Friday, March 29, 2013

Did my band fail me, or did I fail my band?

The first time I heard the catchy title of this article was in a magazine article written by fellow bandster and author Cher Ewing. Her article told the story of losing weight at a great rate at the start of her band journey, then slowing to a halt for month after month. She wondered if her band had failed somehow, but she was also honest enough to take a good hard look at her behavior and realize that actually, she had failed her band. She had become a happier, busier person, and also a somewhat complacent one. She decided to jump back on her bandwagon and finish her journey.

That article made a big impression on me. The idea that we can and do fail our bands was quite new to me at the time. Since then I’ve seen ample evidence of the truth of this, and many people have criticized me for talking about it. It sounded to them like I was blaming unsuccessful bandsters for their weight loss failure. I’m sorry that it came across that way, but I stand by my conviction that when any human enterprise fails, we must look for the causes (and the cures) in every nook and cranny. Your bandwagon stalls at the side of the road. First, check the fuel supply – is it adequate? Next, check the tires – are they inflated? And the driver – what about the driver? Is the driver properly trained and motivated? Perhaps the failure can be blamed (if blame you must) on a combination of factors: the driver forgot to fill the fuel tank; the wagon ran over a nail that pierced a tire; or maybe the driver should have chosen a different wagon altogether – maybe a jet ski or a skateboard?

Sometimes, no single or obvious cause for medical failure can be found. It’s very, very frustrating. Doctors deal with dilemmas like that every day, when all the examinations and tests reveal nothing clear or significant and yet the patient is still sick. Even diagnosing a medical problem can be complicated, never mind curing or treating it. For those of us without formal medical training, who are relying on what we read or hear from our doctors, friends, and online acquaintances about band problems, it’s an overwhelming and baffling business.
That was certainly my experience when my band problems began 15 months ago. For months I struggled to keep my balance in my ever-shifting WLS journey. Eventually I gave up trying to identify and understand every little detail, because doing that was taking too much of my energy when I needed to devote my energy to figuring out what to do next and then doing that. During that time, I lost my band and eventually had VSG surgery, and for the next 6 months or so, I had to concentrate on adapting to and dealing with my disappointment with my sleeve.
Although both my band and my sleeve were/are successes in that they helped me lose my excess weight, I'm not sure if it's even possible to call one a success and the other a failure. I'm trying (again) to get used to be a thin person and to adjust my expectations of myself and my sleeve. I'm often tired and struggle to decide what task to put at the top of my to-do list, but I pledge to make my health a top priority going forward. It's not something I ever want to take for granted.

Wednesday, March 20, 2013

The Secret to WLS Success

What is the secret to being a weight loss surgery success?  

When aspiring writers ask me, “How can I become a writer?” my answer is invariably, “Be one. Write.” I’m a writer not because want to be one, but because I write. I’m constitutionally unable to not write. It’s not always easy, but I always do it. Writing keeps me alive and vital. In that sense, it’s a big part of healthy living for me. 

So, do you want to know how to be a successful WLS patient?  

The answer is: “Be one.” Make your health a top priority, not because you’re so ridden with medical problems, but because it will help you thrive. 

Sounds so simple, doesn’t it? But exactly what does that mean? It means that I write every day. Other than finding or making the time to do it, it’s not hard, because I love to write. So to be a writer, I practice the art of writing every day. What I write varies, just as what you eat varies, depending on how much time I have and what I’m in the mood for. Within 15-30 minutes of getting up each morning, I write something. I write e-mails to my accountability partners, telling them about my eating, exercise, and perhaps some funny, or infuriating, or interesting stories about my daily life. I write down the thoughts I have about magazine, newsletter and blog articles. I write lists of things to do and things to think about. At some point during each day, I write sentences or paragraphs or chapters of articles, essays, stories and books. I write journal entries that help me muddle through puzzling situations and relationships. 

