When do you need a LapBand fill

By Dr. Rachael Keilin May 28, 2013

     

I’ve said it before, but I’ll say it again: The lapband is to help control your hunger allowing you to diet without feeling deprived.

It is NOT about preventing you from being able to eat – that is what we call “using the band as a barrier”. When used this way with frequent throwing up (PB’s) you put yourself at risk for band slippage, possibly permanent damage to your esophagus and erosion of your teeth.

When we ask about your level of restriction when you come to the office for appointments, it is for us to determine if (a) you are already too full, (b) if you are trying to eat foods that are hard to swallow, (c) about how much we can safely add to the band.

It is NOT about tightening the band until you can’t eat. If you already have frequent PB’s (productive burps), then tightening the band is not going to help you lose weight.

In fact, it is more than likely that it will cause you to gain weight since you will then be so tight that you’ll make poor food choices because “they’re the only ones that will go down.

Tightening the band is not how you lose weight. You lose weight by eating three small meals per day made up of sensible, nutritious food with one protein snack during the course of the day.

Tightening the band allows you to do that without feeling hungry and deprived. There is no other reason to fill the band. We will not fill the band because, ” I can eat more than I should.”

That is a failure of the person, not the band. Why? Because you should be testing the band not by seeing how much you can, but by seeing how little you can eat and not be hungry again for several hours.

If try to eat as much as you can until you throw-up, then you are simply not using your band correctly. If you are losing weight and you are not hungry, it doesn’t matter if you NEVER have a PB.

I have patients say they are concerned because despite losing 60 or more pounds, they can still eat bread and that can’t be right. The truth is, that is the best of all.

Here are a few patient questions and answers on this topic:

Sylvia Says:

I am about 1 month post op and I have not had a fill yet. (I have an appt June 2) I’m trying really hard to follow the rules and I have noticed that if I eat a teensy bit more than I’m supposed to during my meal – or if I eat something kind of dry like butter beans, my chest hurts and I feel like I am about to suffocate for a few seconds. I have never thrown up and never felt like I was going to. Am I normal?

Rachael Keilin, MD Says:

You are normal, in the sense of that’s the feeling you get when you overeat – that is the feeling of having over stretched your esophagus and/or stomach pouch to the point of just beyond full. The stretch is what causes the feeling of pain.

The reason you feel it in your chest is because the top part of your stomach and your esophagus are up behind your breastbone (sternum) not down low by your belly button.

Don’t eat more than you should! This feeling is likely due to swelling after surgery. Over the next few weeks, you should reach a point where you don’t feel tightness when you eat. Also, make sure you are taking very small bites, about the size of a quarter, and chew your bites 30 times before you swallow.

Jennifer Says:

I got a fill on Monday and have not been able to even drink water without getting sick. I tried some soup last night for the first time and kept getting sick after eating only three bites of the soup.

My problem is that if I come back and ask for some to be taken out then I feel like I am not getting anywhere on losing weight. I have tried before waiting two weeks before coming back and having some taken out and seem to get terrible migranes because I can’t eat anything.

What can I do??? Should I try to just wait it out until it stretches out a little to where I can drink something again???

Stacey Says:

I have often wandered about the feelin that Sylvia is talking about and Dr. Keilin has just explained it very well. I have too experienced the above mentioned but just thought that it was cause I had made a bad food choice and it was a sign that I was beeing punished (LOL!) I now know the truth.

Dr. Ron Hekier Says:

Glad it all helps!

Rachael Keilin, MD Says:

Jennifer, if you cannot hold down even liquids then it is VERY unlikely that the band will “loosen up” significantly enough to make a difference. While you wait, you are becoming dehydrated and losing lean muscle mass which may be contributing to the migraines.

When you are too tight only bad things will happen: 1) you will dehydrate and need an unfill or 2) you will be able to eat just enough to make bad choices (like ice-cream and chips) and will lose nothing or even gain, all while having significant PB’s.

There is no magic in a fill – if it’s too tight, it’s too tight and by having it loosened you will not stop losing weight. Unless that is, you are using the band purely as a barrier to being able to eat which is not the right way to use it. Read the several posts on when you actually need/want a fill and let’s discuss it next time you’re in the office.

LaTange Says:

I am very concerned about my band. I was in for a fill last week. I did fine until the weekend and I started having trouble getting my food and drinks down. For two night I was having refluxes. I have not had a reflux since my surgery almost a year ago. I came back in the office and had part of my fill removed.

