From this day forward

June is for weddings, isn’t it? Sunshine, blue skies, white gowns, white flowers. I was married the first time 38 years ago. After a four year courtship, Joe and I exchanged our wedding vows in front of a Catholic priest, a Presbyterian minister, and 40 guests consisting of family and friends. We walked out of the church and into our married life with “until death do us part” in our young minds. Six years later, we divorced. Eventually each of us married again, this time to the right partner, and we’re all still happily married today. As the saying goes, practice makes perfect. 

It’s practice that will make your “marriage” to your adjustable gastric band perfect, or as perfect as any human endeavor can be. When you wake up in the recovery room after your surgery, you won’t be magically endowed with all the knowledge, experience, and habits you’ll need to succeed with your band. Even if you did tons of research, faithfully attended every pre-op educational class, and listened closely to and made detailed notes of everything your bariatric team told you, some things – important things – you’ll have to learn through the everyday experience of living and eating with your band.  

When you leave the hospital or surgery center after your surgery, you probably won’t be headed for your honeymoon quite yet. That will come later, when you’ve had enough fills to achieve optimal restriction and you begin to feel that your band is really working. The excess weight will start coming off and you’ll walk around in a dreamy pink haze, delighted with your new life partner. You might even give your band a silly private pet name, the way my husband calls me “Love Bug” (which always makes me think of my first car, a chubby yellow Volkswagen Beetle). 

Then one day, the reality of banded life will wake you up. You’ll think, “Who is this creature I’ve married?” And like Jenny, a former coworker of mine, you’ll realize that while the engagement, wedding and honeymoon were exciting and fun, the day-after-day business of marriage isn’t exciting or fun 24 hours a day. It’s hard work. It’s boring. It’s frustrating. It’s humdrum. Jenny left her new husband after only three months of marriage not because she didn’t love him, but because she didn’t love being married to him. Being a wife isn’t nearly as fun as being a bride. 

I suspect that Jenny just wasn’t old enough or mature enough to be a wife. Neither was I when I married the first time. One of the reasons most bariatric surgeons and insurance companies require a patient to have a pre-op psychological consult is to evaluate the patient’s understanding of what they’ll have to do to succeed after surgery. Are they ready for a lifetime commitment? Do they have reasonable expectations? Can they follow instructions? Are they capable of learning the new behaviors they’ll need for a productive, peaceful partnership with their band?

 

HABIT FORMING

New bandsters need dozens of new habits – something like 60-70% of my book Bandwagon is devoted to explaining those habits, so I’m not going to try to cram them all into a blog entry (anyway, I’d rather you buy and read the book!). I’ll pick one at random. Hmmm…how about EAT SLOWLY? How are you going to turn that behavior into a habit that will serve you well for the rest of your life? 

So Dr. McMillan tells you, “Eat slowly,” and you nod your assent while thinking, “Get real! I’m too busy to do anything slowly. I have 3 kids and 2 dogs, I work 2 jobs, I take care of my elderly Aunt Bertha, I coach my daughter’s softball team, I have a house to run and a spouse who’s always on the road…” Well, you get the idea. Dr. McMillan has just told you to do something that’s very simple and yet impossibly difficult, you think Dr. McMillan needs to wake up and smell the coffee, and a door in your mind slams shut. 

Actually, Dr. McMillan is already awake, has had a cup of coffee, has tended to all 11 of her dogs and all 3 of her cats, is about to leave for the fitness studio, and when she returns she will deal with a home renovation project while running her home-based publishing business off the kitchen table; tomorrow the fun will start all over again, including a 5-1/2 hour shift at her retail job and a trip to the supermarket. She’ll do the laundry, pick another batch off ticks off the new dog, cook several meals, and get someone to come look at the leaking French doors. Dr. McMillan’s friend Nina calls her the “Tennessee Tsunami”, and despite all that, Dr. M. still manages to eat slowly every time she sits down to a meal. As a pre-op, it took her maybe 5 minutes to hoover her way through a meal that would feed a farmhand, and now it can take her up to 5 minutes to chew her way through the first bite. 

The EAT SLOWLY habit (or any other habit) doesn’t become a habit overnight. It takes many, many repetitions to turn a new behavior into a habit (a British study found that it takes anywhere from 18 to 254 days of daily repetition to make a new behavior “automatic”).  I know it’s a big challenge, especially when you’re also trying to learn a few dozen other new behaviors and turn all of them into habits while somehow conquering the dozens of bad habits you already had, but I assure you, it’s worth the effort!

 

HOW TO EAT LIKE A BANDSTER

...and other things you need to know about WLS but are afraid to ask...   

I wonder sometimes if bariatric professionals forget to emphasize the importance of good band eating skills because they they've never had to live with a gastric band. Of course, a few bariatric professionals are also bariatric patients, and thank goodness for that. 