I also love being slim and healthy, so I practice the art of being slim and healthy every day. This too varies, but within 15-30 minutes of getting up each morning, I practice my healthy lifestyle. I update my food log and report my food plan and eating behavior to my accountability partners. I get dressed in workout gear and spend 45 minutes at an exercise class, 5 days a week. I write a weekly menu plan and I write my grocery list. Even when I’m doing something that isn’t directly related to weight and health, I’m practicing. I see a plate of home-baked cookies on the break room table at work and think about whether I want to eat one or if I’ll regret doing that. In a short 15 minute break, I practice good eating skills as carefully as I can despite feeling hurried. When I get in my car to go home and notice I’m thinking wistfully of Chicken McNuggets or Dulce de Leche ice cream, I take a deep breath and ask myself if I really need those things or just want them as a quick fix. I try to see myself driving home and preparing the healthy meal I’ve planned. I try to remember how good I felt when I did that the day before. I think about how happy my dogs will be if I get home on time (anybody who claims animals can’t tell time has clearly never lived with a dog).

The key words in the two paragraphs above are “love” and “practice”. 

If you’re thinking, “But I don’t love to diet!” maybe it’s time to adjust your thinking. Instead of thinking, “I hate dieting,” try this on for size: “I love being a WLS success.”  

And it’s definitely time to discard the notion of being “on a diet”. A diet is something you do for a finite period (a week, a month, 3 months). It’s temporary, and when it ends, your eating goes back to the way it was before the diet, and lo and behold, the weight you lost comes back, and often it brings all its friends, and its friends’ brothers, sisters, and cousins. I know that for an absolute fact because it’s happened to me so many times since I was 14 or 15 years old. 

Being a weight loss success means practicing healthy eating every day of your life, for the rest of your life. Some days may be healthier than others, and that’s OK. You’re just practicing, right? It doesn’t have to be perfect; it just has to be regular and ongoing. I don’t think about weight loss and health and all that good stuff every waking minute, and not all my thoughts are virtuous. I spend quite a lot of time thinking things like, “Why doesn’t that pickup truck just pass me rather than riding on my tail?” or “If he spits toothpaste on the bathroom mirror one more time, I’m gonna be one happy widow.” But thoughts about weight and health go through my mind every day. I’ve heard WLS patients say they never want to have to think about that stuff ever again. I don’t think I could succeed that way, and those thoughts are not a burden for me. The real burdensome thoughts I bear are ones like, “I should have hugged Mom more often before she died.” 

Oh, I know that “shoulda, coulda” thoughts are a waste of time and energy. That’s probably why they’re so hard to bear. But that’s a topic for another article. 

So, do you want success? I want to hear you say it, loud and proud:




And give yourself three cheers for your effort, even if you feel you haven’t yet achieved success. Sports teams get cheered at every game, whether they win it or not. When they win, they want to win the next game, and the next. When they lose, they go back out on the field to practice the next day, and to play another game the day after that. They don’t do that just because they owe it to their coach and teammates. They do it because they love to practice, play and win. 

“But I’m not an athlete!” you say? Me neither. But I do love being a WLS success!

Wednesday, March 13, 2013

Why Does WLS Fail?

Bariatric surgery can fail. No one wants to talk about that, especially when we’re filled with hope about what bariatric surgery can do for us. Why does weight loss surgery fail, and what does that mean for each of us? 

In the bariatric community, we spend a lot of time debating about which WLS is the best – that is, which one yields the best outcome (my own definition of that is optimal weight loss with minimal complications). I think we can all agree that there’s no such thing as a perfect or one-size-fits-all bariatric surgery. If we’ve all fought weight battles long and hard enough to need or choose WLS, we can surely agree that obesity is tough to overcome. And that is, I think, the grounds for further agreement, about why WLS fails. 

Here’s my premise: weight loss surgery fails because of obesity. If you’re thinking you need not read further because you already knew that, please wait until I explain a bit more. And those of you snickering in the back of the room, simmer down. I’m a natural blonde (duh) as well as an old fogey who needs time to make her point, but like Ellen DeGeneres, I do have a point. 

OK, let’s continue. Some disappointment or failure can be attributed to the inadequacy of a bariatric medical device or surgical procedure or surgeon or patient, but underlying all that is the basic reality of obesity: it’s a chronic and currently incurable disease, caused by a mixture (unique to each patient) of genetics, behavior, environment and biology. Weight loss surgery may address some aspects of those factors, but not enough to cure obesity. So it fails because of obesity.

In the past, I’ve given a lot of thought to how genetics, behavior, and environment have contributed to my own case, but no more than a passing glance at the biology of it. I’m the daughter of a gifted scientist who passed on not one single gene of scientific aptitude to me (instead, I got his nose and the name McMillan). 