I was able to have soup last night, and I am drinking water again today, but I did have a small reflux last night. Do you think I am still to tight? Should I come back in and have some more removed, or should I wait a couple of days, try to eat solid foods, and see what happens? This is the first time I have had to have any removed. I have had problems with PB’s and vomiting, when I got a fill back in April, but I didn’t have any taken out. When I came for my appointment in May, I talked to the Nurses Practioner about and we both decided not to take anything out and that I should not have a fill.

I thought I need one this time. Did I make the right decision? I have only lost 38 pounds since my surgery, and I experienced my port flipping after my surgery. I have not gained any weight, and I am happy about that. I am loosing very very slow. Should I be loosing more? What do you recommed I work harder at? I must say that I know Lapband was the best thing that I could have did for myself. Since my surgery, I have been able to have some of my medications reduced. Looking forward to the day I can stop taking them all! Thanks for all the advice and support.

Rachael Keilin, MD Says:

I would definitely see how solid food goes first. After being too tight, even if it was just a few days, you can have some swelling and irritation of the esophagus/stomach border which can take a few days to resolve.

This irritation and swelling can make the band functionally a little tighter causing a small reflux at night. But it ought to go away within just a few days. As to whether or not you needed the fill, it really depends on a lot of factors, the most important of which for me is hunger level. Hope that helps

Susan Says:

I came in the week before the 4th and had an unfill. now i have NO restriction. how can this be? i have a 10cc band with over 6 cc in it. i have already gained a couple of pounds and i am stressing out. what should i do? my small portions isn’t satisfing like it was please help!! i don’t want to gain any more back. Susan

Rachael Keilin, MD Says:

After the band is loosened there is usually a small amount of weight gain immediately because it’s easy to get dehydrated when it’s too tight and you quickly re-gain the water weight you lost in just a few days. But if you’re making good food choices, you should not be gaining any more weight than that. Not losing? Possibly if you’re no longer adjusted to your sweet spot. But gaining? No. That means you’re making poor food choices. Even with the band wide open, you should not gain weight unless you are falling back into bad habits. Avoid the gain and maintain – you’ve got the knowledge to do it now. We’ll see you soon

Susan Says:

ok, it has only been 6 or 7 days that i had the unfill. on the 4th i may have had like this tuna dip on melba toast and some kind of fruit salad with cool whip, grilled pork. i was had lost 1 pd in the four days of being to tight. and my scale says i have gained 6 pds. i know this can’t be gained from one day of not knowing what the calories were. so could this be fluid? that 6 pds? i am eating regular meals on my small plate. no sugary drinks. is there anyway i could have gained this much in fat in such a short time? thank you so much for your response. Susan

Rachael Keilin, MD Says:

It’s very unlikely that you can gain 5-6 pounds of tissue in only a day or two. It’s is almost physically impossible (unless you’re a professional hotdog eating contestant). Most likely water, but let’s talk about it some more when you come in for follow-up. We’ve seen people gain or lose 5 pounds of fluid within a day or two.

Amer Says:

i have had my surgery about 13 months ago and i lost about 120 pounds so far. Everything was normal untill about 3 months ago when i started to eat more and more, and actually i am kind of worried now, because i am eating just like the way i have been eating before the surgery, and even after adjusting the band about 2 weeks ago, am still not feeling that i am full the way i was up to 7 months after the surgery. i want to know what should i do, do i need to adjust the band more,or does this mean that the band is ineffective anymore??!

Rachael Keilin, MD Says:

I think you need to see your surgeons and disuss these symptoms. My concern is that a sudden lack of restriction after everything was doing well and especially a lack of restriction after a fill when everything had previously been good could mean one of two things: (a) there is a leak in the band/tubing/port or (b) you simply need an adjustment to fill the LapBand a bit. Both of these are fairly easy to diagnose, but you will need to see your surgeon about this. Hope that helps!

della Says:

You have no idea how much this is helping me as i live to far from my Dr’s and can not attend their meetings on all of this.THANK YOU !

