Saturday, November 27, 2010

The Band versus the Sleeve

I'm glad we have choices of different bariatric surgery procedures, but sometimes having choices makes our decisions harder. I'm working on a weight loss surgery decision making tool to help bariatric patients weigh their options, risks, benefits, and so on. In the meantime, I'll just talk a bit about my own WLS decision.

When my surgeon explained the vertical sleeve gastrectomy (VSG) procedure at the educational seminar I attended at the start of my WLS journey, I thought it sounded interesting, but the idea of losing most of my stomach forever unnerved me, whereas the band (and its adjustability) just seemed right for me. I felt that I intellectually understood how the band works (though later I realized that I had understood only a fraction of that), and I had an intuitive sense that it was going to work for me.

For a year or so after my band surgery, I thought that if (God forbid) I ever lost my band, I would revise to the sleeve. Then I learned that the sleeve causes acid reflux in many patients, so that sleeve patients are automatically prescribed acid reducing medication from day one. I could not tolerate one day of acid reflux, and one of my goals in losing weight was to lose some or all of my meds, not gain a new med!

But I also must mention that the sleeve still might be a good choice for me, especially if getting the fills and aftercare the band requires would be difficult for me (logistically or financially). I don't personally know anyone who's had sleeve surgery, so (sadly) I have no stories to tell about it.

My poop-eating dog

Georgie, my poop-eating dog, usually appears on my pet blog,, but since I mentioned him in my Green Eyed Monster post, I feel I should share a picture of him with you. If nothing else, it will remind you that even supremely handsome men like Georgie can have nasty habits.

The Green-Eyed Monster

Shakespeare called jealousy the green-eyed monster. I use the same term rather loosely, to describe the malevolent beast who chews on my heart when I'm jealous or envious. Officially, though, jealousy and envy are different things.

Jealousy is what you feel when you fear that something or someone (like your spouse, or the job that you and a coworker named Debbie are competing for) will be taken away from you. Envy is what you feel when you want something or someone that another person already has: their weight loss success, their bank account, their fancy car, their 9-bedroom home.

In my experience, both jealousy and envy get me on a never-ending, tiresome treadmill of comparison and criticism. It becomes an obsession so blinding that I can't see any of the good things happening in my life. I compare myself to others, like my ex-husband's beautiful and devoted female lab assistant, or Debbie's MBA degree that I'm sure will earn her the promotion I want, or Marcia's 148 pound weight loss which is 100 pounds more than mine. Adding up my skills, talents and accomplishments results in a negative number every time, and those flashing red numerals reinforce my often unrealistic concept of all the pluses on Debbie's and Marcia's side. I hate them for it. I hate myself. Instead of making a new plan, I end up planning an appropriately painful and extremely unlikely demise for my rival.

Hearing me say that I hate myself may surprise you. I'm well aware that I have the reputation of being a Little Mary Sunshine, or the relentlessly cheerfuyl storybook heroine, Pollyanna, who triumphed over every adversity with a smile on her face and a "thank you" on her lips. Am I telling you to deny that you're envious, to smile even as your rival receives a round of applause at the Weight Watcher's meeting when she reaches her weight goal? After all, I've implied that you're suspicious of successful people and bear a grudge against them, as if you're the child who didn't win a prize playing Pin the Tail on the Donkey at your sister's birthday party...your evil sister who not only won the prize but also received hundreds of marvelous birthday presents and the first piece of birthday cake, the big corner piece with all the extra pink frosting roses on it. Your evil sister who deserves to get food poisoning from that cake and die a horrible, slow, painful death. Am I saying that you should just grow up and get over it, or that you're weak and spineless for feeling something as unworthy as envy?

No, actually, I'm not. I'm just suggesting that this one time you try stating your wish plainly, preferably out loud, and framed as intent instead of as secret longing. Give up the "I wish Jean wouuld gain 500 pounds and have to be transported with a crane." And no, saying, "I wish I were as successful as Jean" won't work either, though it's certainly better than devising cunning punishments for me. Try something more like, "I will lose another 62 pounds and celebrate that next year just as we're celebrating Jean's success today." Tell that to your reflection in your mirror and to a friend who'll be sure to say, "Go for it!"