I realize that saying that WLS fails because of obesity is like saying the ocean is wet because it contains water, but as with many obvious facts of life, it’s easily overlooked. We go into WLS believing or at least hoping that surgery will fix enough of what’s wrong in us to help us lose weight and maintain that weight loss, but we need to remember that no WLS will cure our obesity. We need to remember that our obesity is at least partly caused by factors that are invisible to us. 

Those factors were invisible to me until a few months ago, when I was asked to write a magazine article about some recent research studies that found a link between obesity and fibromyalgia. I’m uniquely qualified to write that article because I’m a veteran of both wars. 

When I began researching the article, I was astounded by the dense mountain of information: scientific data, theories, probabilities and conjectures that I’d heard little or nothing of before despite my exalted status as the World’s Greatest Living Expert on the Adjustable Gastric Band. I’ve had WLS, talked to dozens of bariatric medical professionals, attended three bariatric conferences, read countless books, articles, blogs and reports, but suddenly I felt like a babe in the bariatric woods. Why hadn’t either of my bariatric surgeons (never mind my primary care physician) mentioned any of this to me? Are they unaware of it? Are they hiding it from me and the rest of their patients? Is there a conspiracy afoot?  

This information is of enormous importance if only because it knocks a big hole in the old-school blame-the-patient approach. The paranoid in me wonders if the information is hidden to protect an industry or to further a political cause, but I put those thoughts aside and instead considered the very real possibility that bariatric surgeons are well aware of the obesity mountain but are practicing a form of medicine that circumvents it. They don’t climb the mountain and they don’t hike around it. They cut right through the middle of it. 


To explain myself now, I’ll have to resort to another simile. In a sense, bariatric surgeons treat obesity by stuffing a many-armed octopus in a sack and bludgeoning it with an axe. I’m not criticizing the surgeons. Surgery of any kind requires a breathtaking degree of confidence, skill, and audacity. Although surgery doesn’t address every waving octopus arm, it is the only effective long-term treatment for obesity available in the United States today, and I’m very grateful that I was able to have WLS and lose my excess weight as a result of it. At the same time, I sometimes worry about the future. This spring, treatment of a medical problem required removal of my band. I’ll soon have vertical sleeve gastrectomy surgery, but what if obesity takes over my life again in spite of my band and all my hard-won lifestyle changes? Are researchers working on an obesity cure now that can help me with that in the future?

It turns out that researchers have indeed been busy searching out the causes of obesity in the hope of finding a better way (or ways) to treat it, prevent it, and/or cure it. 

As I mentioned above, several studies have reported a link between obesity and fibromyalgia. It’s easy to get caught up in a chicken & egg debate about that – does one disease cause the other? I don’t want to go down that road right now. Instead I want to talk about some factors that are associated with (and may be contributing to) both conditions. They are: 

Non-restorative sleep – Sleep affects the production of hormones (leptin, grehlin, cortisol) that are key to the experience of hunger, appetite, and satiety. Poor sleep tends to decrease leptin (satiety hormone) production and increase grehlin (hunger hormone) production. It also seems to increase sensitivity to pain. If you have sleep apnea or another type of sleep disorder, or even subclinical sleep disturbance, it’s likely that your physical hunger is increased and your sense of satiety is decreased. The adjustable gastric band can intervene on your behalf, but it doesn’t correct the hormone production problem.  

Neuroendocrine dysfunction – the nervous system (neuro) and endocrine system (glands) control all physiologic processes in the human body. The nervous system works by sending messages through nerves, as if it’s a hard-wired telephone system. Nervous control is electrochemical in nature and is rapid. The endocrine system sends messages by the secretion of hormones into the blood and extracellular fluids. Like a radio broadcast, it requires a receiver to get the message. To receive endocrine messages, a cell must bear a receptor (a receiver) for the hormone being sent in order to respond to it. If the cell doesn’t have a receptor, it doesn’t “hear” or react to the message. 

Researchers studying neuroendocrine interactions discovered (among other things) that in fibromyalgia and obesity patients, certain cells have damaged or malfunctioning receptors for the leptin, the satiety hormone. It’s the one that tells your brain you’ve had enough to eat. So one of the reasons you rarely feel satisfied by a reasonable amount of food (or in my case, an infinite amount of food) may be that satiety messages are going astray because your cells’ in-boxes are locked or absent. 

