Gastric Banding Rules

This is a list I created for my patients to help them get out of trouble, and then i thought, “What if it keeps them out of trouble?”

Pardon the almost run-ons! Loads of info to get out. Good rules to follow for great reasons!

GASTRIC BANDING RULES

• In general, do not eat or drink 2 hours before sleep. The esophagus works by squeezing food down toward your stomach, and it also works by gravity. So, when you are standing upright, the food goes down and the liquid goes down to the stomach with some squeezing from the esophagus and the effect of staying upright. When you eat something or drink something and then lie down, everything that is above your band, as you lie down, just lays there and then the esophagus squeezes in both directions- toward the Band and the stomach, but also toward the upper chest and your mouth. So, because of that you can get esophagitis or inflammation (swelling). When you have a well-adjusted band, the thing to do is to hold off on eating, drinking and then lying down. You should wait about two hours.
• There is such a thing as pill esophagitis, and in a well- adjusted Band, your pill should be chewable when you can or a liquid, such as a multivitamins, calcium, but any other pill should be either cracked or, if they are capsules, you should take them between 12pm and 6pm, when your esophagus is more open. This is something you should discuss with the doctor. The other thing is that, if you have to take a pill right before sleep, try and make it at least an hour before sleep and swallow with the minimal amount of water. Also, make sure that it is a small pill, and if it is a large pill, to break it up into smaller pieces.
• If you find yourself in the position of being too tight, and you have thrown up, before you go ahead and take something else in, try to wait for about 2-3 hours after you throw up and then take a teaspoon of warm liquid, something decaffeinated- could be water, could be a herbal tea,: just take 1 teaspoon – and put it down and see if you can get 1 teaspoon down every 2-5 minutes. You have to time it. When you throw up with the Band, sometimes it tightens on its own. This is because of swelling
• If you are flying and your Band is well adjusted, some patients seem to get tighter during the flight. We recommend that you go on a general liquid diet before and during the flight as well as for a few hours after you land. The reason is that you can get tighter in the air. This will ensure that you will have a good vacation or business trip when you travel rather than taking something in and having that awful sticking feeling or throwing up and being in a strange location and not being able to get fluid out of your band.
• If you are throwing up often, try and figure out if it is during a particular time of day. If you throw up more at lunch, try having soups, yogurt or protein shakes for that meal. If it is dinner (and you are home) or if the first bite makes you throw up, perhaps try to drink a little warm fluid, about 1-2 ounces (which is less than ¼ cup) 15 minutes before you are going to eat. This helps to relax your esophagus, and lets it know that you are going to eat.
• The esophagus responds to extremes of temperature, so you may find that ice-cold and super hot cause you to experience a pain in your chest. The pain is your esophagus squeezing in response to temperature. This is why many patients find that warm or room temperature liquids “go down easier”.
• Normally, the esophagus is tighter in the morning when we get up. Add a band around the stomach, and the effect can be magnified. As the band is adjusted, many patients find they can’t eat breakfast. Some patients also find they can’t drink anything until 10 or 11 in the morning. When you first get up in the morning, don’t try to and drink something right away. Wait until after you have gotten ready for work and have been upright or standing for about 45 minutes. Then try a sip of coffee or room temperature water and wait 15 minutes before you try to finish your cup.
• The esophagus also responds to stress and anger! The esophagus squeezes more and gets tighter- So if you are running around trying to multi-task, go with room temperature liquids. Also, for the ladies, the esophagus can get tighter when you have your period. This effect is usually only seen when your band is well adjusted. You ma y need to go on liquids during your period or menses. You may also need to come in and get a little loosened.
• Remember the old adage: Chew Chew and Chew. We recommend that you chew at least 15 times, then put the fork down and wait 30 seconds. This will let you know if you chewed the food well enough and it will go down OR if it is going to get stuck
• Please do not wait too long. If you cannot tolerate liquids and you still cannot 24 hours later, come in! If you cannot tolerate your own saliva, make the call to our office early! Don’t try to tough it out! Any delay may necessitate intravenous fluids in the Emergency Room instead of just getting the band loosened in the office and then drinking water yourself to hydrate.