I'm an analytical as well as an optimistic person (I choose to see that as a felicitous if conflicting combination of my parents' strongest traits), and when evaluating myself, my past, and my prospects for the future, I tend to get stuck on the "Why? Why am I this way? Why am I acting like this?" and on and on and on. But as the old Budweiser commercial said, Why Ask Why?
Don't torture yourself by asking, "Why am I so envious? Why can't I let it go and be the positive, optimistic person Jean says I should be?" The asking probably won't get you very far. The answer could just be as simple as, "Because you're a living, feeling human being." Nothing wrong with that! Although I do like art museums for an hour or so, it's boring to spend a lot of time with inanimate (if beautiful) marble statues. I want friends who are flawed (like me) and capable of both deep feeling and high aspirations.

On the other hand, don't spend too much time with the loyal, well-intentioned people who feed your envy by saying, "You're so right, she doesn't deserve that success, she hasn't worked nearly as hard as you have, and did you know she has six toes on her left foot and even worse halitosis than my poop-eating dog?"

Oops! Did I say "poop-eating dog"? Indeed I did. Which brings me (finally) to my final point. Try to see the humor in the situation. Admit it, if Tracey Ullman were up on the stage acting out the part of an envious character and using your words, you'd be laughing your a** off now.

Thursday, November 25, 2010

Jean's Band Story - the short version

I've been writing this blog since May 2009. I'm a quick (some might say impulsive) decision maker. I just jumped in blogging my band stories...full speed ahead. When I began it, I wrote a short bio for one of the "gadget" blocks on the left hand side of the blog, but I don't think I ever posted anything more detailed than that. So let me rectify that now.

Today I'm 57 years old. I'm 5'2-1/2" tall, weigh 135 pounds, wear misses size 10 clothing and a size 7 shoe. Aside from a chronic pain problem, I'm disgustingly healthy. I enjoy exercising 5 days a week, work a part-time job as a bra fit specialist at JC Penney, plan and eat healthy meals about 90% of the time, and will do almost anything for a laugh. Born in Massachusetts, I now live in Tennessee with 10 dogs, 5 cats, and a sadly neglected husband.
I've written four books and published two so far: a novel, No Ransom, and Bandwagon, a self-help book for adjustable gastric band patients. I'm working on several Bandwagon follow-up projects and also publish a free weekly e-newsletter, Bandwagon on the Road (to subscribe to it, click on the envelope image in the brown box at the left side of the blog page).
I'm also a collage artist with an online gallery at: There aren't enough hours in the day for me to accomplish everything I want to do. My chronic pain makes it impossible for me to sit for longer than 5-10 minutes, but so far, that's not a big problem because I'm so busy running around and catching up on all the things I missed out on when I was a morbidly obese couch potato.

Yes indeed, I used to be a fat girl. When I turned 50, I weighed 221 pounds, wore size 3X clothing and size 8 shoes. I had a BMI of 40.5, Type 2 Diabetes, high cholesterol & triglycerides, joint pain, stress incontinence, sleep apnea and a glamorous but extremely demanding job as a designer and buyer of decorative home accessories. My hobbies were eating, cooking, reading (with a dog or two on my big lap), eating, cooking...and did I mention eating? I was fat, depressed and miserable.

In September 2007, at age 54, I had Lap-Band surgery. Since then I've lost 90 pounds, regained 25 after a band slip and flipped port in 2009 (it was a bad year anyway - my mom died that November). My band slip was cured by a complete unfill and rest period, my flipped port was fixed by outpatient surgery in April 2010, and I've re-lost 22 of the pounds I had regained. In the course of all that, I've learned a lot about the adjustable gastric band, and a lot of stuff about myself that I'd really rather not know, but on the whole, I'm the better for it.

As my 60th birthday marches relentlessly towards me, I'm determined to make up for all that lost time - all the years I wasted on overeating and self-loathing. Perhaps those years weren't really wasted - I think I had to survive all of that in order to arrive at my current location. Sometimes you can go around the mountain, and sometimes you just have to climb up it. And the climb was worthwhile, because the view here is marvelous.

Should you know your band's fill level?

I've always known my band size and fill amounts, not because anyone volunteered that information but because I asked for it. I'm a very curious person who loves information (especially when it pertains to me!) and I ask a lot of questions. If my parents were still alive, I'm sure they'd testify to that.

Quite often I've heard bandsters ask, "Why won't my surgeon tell me how much fill is in my band? When I ask, he/she says it doesn't matter."

In a way, those doctors are right, because how much fill you have at 2:00 pm on October 3rd is only one of the things that affects your restriction that day, and at 2:00 pm on October 4th, with the exact same amount of fill, your experience of restriction could be completely different than it was the day before. The most important thing about your fill level is: does it produce the early and prolonged satiety that helps you lose weight?

But those doctors are also wrong.