Lisa Says:

I had a tummy tuck in October 09 and over the last 3 months or so I heard and felt several snaps. They were slightly painful before and a day or two afters. I thought it was due to my tummy surgery but when I returned to the Dr. he said everything checked out ok. It dawned on me at 3:00am this morning that it might have something to do with my lap-band. Before the tummy tuck I was at a good level of restriction so I know what feels right for me but afterwards I had 1cc removed because I couldn’t hold down water. (maybe due to swelling of surgery). Should I get a fill now?

Dr. Ron Hekier Says:

The snaps you heard and felt are probably related to the tummy tuck and it is less likely something to do with your LapBand.

There are multiple factors that have to be taken into account when deciding whether or not to fill someone’s Lap Band. It is much safer to not fill someone than to fill someone if they are “on the fence.”

We remind Lap Band patients to not focus on restriction. The best Lap Band fill is one that helps hunger, not one that creates restriction. If someone feels restriction as they eat, they are possibly too tight.

Ramona Says:

I have had the Lap Band now for 1 month. I have only lost 3 lbs. I started with 222 lbs and this morning I weighed in at 218.8 lbs. I am following the diet and walking for 30 min. every morning. Why am I not losing much weight? I know that the diet plan is for 800 – 1200 cal. a day but I have never been a big eater and fill stuffed at about 500 cal a day. What more can I do to jump start the loss of weight?

Dr. Ron Hekier Says:

Everyone loses at a different pace. Follow the guidelines and the tips presented here in our blog as well as your instructions. Here are just a few general tips we provide to all patients: Make sure you get enough protein. Make sure you get enough calories. Too few calories can lead to your body losing muscle and keeping fat. Add resistance training to your exercise regimen, e.g. weights, machines at a gym, resistance bands. Keep up the good work!

michele Says:

I dont know if I am having problems with the band or not. Its been one week and four days since I have had surgery and all my insicions are healed the brusing is almost gone and I have been able to eat solid foods. My first week out I had no problems with mushy food. I didnt really have a liquid diet. Maybe the first day but by the second I was already eating puddings, friut sauces, yogart and rice pudding. I have only lost 6 pounds since the surgery. however, my clothes are all getting bigger and if you look at me you can see I am loosing weight. even my stomach is starting to shrink. My husband has said he can notice it. even if it looks like I am loosing weight I am worried about how much I can eat. I have noticed I can eat a fair amount but its not as much as I could eat before and if I dont chew properly I feel a little discomfort and have to wait untill the discomfort stops so I can finsh eating if I get the discomfort feeling again I stop eating all together and look at it as if I am full. I eat only three times a day. Before I have breakfast lunch or dinner I am so hungry I feel like I can eat a whole cow. However, I eat half of what I ate before the surgery and I just dont feel like eating in between meals. I thought I would be eating alot less a week after surgery. I was told that I should only be able to eat one to two cups of food per meal and for me its about three. Should I be able to eat this much? and is this normal weight loss after surgery? my first band fill is not untill March 31 so, what should I do if anything untill then? also, I just weighed my self and I am starting to gain weight. Thanks for your time and I hope I hear from you soon.

Dr. Ron Hekier Says:

If you just had surgery your Lap Band is essentially unfilled. It is like a flat tire on your car. In our experience, most people need 3 or 4 fills until they get close to their sweet spot. Here is some advice for you: SLOW DOWN!!!!!! You have had your surgery 11 days ago and already you are worried about your weight loss?!?!?!?!?!? You really need to step back, slow down, and realize that progress is measured in months, not days. We tell our patients to expect to get close to their goal weight in about 18 – 24 months. You will feel hungry in the beginning until you get a few fills. Since generally you get a fill every 4 to 6 weeks, you won’t be at your ideal spot for a few months. Slow down sister. You didn’t gain the weight in 11 days. You won’t lose it in 11 days. But you have an amazing tool that will help you reach your goals in a healthy period of time. Keep working at it!

DENISE Says:

Hi Michelle,

I just found this site and saw your questions. I was banded Jan. 19 and will have my first fill March 9. I suggest that you go back to the full liquid diet, it may help you maintain the weight you lost and you may lose more. I’ve lost 28lbs so far, yes the last few weeks have been difficult (I’m more hungry now than the first three-four weeks) but I’m trying to hold on. Also, drinking lots of water/liquids help.

Dinnerland Says:

Wow docs– what a GREAT blog, thank you. I am way out East in NYC with Dr. Christine Ren as my lap band surgeon–and I want to say that it seems like anyone who has you both for their surgeon will be a lucky patient from the looks of it. (I also happen to be a hospital administrator.)