I also wonder if bandsters are unaware of the importance of good band eating skills because their brains slipped into neutral during that part of their pre-op education. You'll have a hard time convincing me that's never happened to you, because I am the Queen of Lists and Note Taking. In high school and college, classmates would pay me for copies of my class notes. (Not only were they thorough, they were neatly penned in my prize-winning handwriting and decorated with cunning cartoons depicting my teachers and professors in embarrassing situations.) I take a notebook and a list of questions to every medical appointment, I ask questions, I re-read my notes, but despite all of that, my brain tends to shift gears when I see or hear something that strikes me as unimportant or irrelevant. And aside from being The World's Greatest Living Expert on Everything, what exactly qualifies me to make the unimportant or irrelevant judgment? Nothing. Nada. Nichts. Niente. 

During my pre- and post-op patient education, which was tailored for bandsters and administered by well-prepared bariatric dietitians, nurses, physician's assistants, and so on, I must have heard the eating skills lecture a dozen times. I was told that if I didn't eat carefully, I would end up in pain or with my meal in my lap. I nodded my understanding each time I heard that and could repeat the lecture verbatim, but it wasn't until I took a huge bite of a grilled cheese sandwich 24 hours after my first fill that I truly understood what all those folks had been telling me. And that’s not an experience I’m likely to forget. 

Take Tiny Bites!

I talk about good eating skills a lot. Why do I go on and on about that? Is it because I like the sound of my own (editorial) voice? Well, sure - that's no secret. But for what reason besides that? 

Important information bears repeating, and repetition is one of the ways that we acquire new information and learn new habits. If you doubt that, pay attention to how many times the Geico lizard appears on your television screen each day. Good band eating skills must become a habit if you're going to succeed with your band and avoid side effects and complications. The fact that some side effects and complications can happen to even the most conscientious bandster does not excuse us all from doing our best to avoid them. You'll need good band eating skills every hour of every day, not just as a new post-op or after each fill, but every day for the rest of your life. 

That sounds like a pretty tall order, doesn't it? Don't panic, though. A well-ingrained habit doesn't take as much conscious thought as a brand-new one. Your own behavior has already proven that if you've ever found yourself with a half-finished Twinkie or a cigarette or a beer in your hand and couldn't remember how it got there. It works the other way too. Your healthy new habits will eventually dig themselves into your life and using them will get easier as you go along. 

When you forget your band eating skills, your band will give you a loud reminder in the form of side effects like PB's, sliming, or stuck episodes, but I beg you not to rely on your band's built-in warning system on a regular basis, because doing so will send your bandwagon skittering down the road to complications like esophageal dilation, stomach dilation, band slips and even band erosion. 

One of the problems with the band's alarm system is that the truly destructive behaviors it reacts to may trigger relatively mild warnings so long before the damage is done that it's easy to shrug them off. For example, let's say that you often take big bites, don't chew very well, eat quickly, and/or eat beyond your soft stops (soft stops are gentle stop-eating signals, like hiccups). Each time you do those things, you experience mild discomfort. Nothing horrific. It happens, you think, "Oops," and you go back to whatever you were doing before the discomfort happened. Eventually this mild discomfort becomes just a part of your post-op life - the same as the way you sneeze when you pet a cat, pass gas when you eat beans, or get a headache when you don't wear your eyeglasses. Hey, that's just the way it is, right? 

But one bad day after dozens of ordinary days you can't even swallow your own saliva. You rush to the doctor, who does an upper GI x-ray and tells you your band has slipped. "How can that be?" you cry, "Everything's been fine until now!" 

In fact, everything has not been fine, because your careless eating has been pushing, pushing, pushing at your band's limits, until finally it pushed your band up your esophagus or down your stomach. I don't like finger-pointing any better than you do, but whose responsibility is that band slip? Is it your surgeon's, for not stitching it on there well enough? Is it the band manufacturer's, for not making your band slip-proof? Or is it yours? 

There can be a happy ending to your story, though. Even if the band slip is clearly your fault, you won't get sent to prison to sip brackish water and gnaw on stale bread for the rest of your days. Your surgeon can unfill your band (or, less likely, re-operate to reposition your band), and you can revamp your eating skills, lose weight, and live happily ever after. Or better yet, you can avoid the pain, inconvenience, financial and emotional costs, and pay attention to your eating from now on. 

I ain't gonna lie to you...acquiring and practicing this new habit won't be easy, but I can think of a lot of things that could be worse. A lot worse. 

The official Bandwagon® Eating Skills are: 

1.    Don't drink while you eat or for 30 to 60 minutes afterwards.

2.    Take tiny bites.

3.    Chew, chew chew.

4.    Eat slowly.

5.    Eat the protein first.

6.    Learn your stop signals.

7.    Pay attention to problem foods.

8.    Eat only when you're hungry.

9.    Avoid liquid calories and slider foods.

10.  Use a small plate.

11.  Plan your food in advance.

12.  Don't watch TV or read while you eat.

13.  Don't put serving dishes on the dining table.

14.  Eat sitting down at the dining table.

15.  Follow the HALT rule (don't eat when you're too hungry, angry, lonely or tired). 

You’ll find full explanations of each skill in Chapter 12 of Bandwagon, Strategies for Success with the Adjustable Gastric Band, by yours truly.