Dysregulated HPA is a factor contributing to both obesity and fibromyalgia. HPA stands for hypothalamus-pituitary-adrenal, three glands (part of the endocrine system) that are crucial to healthy functioning of many bodily processes. The HPA axis is a grouping of responses to stress. When you experience stress (whether it’s physical, like an injury or illness, or mental, like a fight with your spouse), your body produces a biomarker (messenger cell) that stimulates your HPA axis. Your hypothalamus (in your brain) then sends a message to your pituitary gland (also in your brain), where it triggers the release of ACTH (adrenocorticotrophic hormone) into your bloodstream and causes the adrenal glands (on your kidneys) to release the stress hormones, particularly cortisol. Cortisol increases the availability of the body's fuel supply (carbohydrate, fat, and glucose), which is needed to respond to stress. However, prolonged elevation of cortisol levels can cause havoc: muscle breaks down, your body’s inflammatory response is compromised, and your immune system is suppressed. If you’ve ever taken a corticosteroids medication like Prednisone to treat an inflammatory problem (like an allergic reaction) or disease (like lupus), you’ve probably learned the hard that it can turn you into a bad-tempered eating machine. 

Inflammation, as mentioned above, is another culprit in both chronic pain and obesity. A European study of showed that obese rats have chronic low-grade systemic inflammation that sensitizes them to pain. Immunological vulnerability is common to obese and chronic pain patients and contributes to pain, fatigue, sleep disturbance, and depression. All of those are factors that can prevent us from exercising and are associated with the neuroendocrine dysfunction described above. 

Mitchondrial dysfunction may also play a role in both chronic pain and obesity. According to Karl Krantz, D.C., “mitochondria are the power house of the cell. If energy is not being produced, logically it can lead to or contribute to chronic fatigue and pain.” A Finnish study of identical twins (each pair including a normal weight and an obese twin) found that the fat cells of the obese twins contained fewer copies of the DNA that’s located in mitochondria. This DNA contains instructions for energy use by the cell. The lead researcher of the study says, “If one were to compare this cellular power plant with a car engine, it could be said that the engine of the fat individual is less efficient.” So it’s no wonder that obese people are not able to burn or use all the calories they consume. Some medical professionals believe that chemical toxins (such as the preservative sodium benzoate, used in many soft drinks) and biotoxins (such as mold) can damage the mitochondria, increase inflammation, and aggravate both obesity and chronic pain.


Your own brain may in overload now after working its way through all the biological business I’ve ineptly but earnestly tried to explain. Even if nothing else is clear, I hope you’ve grasped the message that the causes of and factors in obesity are extremely complicated and well beyond the means of any currently existing medical device or surgical procedure to cure. I also hope you can see that blaming yourself for your obesity doesn’t go very far in treating it. You are not in conscious control of your neuroendocrine system. But neither are you entirely helpless. You have, or will soon have, a bariatric tool that when carefully used, can bring your appetite under better control and increase your sense of satiety. You can learn as much as possible about the factors that can improve your overall health and counteract the misbehavior of your nerves, hormones, and immune system. For example, I know for a fact that regular exercise helps me manage not just my weight but my depression and pain. You may feel defeated by the very idea of that, but according to an article in the July-August 2011 issue of IDEA Fitness Journal, as little as 5 to 15 minutes of exercise a day can yield health benefits and also increase your self-control when it comes to food choices.

At the end of the day, I still suffer from obesity and fibromyalgia, both puzzling and difficult to treat, but I try not to think of myself as a victim of those diseases. I can curl up in a chair with a box of chocolates and weep about my situation, or I can go on learning about my medical conditions and experimenting with ways to improve my health and quality of life. The author of one of the obesity-fibromyalgia studies, Akiko Okifuji, recommends that patients adopt healthier lifestyles and take more positive attitudes toward symptom management. That may sound condescending, but as Dr. Krantz wryly pointed out, “every person in America would benefit from that approach.” I know that’s easier said than done, but I’m willing to try it…are you?

Friday, March 8, 2013

My Band-to-Sleeve Experience

A lot of people (especially those considering first-time bariatric surgery or revision surgery) have asked me about my band-to-sleeve revision, and how my sleeve compares to my band. Below is a summary of my experience so far. I'll warn you in advance that I'm not happy with my sleeve. I do know several sleevesters (band-to-sleeve patients) who love their sleeve, but I have a strong suspicion that they feel that way because their experience with the band was unhappy, not because the sleeve is intrinsically better than the band. When they had their band removed and revised to the sleeve, the euphoria they felt was a bit like the relief you feel when you stop banging your head against a wall.

