4.6 cc. Dr. Martinez comes in briefly. I have the sense that he has a busy day scheduled, but that he wants to make sure that all his patients are well looked after. He tells me that he has done around 8000 fills, but that was before the advent of the VG band, and even with their lower numbers, both Dr. R and Dr. A are now much more proficient and experienced than him.

He wants to be sure that I am properly adjusted this time and wants me to take the toast test. I sit in the waiting room until a nurse brings me two slices of dry whole wheat toast and I take small bites and chew thoroughly before swallowing. All four wedges of toast go down without any restriction at all. The waiting room is packed now and Claudia tells me that this has been a strange day since there were very few early appointments and many patients showed up a little late, so the schedule is fairly jammed now.

Around 20 minutes later, Dr. A takes me into the fill room again. Once again we go through the preparation routine. This time when the needle goes in, the pain is significantly elevated. After all, it is being inserted into almost precisely the same tissue that has already been injected twice before. Dr. M pops in again and he is very gracious even though he is now clearly very pressed for time. Under the fluoro, it is clear that all the toast has already passed through the stoma. In spite of the increased fill, there is still virtually no restriction. The two doctors decide to bump me up by a full cc to 5.6.

I've already been considerably longer than my guess to the security guard, so I'm not surprised when I return to the parking garage that my car is trapped behind another vehicle. It takes 15 minutes to get my vehicle untrapped, and then I am on the road. While I'm driving around looking for the route back, I feel a terribly strange sensation. As much as I swallow, I can't seem to get my saliva down. The back of my mouth seems permanently awash in liquid. This can't be good. Reluctantly, I make my way back to the clinic. I park on the street this time and head upstairs.

It takes around 25 minutes before Dr. A can see me again. Even as we go through the now-familiar routine, it is clear that I'm over-filled. Dr. A and Dr. M consulted shortly after I left and decided that the toast test is simply not an accurate gauge. They're going to find an alternate test. This time when the needle goes in it really hurts. The skin above the port is tender and inflamed from the barrage of syringe pricks.

Dr. A wants to take out .6 cc, but I am reluctant to give up that much. We negotiate and I convince him to take out only .2 cc. When I leave the clinic this time, I am filled with 5.4 cc of saline. I bump into Francisco in the waiting room and he gives me directions to the border. I climb into my car and head off again.

Turns out the Avenue Heroes is closed each weekend and becomes a long lineup of cars backed up from the border crossing 1-1/2 miles away. From the clinic, I have to drive away from the border, turn left at the McDonald's, drive over the bridge and then return to join the back of the queue. From there, it can take anywhere from 1 to 2 hours to cross the border. As the line of cars inches forward, I start to feel the sensation of liquid backing up into my mouth again. I try and ignore it. I make a few phone calls to friends, I listen to music, but the sensation will not pass. I have been in the lineup for 40 minutes when I begin to approach the last exit before the border. And the sensation is still there. It's decision time. Also hanging in the balance is the knowledge that this is my last chance for making my 5:00 p.m. flight. If I return to the clinic now, I will almost certainly miss my departure. As I creep past the exit I know that I can't take the chance and I reluctantly pull out of line and head back.

Back at the clinic, the last patient is in with Dr. A and the waiting room is empty. It is already just past the OCC's 2 p.m. closing time. While I'm waiting, I ask Claudia's permission to use the clinic's computer to try and find another flight home. Before I can finish doing that, Dr. A is ready for me.

This time the pain of the syringe going in brings a tear to my eyes. For days later I can see a cluster of tiny inflamed red dots where the needles went in. The image on the fluoro is a jumbled mess; there are clustered pools of barium everywhere. Dr. A recommends a significant unfill back to 4.6. I think that 5.0 might be better. We split the difference and he adjusts me to 4.8. What he hints at, and what I realize is true, is that it's all guesswork at this point. The stoma is probably rather inflamed and swollen by the constant barrage of tightening and loosening and it will take some time to return to a normal state.

We all leave the clinic together. The front exit is locked, so we leave through the garage. I drive to the back of the line to the border and it hasn't moved much, but at least I'm now a pro at getting there. It takes a little under 2 hours to cross to the US it keeps me close to the glimmer of actually making my flight. But by the time I return my rental vehicle and take the shuttle to the airport, my flight has already departed.

While I'm waiting 3 hours at the airport for my new flight that will take my home through an absurd series of connections, I decide to have a cup of hot tea with lemon to soothe my insides. Twenty minutes later my mouth is once again awash in liquid. I call my bandster buddy and ask for her recommendation. She recommends that I continue home. If the problem persists until Monday, I can always make another trip down. She tells me that when she is severely restricted she has an ice cold drink and it usually un-restricts her. This is contrary to my sense of logic that tells me that heat soothes, but I'll try anything now.

It's past midnight when I get home and the first thing I do is grab a popsicle from the freezer. Ten minutes later, I feel completely un-restricted and at least able to sleep. In retrospect, I would guess that the hot tea further inflamed the already senstive lining of the stoma and the swelling closed it entirely. The time lapse, further assisted by the cold of the popsicle, eased the inflammation and opened the stoma again.

Dr. A and Dr. M had both recommended that I go on liquids for 5 days - instead of the usual 3 - to allow the stomach to heal. I started immediately upon my return, and sure enough, everything went swimmingly well. I had no need of returning to the clinic the following Monday as I had worried about at the airport.

[NoWorry]

First Fill (Conclusions)

Since my first fill, I have discovered the conditions of sliming (which, it turns out, was what I was experiencing in TJ) and PB'ing, another thoroughly unpleasant experience. I have found that turkey and chicken are the most frequent causes of PB'ing for me while fish and red meat go down fairly easily and smoothly. This is almost the opposite of most of what I've read, but I'm beginning to realize that this procedure is in its infancy and there are simply no absolutes, just a long series of educated guesses.

Clearly the surgery is an exact medical science and OCC has perfected it. As best as I can tell through my research and experience, the procedure of fills and adjustments is much closer to an art than a science. And the results each individual encounters are fairly hit or miss, in spite of the fill doctors' high level of competence and skill.

I have now had the opportunity to test my adjusted band fairly extensively and my early conclusion is that while I have some restriction, I am not at my optimal fill level. I would guess that my optimal fill is 5.0 cc.

The band prevents me from eating too fast, it keeps me from not chewing enough and whenever I eat too soon after drinking a lot of liquids, I can usually count on an incidence of sliming. At a normal meal, I can eat around 2/3rds of my pre-banding capacity, which is significantly less than my goal of 1/3rd, but still a definite improvement. More importantly, I am far more aware of my eating habits and patterns, more than on any recent diet, and this is contributing towards slow but continuous weight loss. I am afraid of what will happen once the novelty and attention wear off.

In an ideal world, I would head back to TJ for another adjustment sooner than later, but I must first get around a fairly busy schedule over the next 4-6 weeks and also justify the cumulative expense for what feels like a relatively tiny adjustment. And I am a little fearful of repeating my past experience.

I have mixed feelings about the repeated attempts at fine tuning my first fill, since it got me a lot closer to optimal than the first attempt. I am certain that I would be extremely unhappy if I had returned with 4.0 cc, since it provided no restriction at all. But I wonder if I wouldn

[BSN]

Perhaps the same popsicle would have eased the 5.4 cc fill once I got home and I would now be in the highly preferable position of being slightly over-filled than slightly under-filled.

Whoaaa there, there is NOTHING preferable about being slightly overfilled. It is pretty dangerous. Overfills are responsible for slips and erosion. Drinking water causes one to slime and barf with even a slight overfill. But I do agree, fills are an art and not a science.