That band is inside YOUR body. You (or your insurance company) paid for it, and it is YOUR property. Legally, you have a right to see all your medical records, including file notes about your band size and fill level. Some medical practices charge the patient a fee for photocopying or printing those records, but whether the info is free or costs you $5 or $15, it should be available to you upon demand (be reasonable though: the office person who has to do that for you probably already has a zillion items on her/his to-do list).

You also should have your fill level data because at some point, it might have a direct influence on how you evaluate your weight loss success and how you make decisions about how to deal with inadequate weight loss. For example: you have a 10cc band, have had 14 fills, and have not yet experienced any restriction. Is that because your surgeon has been doling out miniscule fills (like .1 cc at a time)? Is it because your band's tubing is leaking? Is it because the band just doesn't work for you?

Let's say that after a year of struggle, you have lost 5 pounds and have 1.4 cc in your 10 cc band. A whole year has been wasted because you didn't have enough information to advocate for bigger fills. Or let's say you discover that you have 9.75 cc in that 10 cc what do you do? Will your insurance pay for you to revise to a different WLS procedure? Are you going to have to start all over again with your research, tests and evaluations, insurance approval, scheduling and undergoing surgery, recovering, and getting back on some kind of wagon, be it the sleeve or the bypass or the duodenal switch wagon? If you had known your fill level 3 months or 6 months earlier, would you have started all those chores before and/or had a heart-to-heart chat with your surgeon at that time instead of at this late date?

Time for a new wardrobe

Yesterday at work I was mildly uncomfortable for several hours before I realized that it was because the black dress pants I bought in September were falling off me, so that I had to keep hiking them up - such an attractive look in a public place like JC Penney. So I'm sad and glad to report that it's time for a new wardrobe. Sad because I'll have to spend money to get it, even at the Good Will Store. Glad because it's so much fun to shop for size 10 clothes!

I did get a good deal at JCP the other day, though. I found a pair of dressy white "city shorts" on the clearance rack for $1.97. They're size 10 and I got them because I figured I'd fit into them by next spring. When I got them home and tried them on, I was delighted to find that they fit me perfectly!

Sunday, November 21, 2010

The closer she comes, the scarier she looks

When I was growing up, lo those many years ago, there was a popular commercial for Clairol hair color. In this commercial, a beautiful woman and a handsome man ran towards each other through a field of flowers, with smiling joyous faces, arms outstretched, shiny hair streaming in the breeze (well, hers was, anyway). The tag line was, "The closer she comes, the better she looks," which implied that Clairol hair color was so convincingly real, its user's hair would actually look even better on closer inspection.

Later, someone did a spoof of the commercial in which the man and woman ran right past each other into someone else's arms, and I had a lot of fun re-enacting that scene with a coworker named Joe Riley when we caught sight of each other in the hallway one of those spontaneously silly things that makes my life worth living. I'm not sure that our business associates thought it was funny as we did, but as Joe would've said, "To hell with you if you can't take a joke."

But anyway, back to the actual subject of this post. The closer the holidays come, the scarier they look. When I looked up my JC Penney work schedule for the next 2 weeks (including a 3:45 am to 1:00 pm shift on Black Friday), my heart sank. I should be grateful for all the extra work hours (and resulting pay), especially when so many people are desperate for a job, but all I could think of was the break room tables loaded with baskets of potato chips & candy bars, with pans of brownies and plates of cookies... I remembered being desperate last year for fuel, any kind of fuel, and comfort, especially in the form of junk food...

I considered printing up my plan for how to handle the holidays this year and taping it to the inside of my locker door, but since my locker is on the bottom row, I'd have to hunker down to read it, thereby sticking my butt (smaller, but not tiny) into the narrow path between the lockers and the kitchenette, which is also the vital and well-traveled pathway to the vending machines and employee rest room.

So instead, I'm going to make multiple copies of the plan on index cards and tuck them into my purse, in my car, in my netbook case, on my bathroom mirror. After all, I'm 57 years old, with short term memory deficiencies. The other day at JCP I was helping 2 customers in the shoe department. I got out to the stockroom, climbed a 10 foot ladder, reached for a box of shoes, and suddenly thought, " this the one who wants a size 8 pump in black, or the one who wants a size 9-1/2 boot in brown?"

Thursday, November 18, 2010

My weight loss eating plan

Bariatric centers vary greatly in their post-op weight loss eating plans. How many calories you should eat in a day will depend on your weight, gender, activity levels, and weight loss goal. My weight loss eating plan was 900 calories a day, 35% of the calories from protein (78 grams total), 35% from carbs (80 grams), and 30% from fats (30 grams). That worked very well for me. As I began to work out harder and more often, my calorie intake ranged from 900 to 1100 per day and I still lost weight.