Anyhow: I really appreciate the wonderful feedback and guidance from reading this post. I am glad to report that I have had just 2 PB’s since my surgery on January 4th, 2010– and I avoid this side effect like the PLAGUE. It is my understanding that frequent vomiting can cause band slippage and this must be a lifelong concern.

In any case: I am a patient who started at a ‘lower’ BMI of 33, and my weight loss has been slow and steady, at around 5 pounds per month. Dr. Ren is pleased and encouraging.

She tells me that this is a perfect rate for me, and that as I reach an optimal adjustment, the weight will just come off. I agree– I am now at 6.1 cc in a 10 cc band, and I feel that I’ve really reached the “green zone.”

It is wonderful, as is the band: and the #1 best part– HUNGER CONTROL.

From here on in, I will call it that instead of restriction, because your post was an excellent reminder of what I’ve known and been seeking all along– I want my hunger to be managed, while still being able to enjoy all of the ‘fruits’ of life. I am watching my portions and working to keep them as small as possible and focusing on ‘whole’ (unprocessed) foods…

the band is the best!! Cheers to you wonderful surgeons and to the field of bariatric surgery for setting me free of 39 years of obsessive dieting

Dr. Ron Hekier Says:

Thanks for the support! Dr. Ren is great. We have both met her in passing at a few conferences. The only advice I would give you is to make sure you do not focus on the fill volume. You remark that you have 6.1 cc’s. It shouldn’t matter if you have 6.1 bajillion cc’s, or 1 cc or 11.28372123 cc’s. Too many patients focus on not only their fill volume, but also the fill volume of others. “My friend has 5 cc’s and she is just right, but I am at 7.3 cc’s and I can eat everything.”

Check out http://blog.noscales.com/how-much-is-in-your-friends-lap-band-what-size-shoe-do-they-wear.html

janice williams Says:

Hi Michelle, I was banded in 2006 and lost about 60 pounds, then for the last year I was able to eat anything without restriction. I had several fills and finally my doctor had to replace my band as there was a defect in the one that was installed originally. However, with my new band it is a 12cc band and I have 5cc’s in it now but still feel no restriction. Can you tell me in your experience where on a 12cc band does a person find their “sweet spot” I am really tired of gaining weight.

Thank you, Janice

Dr. Ron Hekier Says:

Janice, I am EXTREMELY curious about your experiences. I have been to several high level meetings with Allergan personnel, the manufacturer of the Lap Band. I have NEVER heard of a defect in the Band. I have no idea what that could be and I have never heard of a defective band having to be replaced. We have seen uncommon issues with ports, but those can be replaced fairly simply. A defect with the Band itself requiring replacement is almost unheard of. The port tubing can develop problems infrequently, but it is extremely rare to hear of a problem or defect of the LapBand itself. Did you have your Band in the U.S.? What type of Band was it? What defect did your doctor tell you was present? Regarding your sweet spot, everyone is different, and at 5cc you might just need more fluid. For some people 5 cc is too much, for some it is too little. Check out our many posts on fills, by searching for “fill” or “sweet spot” in the search bar. Here are a few posts that might help: Lap Band sweet spot Lap Band fill Thanks for the post!

Ramona Says:

Good Morning. I have had my Lapband since Jan 20th. I only lost about 5lbs. I then started having problems with my arthritis and had to have an injection of cortisone. I gained that 5lbs back plus more. I now weigh in almost 5lbs more than when I started. I have gone back to liquid diets and still have gained weight. I would like to know if there is another problem that my PCP and I are over looking. There is problems with thyroid in my history and my family history. I weighed in at 226lbs and now weigh in at 230.8 lbs. I am only 5’1″ I really need help.

Brenda Smith Says:

Hi, my question is this. I have a lapband, I was wondering if although having the band, should you still count calories and if yes, how many should you have to lose weight? I have not lost for months. And how much protein should you have in a day? thx

Dr. Ron Hekier Says:

You should always be aware of your caloric intake, protein intake, and carbohydrate intake. Every person is different and see if your doctor offers metabolic testing. 1200 – 1600 calories per day is a common range for people who are seeking weight loss. For protein intake the FDA recommends 0.7 grams for protein per day for each kg of body weight. So if you weigh 200 pounds, that is 91 kilograms. 91 kilograms * 0.7 = 64 grams of protein recommended per day.