I was banded in September 2007. I lost 100% of my excess weight (90 lbs) in one year. I had a minor band slip (cured with a complete unfill and 6-week rest period) and a port flip (fixed with outpatient surgery) and loved my band. When it was properly adjusted, it drastically reduced both my physical hunger and my appetite (desire) for food. Food just did not taste as wonderful to me as it had in the bad old days. I also experienced the early and prolonged satiety that is the band's #1 claim to fame.

Unfortunately, I lost my band in April 2012 because of damage from 20+ years of silent reflux, which my band may have been aggravating. My surgeon and gastro doc agreed that my band had to come out, so I opted to revise to the sleeve in the same procedure. That didn't happen because my surgeon couldn't pass the bougie (the sleeve "calibration" tool) through my esophagus because of an undiagnosed stricture, so I was bandless until my 2nd attempt on August 16, 2012. I had the stricture dilated during an EGD in May 2012.

I had thought that the sleeve would be a good 2nd choice for me because I wasn't crazy about the malabsorption aspect of RNY or DS, because one of the best features of the sleeve is that the reduced stomach size drastically reduces production of the hunger hormone, ghrelin, and because the idea of a surgery that wouldn't require fills to achieve optimal restriction was appealing.

Unfortunately, it didn't work out that way for me. I am now ferociously hungry on an hourly basis no matter what, how much, or when I eat. I have to eat 8-10 times a day in order to keep my blood sugar steady. I've had to start taking metformin for my type 2 diabetes after easily managing it with diet and exercise for 7 years. I've discovered that sleeve patients can dump just like gastric bypass patients. The official term for dumping is rapid gastric emptying. My surgeon says that my sleeve is too small to hold food long enough for the stomach to start digesting it, so it passes rapidly into my intestines, causing my blood sugar to spike and then dive. It gives me miserable symptoms of nausea, dizziness, drenching sweats, and fatigue. That happens not just when I eat something with sugar in it but also when I eat so-called healthy foods (protein bars, milk, cottage cheese, yogurt, protein shakes, many fruits). And it happens when I eat too fast or too much.

At 6-1/2 mos post-op, I'm still trying to learn my satiety signals. They are not as clear as the stop eating signals I got with my band. All I've identified so far is that when I start feeling slightly nauseated, I've probably eaten one bite too many. Other sleevesters have told me that with their sleeve, they never have a stuck episode or a PB (productive burp or regurgitation). With my sleeve, 2 times I've felt like I was ready to PB, but I didn't. My strategies for dealing with all this are to serve myself half of my planned portion of food, eat that, and if I still feel physically hungry, I eat the rest. When I was banded, I used a salad plate (8") instead of a dinner plate (10"). Now I use a small bread plate (6").

I've become anemic and have to take an iron supplement twice a day in order to give me enough energy to function. Turns out that micronutrient malabsorption isn't unique to RNY & DS patients (anemia and other conditions related to micronutrient malabsorption have been documented by scientific studies; to read an abstract of one study, click here.

Also, a few months after my sleeve surgery I developed a gastric bleed. When doing an EGD to locate the source of the bleed, my gastro doc discovered a gastric polyp (probably the cause of the bleeding) and duodenitis (inflammation of the duodenum), neither of which were present when I had an EGD 3 months before my sleeve surgery. He theorizes that those were caused by surgical trauma.

I'm not able to be objective about my sleeve at this point, and it's probably too early for me to decide it was a mistake. But even if I decide it was a mistake, I'm never going to get that missing chunk of stomach back. It's gone forever. I do know that I absolutely refuse to go back to the land of obesity, and I'm grateful that my sleeve has helped me avoid that. I've lost the 30 lbs I had regained after losing my sleeve (plus another 7 lbs), and that is wonderful thing.