Here's an example of a day's menu:

B: 1 serving carb (1 slice whole grain bread, toasted), 1 serving protein (1 soft-boiled egg)
S: 1 serving fruit (1/2 banana)
L: 1/2 serving starchy carb (1/4 c. chick peas), 1/2 serving non-starchy carb (1/4 c. fresh
tomato), 2 servings protein (2 oz. chicken breast)
S: 1 serving fruit (1 c. cantaloupe chunks)
D: 1/2 serving starchy carb (1/4 c. sweet potato), 1/2 serving non-starchy carb (1/4 c. green
beans), 2 servings protein (2 oz. halibut)
S: 1 scoop protein powder mixed with 8 oz. skim milk

Saturday, November 13, 2010


As I explained in Bandwagon, self-sabotage is the deliberate destruction of property or the hindrance of operations by an enemy. As you start your weight loss surgery journey, you might believe that your mother and her famous biscuits and gravy, or your husband and his Pizza Palace Frequent Customer card, or your children with their 9:00 p.m. demands of "Mom, I need some cookies for our class Christmas party tomorrow", will be your worst saboteurs.

But beware! There is another saboteur who is with you 24 hours a day, 365 days a year. Who is it? Go look in the mirror. The saboteur is you. That earnest, innocent face hides a food demon who is determined to prove what you believed for so long...that you are destined to fail at weight loss...that you don't deserve to be slim and healthy....that without your protective layer of fat, you'll be too easily hurt or too easily noticed...that once you're up on the Pedestal of Success, you'll lose your balance and tumble back down into obesity anyway while all your friends and enemies point and laugh at you.

Some signs of self-sabotaging thinking are: jealousy (comparing yourself to others), extreme anxiety, negativity, procrastination, giving up easily, ignoring feedback, feelings of worthlessness, living in the past, blaming others, and the all-time favorite: DENIAL.

How can you overcome bad stuff like that? Professional counseling has helped me tremendously. Attending Overeaters Anonymous has also helped me. Checking in daily with my Accountability Partner helps me.

Sunday, November 7, 2010

Holiday Eating

Today is November 7th. I survived Halloween and a minor incident with some evil candy corn, but the holiday season with all its social eating challenges looms on my horizon. Last year I had just started a new retail job, had little fill in my band, was struggling with untreated and undiagnosed fibromyalgia pain, lost my mother, and lost control of my eating during the holiday season. I responded to my unpredictable work schedule and my physical and emotional pain by using my old friend, Food. So I hurtled through potluck meals at work and church, and eating on the run, with my mouth open, cramming everything and anything I could grab into it. I couldn't seem to get or stay organized well enough to come up with an eating plan and stick with it, but planning is the #1 tool that helps me in social eating situations.

Thank goodness, I'm facing the 2010 holiday season with a well-filled band, medical issues under control, emotional issues that aren't as overwhelming, and greater mastery of my retail job now that in 2009. Here's my plan for the coming months:

1. I will not let myself get too hungry, especially before social events.
2. I will bring something healthy that I can eat to every potluck meal.
3. I will keep a supply of protein bars in my purse and my locker at work.
4. I will plan each day's meals in advance, commit them to my accountability partner every day,
and report to her the next day how that day's eating went.

Wednesday, November 3, 2010

Fill philosophies

Bandsters are often puzzled by the difference in bariatric surgeon's fill philosophies. Some surgeons are very conservative, giving fills in small amounts over a longish period of time. Others are more aggressive, giving larger fills over a shorter period of time. The best way to understand your own surgeon's philosophy is to ask him/her about it, but you may get a vague answer like, "We do it this way because we find it has the best outcome."

I've had 2 bariatric surgeons and they both took a fairly conservative approach....but not so conservative that you have to wonder if they administer saline one drop at a time in order to increase their income.

When you're excited about losing weight, you might want to get your show on the road going 200 mph with a first fill of 8 cc in a 10 cc band, but your surgeon is probably not going to go along with that. An aggressive fill like that would be a problem on at least 2 levels:
1. Overly aggressive fills are associated with complications like band erosion
2. The patient needs time to adjust to the effect of the filled band on their eating
ability. One day you can eat anything, the next day you get a big fill, and the
day after that you take a nice big bite of steak, chew it 3 times, swallow, and
BAM! Your bandwagon has just crashed into a brick wall.