Brenda Says:

Seven months has past since I was banded. I lost only 10 pounds after 2 fills. My last band was filled at 5cc. I have hypothyroid disease and take 300 mg of senthyroid per day. I exercise and do weight training 5 days per week for about 1 hour and fourty minutes. For breakfast I eat low fat yogurt or protein shake and one cup coffee with 1 tablespoon cream, lunch a salad w 2 tablespoon low fat dressing and dinner broil fish streamed veggies 1/2 baked potatoe. My band is a 10cc. I never eat large meals but find that I can eat more food than necessary. Do I need to go back on liquids to lose weight faster or get another fill? I have developed a chronic cough.I never catch colds. I believe the cough is related to the lap band. What could be the problem for the cough? I never feel like I have to vomit, because I am careful and listen to when my stomach had enough food and stop eating. What am I doing wrong and why can’t I lose weight?

Dr. Ron Hekier Says:

Thanks for leaving a message. I would suggest talking with your surgeon to make sure you are not too tight. A chronic cough could be caused by many things, and one of the many causes might be reflux from a Band that is a bit too tight. Some Lap Band doctors, including ourselves suggest the following evaluation: Make sure you can eat about 4 ounces of a protein source, i.e. meat, fish, or chicken. Having said that, we understand that for many patients, dry meat such as a well done steak or brisket, or dry chicken, especially white meat, may give you a tough time. But other than those cases, you should be able to have 4 ounces of a protein source with lunch and supper, otherwise you might be too tight. With the meals you describe, make sure you are getting enough protein. The USRDA recommends 0.7 grams of protein intake daily for every kilogram of bodyweight. So count your protein, and your calories. Make sure you are getting enough of both and are not too tight. Make sure to follow up regularly with your local LapBand doctor. Thanks for visiting the website and hope to hear from you again

Andrea Malone Says:

I have had the lap band now for 2 1/2 yrs and lost 50lbs. I was only 80lb over weight when I had the band put in. My Dr. thought there was 8 1/2 cc. in my band and I only hold 9. I told him I still feel no restrictions so he removed all the saline and found out I only had 6 1/2 cc. in my band so he put 1/2 cc. in. Now I was at 7cc. I felt tight for two weeks now and today I was eating and noticed no restriction at all. What happened did my band slip ?

Dr. Ron Hekier Says:

Generally if your Lap Band slips, you can’t eat or drink anything, so it doesn’t sound like a slip I only have experience with the Allergan Bands. The Allergan AP system Lap Band can hold some air bubbles so that one time when you draw back you get either more or less volume than you expected. That being said, there are a small percentage of cases where you could have a leak from the port in which case the port would have to be replaced, which is a fairly minor procedure. Talk to your surgeon at your next visit. Good luck!

Rachael Keilin, MD Says:

Speak with your surgeon or program director. You shouldn’t be in a situation where it hurts to eat everything. Maybe your are eating too quickly or taking bites that are too large, maybe your Band is too tight, or maybe there is some other issue. It also depends on what size Band you have. Ask your doctor what they recommend. We would want any of our patients in a similar situation to discuss our case with a member of our staff. Good luck!

Dierdre Armstrong Says:

I am a new bander and I was wondering if headache’s or migraines or common following lapband surgery? I had my surgery done on 7/23 and the last few weeks I have had some bad headache’s, migraines. I have been working out three days a week with once of those days with a trainer for a half hour. I have lost 16 inches so far and a little bit of weight, so I thought maybe more excerise can cause my headhaches too…My primary doc is putting me through tons of tests and right now we do not have an answer. Thanks for your time.

Dr. Ron Hekier Says:

Congrat’s on your new Lap Band. I can’t recall any of our patients having significant issues with migraines shortly after surgery. I would make sure you are hydrating well. As you eat less, your body gets less fluid, since 40% of our fluid intake is extracted from food. Also, your increase in exercise will cause loss of fluid. So my suggestion would be to make sure you are drinking enough water. Good luck!

annie Says:

just got a fill for my lapban and i cant eat, everytime i try i throw up my food and some green stuff. what is it? what should i do?

Dr. Ron Hekier Says:

Call your doctor’s office. You might be a bit too tight and need some fluid out; you might be eating too quickly and need to slow down. Good luck.