One difference between my band surgery and my sleeve surgery is that my sleeve surgery was much harder to recover from. It wasn't more painful, per se. My port site was very sore because my surgeon used the incision she had made to remove my port in order to remove the big chunk of stomach she had cut off, but my port site was the most uncomfortable incision from my original band surgery, so that was no surprise. My surgeon says that any revision surgery is difficult because she's not operating on a "virgin" belly. I thought that the slow recovery was due to my age (59) because an older friend (age 61) who revised to the sleeve at the same time also found it difficult, but I met a younger woman (mid 30's) in my surgeon's waiting room whose sleeve was her 1st (and we hope last) WLS was also finding it difficult. I think the length and ease of recovery is also related to the patient's age, pain tolerance, general health, and amount of time spent under general anesthesia. My surgeon keeps band patients overnight in the hospital for one night, and sleeve and RNY patients for 2 or more nights. I hate being in the hospital but I was a mess even after 2 nights there. After my band surgery, I felt fine after one night in the hospital and was bored and restless and ready to go back to work (I worked at home then) within 3-4 days. After my sleeve surgery, just lifting a glass of water to my lips was a struggle. I felt like I'd been run over by a truck, and I needed the whole 3 weeks my surgeon insisted on off work, and even then I was dragging.

The other thing I want to say is that while my food capacity now is small (depending on the consistency of the food), my desire for and enjoyment of food is like it was before my band surgery. I feel like I get way, way too much pleasure out of eating. I believe that food tastes good for a reason (to keep us eating enough to survive and perpetuate the species), but that extreme enjoyment is a very mixed blessing. I constantly have to fight with myself to not take another bite so as to prolong the pleasure of eating. With my (adjusted) band, I did have some intrusive food thoughts, but nothing like it was in the bad old days. Now I think about food far too often than is good for my weight management.

I wish I had a happier story to report. I've been told that I'm not trying hard enough to like my sleeve because I loved my band. That may be true, but I sincerely wanted the sleeve and sincerely wanted it to work. I thought I knew what I was getting myself into. Ask me again in a year or so, and I may be waving the sleeve banner. And as the advertising hacks would say, "Your mileage may vary."

Friday, March 1, 2013


The band gives almost instant feedback about your eating behavior. The feedback comes in the form of Soft Stop and Hard Stop signals. In order to learn and recognize your own stop signals, you’ll need to slow down and pay very close attention to how your body feels when you eat.  If you usually eat with a crowd (family, friends, coworkers), you might need to try eating by yourself so you won't be distracted. Full signals can be subtle and they can come from unexpected parts of your body. It's better to heed a gentle reminder than wait for a hammer to hit you on the head.

Soft stops are your early warning system, gentle reminders from your body that it's time to stop eating. Because they don't hurt much, they're easy to ignore.  Your job is to recognize them (even though they may vary by the meal or the day) and heed them every time you recognize them. They can include: 

   Mild queasiness

   Fullness or pressure in the back of the throat

   Difficulty swallowing

   Burping (or the urge to burp)

   The urge to take a deep breath

   The urge to cough or clear the throat

   A sigh


   Pressure in the chest

   Watering eyes

   Runny nose

   Left shoulder pain

   A sneeze

   Excess saliva

   A full feeling just below the breastbone

   A sudden distaste for the food you were enjoying a moment before

As soon as you notice one of these signs, stop eating. If you go on eating past this point, you won't be changing your eating behavior and you're likely to get into trouble…that is, a hard stop. 

Hard stops are the equivalent of running into a brick wall. They can happen without any apparent warning, but usually you have sped heedlessly past a soft stop before you hit the wall. Hard stops are the painful and sometimes embarrassing reminders that you have eaten too much, too fast, in bites that were too big, without chewing enough. They can include:

   Chest pain or tightness (note: this sensation is happening in your esophagus, not your heart, but if you experience any symptoms of cardiac arrest, such as severe, squeezing pain that radiates down an arm, put down that fork and dial 911)

   Feeling like you have a rock in the back of your throat

   Food stuck in stoma (for me, that involved pain between my breasts, and when the food moved on through into my lower stomach pouch, it felt like a drain that suddenly opened)

   Productive burps (PB's or regurgitation)

   Sliming (excess saliva and mucus that's so profuse that you have to spit it out) 

Do not go on eating after you experience a hard stop. When the hard stop is over, you may feel fine and want to go back to your meal, but you have irritated your upper gastrointestinal system and will just be perpetuating the PB or other response if you continue to eat. You’ll end up in an endless cycle of eat-pain-eat-more pain. I strongly recommend following a liquid diet for 12-24 hours after each and every hard stop experience. For me, that alone is a motivator because after surviving my post-op liquid diet, I never wanted to drink a protein shake for the rest of my life!