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Please don't worry. It is not that bad. It should be about the same as having a blood sample taken for testing. Both generally are straight forward and involve a dingle stab and then it's over. On occasions both can be difficult but hopefully not for you.

What Happens With An Adjustment?

Office Adjustments

We recommend doing the adjustments in the consulting room. You lie on the examination table with a pillow placed under the middle of your back. This pushes the tummy up and makes it easier for us to feel the port. Once we feel the port, we usually put a mark on the skin directly over it using a marker pen. This indicates where the needle should be placed. We put some antiseptic on the skin and, while that is working, we select the length of needle that should be able to reach the port comfortably and attach it to a syringe that is appropriate for the fluid volume of the band at that time. We pop the needle through the skin. This is usually the only bit of pain. It should be no different from having a blood sample taken for a blood test.

The needle then passes through the fat under the skin down to the surface of the port. As fat has very few nerve fibers to detect pain, this is usually pain-free. We then get you to cross your arms across your chest and lift your head off the bunk. This causes the muscle layer to which the port is attached to become quite firm and makes it a lot easier for the needle to go through the injection plug of the port.

Once the needle is inside the port, we draw out all of the fluid onto the syringe so that we can measure the volume, making sure it is the volume we expected, that there is none missing. We then add that fluid back in and also the additional fluid that we have agreed is needed. We then withdraw the needle and may place a Band-Aid over the spot. Generally the procedure takes only 2 or 3 minutes.

Radiological Adjustments

While we almost always do the adjustments in the office, some groups prefer to do the adjustments in the radiology department. The needle is put into the port while imaging with X-rays. You then stand in front of the X-ray machine and drink some liquid barium. They watch this pass through the area of the band. Fluid is added to the port until there is only a narrow column of barium passing through. The needle is then removed.

We are not in favor of the radiological method as the costs are higher, it requires much more of your time and ours, and you will get quite a dose of radiation with multiple adjustments. We see the adjustment as just one part of the clinical consultation. The office model lends itself to that, whereas adjustments in radiology tend to be just a 'fill' and any clinical discussions and assessments generally will have to occur elsewhere. We have no data to suggest that there is any better or worse outcome with either method. We therefore prefer to keep it simple and safe.

After The Adjustment

We make the adjustments in a stepwise fashion over many weeks, seeking slowly but progressively to get to the correct setting. It is simply not possible to go directly to the final volume. After each adjustment, there is an adaption, a setting in, a molding of the band and the stomach. After an adjustment, typically you will feel quite tight in the area for 2 or 3 days and then you will notice it gets easier.

You may have trouble taking solid foods and have to go back to soft foods or even liquids for these 2 or 3 days. We don't insist that you do that. We are happy to leave it to you to decide. If you are struggling with solid foods, go back to softer foods. If you cannot cope with softer foods, go back to liquids only. If you cannot cope with liquids, come back to the clinic to have some of the liquids removed. We must have added too much too quickly. On most occasions you will notice a difference after an adjustment but will still cope with solid food. After 2 or 3 days you will find it a little easier but hopefully still significant and you will be eating less than before the adjustment.

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