Terri Says:

I had lapband surgery in November, 2005. Worked well and lost 65 pounds then suddenly I could eat anything. Found out that my band had an aneurysm defect. Had 2nd lapband surgery in 2008 and was replaced with new band. Well, here it is 2010 and I have never felt much restriction and have gained 25 pounds. I go monthly for fills and have had tests that show no leak or anything. What’s up…I am frustrated.

Dr. Ron Hekier Says:

Which Band did you have? Was it the LapBand made by Allergan, or the Realize gastric band made by Ethicon? We have placed around 1900 Allergan Lap Bands and I have never heard about an aneurysm defect.

sue Says:

I just got banded on October 6th .I was very restricted at the first three days and I was having sever pain on my left abdomen side then I called my doctor and got the fluid out.I’m feeling much better now but I will drink one shake out of three a day and drink two boottles of water and a yogurt. My question is if I tried and felt puree food is passing fine .Is it going to harm to start eating the puree food or is it too soon even if I can take it down?

Dr. Ron Hekier Says:

Ask your doctor. After changing the volume in a gastric band we usually tell patients to try liquids for one day, and mushy or pureed foods the next day. But only your doctor knows what is right for you specifically.

michele Says:

sue, A day after I was banded I was so hungery that I just didnt want to have liquids any more so I started to eat mushy foods, I got tired of that three days later and started eating solids but slowly. After nine months I can pretty much eat anything I want,(even bread) I just have to slow down eat slowly and remember when I feel full stop. I also dont eat if I am not hungery. I have lost 87 pounds since febuary but pls talk to your doctor first. another tip: dont weigh yourself every day and stick to three small meals a day. Dont let your mind tell you your hungery when your not. drink water first. YOu could be thirsty.I dont think it will harm you but not every one is the same. I spent alot of time in the washroom with food that was stuck cause I just didnt want water any more.

Rick Says:

I have developed the hicups I have been banded for a year and a half what cound cause this they have lasted about four days.

sherri Says:

I was banded with a high pressure 4cc lap band I have had good luck on losing weight. I went from 224 to 138 now..The Dr. had my band fill for the last 8 months with a liquid called Gastrograph when My band felt to tight and was causing coughing and acid reflux so the dr. took out gastrograph a glowing liquid leaks were never found. They had this Gastrograph in for about 8mts when they took it out it’s like I have no restrictions. I have 4 1/2cc of sailine in and Feel no restrictions. But prior to the removal I had lots of restriction.. I have now gained 12lbs. Now weighing 153 Did the thicker liquid they had in cause the problems that I’m having now. Why Do I not feel any restriction. Is there a solution to this problem.

Dr. Ron Hekier Says:

The Gastrograph should not cause any problems. Good luck!

Angi Says:

I was first banded in 2007, slipped and repaired surgically July 2010..I have gained 32 pounds since May. I’m exercising just not as intensly as before. I have been told by my doctor that I’m not using the band right. The 2007 band always made me feel like I had an eating disorder, and now this band doesn’t feel like it’s restricted enough. I just want to know how much exercise and for how long I need to workout for. I would ask my own doctor but he seems to think everyone should just workout for hours and run for miles and miles all the time. Just point me in a direction, please just share your wisdom with me.

Dr. Ron Hekier Says:

I think most patients overlook resistance training. Gaining muscle is among the most effective ways to lose fat. Whether you join a gym and use weight machines, or buy a $15 resistance band with handles, introduce resistance training into your regimen. As little as 20 minutes per day for 4 days a week can have tremendous health and weight loss benefits.

Yordy Says:

I was banded on 3/24/2010 and i have lost 56 pounds since after my last fill about a month ago i was so tight i couldnt even swallow my on saliva so i had some taken out. After the unfill i still felt i was tight but decided to wait maybe it will loosen with time. Since then im super tihgt some days other days i can eat but about three days ago i started PBing after every meal and now is not even water goes thru, have reflux and coughing at night and have chest pain when i try to drink or or eat anything. Im affraid my band slipped?? What should i do??

Dr. Ron Hekier Says:

It sounds like you might need some more fluid removed but make sure to review this with your personal physician. Good luck. You should not have constant reflux and coughing at night.

Dr. Rachael Keilin Dr. Rachael Keilin

Dr. Rachael Keilin

2717 Summerhill Road, Texarkana, TX, 75503