The Bandster Fairy Godmother

It's official: I am your bandster fairy godmother.

Bring your problems to me. If I can't reason them out, I will wave my magic wand over you and make it all better.

Please take a number and queue up to the right. No, not that right. Your other right.

Port Repair

As I think I mentioned before, my port has flipped over on its side and can only be accessed with the help of x-rays - at 3 times the cost, and about 30 times the inconvenience, of a fill in my surgeon's office. When this problem first began, I wouldn't have known it if it weren't for the fill difficulty. Now I can see a weird bulge on my abdomen where there was none before, and it can be uncomfortable when I do certain exercises.

So, now that my work schedule has eased up, I called my surgeon's office to tell them to go ahead and submit my port repair to BCBS. I also asked them a bunch of questions about the repair.
Here are the answers.

1. It's done under general anesthesia.

2. I have to do pre-op tests (blood, etc.) 3 weeks in advance.

3. I can go back to work immediately, depending on how I feel, as long as I don't take narcotic pain meds at the same time. (Dang! I had hoped they'd tell me to take a month off, preferably in the Caribbean with Lisa as my nurse)

4. The doctor will not do a fill at the same time as the port repair. I can only have fills when I'm awake and can swallow water. No, she won't do a fill and then put me to sleep.

I thought maybe the no-fill thing was because bringing me in for a fill at a later date brings in more income, but an obesityhelp pal told me that her restriction got tighter when she had her own port repair, so maybe the anesthesia or whatever affects the band.

Another question: nobody at my current workplace knows that I had WLS, and I don't care to share that with them. Not that I want to hide it, but when you get as far as long in your WLS journey as I have come, it's a unique pleasure to interact with people who have never known you when you were obese. And considering the hyperactivity of the gossip mill where I work, I do not want to add grist to the mill. So I decided that I would tell the store manager, and anyone else who persists, that I have a medical implant that needs repair. If they ask what the medical implant is, I will say, "My artificial brain."

Stress & the band

This is my mom and her best friend's granddaughter. A photo taken many years ago (the granddaughter is grown and married now).

Seeing Mom's smile is especially important to me tonight, because she passed away today.

It's probably been said before, but:

Stress can make your band tight.

Driving home from work tonight, I was so hungry I could have eaten my own arm.

My husband greeted me with the news that my mom (age 90) had passed away this morning.

Not really a surprise - I think she was ready to go - but later when I sat down to eat supper, two small bites of very mushy eggplant parmesan got stuck.

But no big deal. I have maybe 30-35 more years to eat eggplant parmesan. What matters is that when I saw Mom yesterday, I got her to eat two bites of chocolate cookie. Yeah, it was Thanksgiving, but she'd rather eat one bite of something chocolate than 10 lbs of pumpkin pie.

So, eat a bite of something chocolate tonight, and say, "This is for Betty."

Tilted Port

So, here's the latest in the never-ending story of my tilted port.

On October 27th, I had my 3rd re-fill, done by my surgeon in the hospital radiology department because my port can no longer be accessed without visuals (x-rays). My port was fine for the first 18 months, but now it is tilted severely towards my right side. It could be the result of - um, indifferent surgical technique during my original surgery (I had to think for a minute there to come up with a non-libelous adjective), or a suture that failed due to dumb luck or exercise.

My surgeon was able to do the fill with only 2 sticks, but the whole thing was a huge chore - taking time off work, driving to Memphis (a 2-1/2 hour drive became 3-1/2 hours in the pouring rain), waiting 2-1/2 hours past my appointment time for my surgeon to finish surgery, driving home again. Dr. Weaver said we can go on doing fills in radiology, or we can fix my port - an easy, 15-minute procedure. I told her I want it fixed. I'm going to live with this band and its port for the rest of my life. I want it easily accessed. But there's no way I can find the time to have even a quick surgical procedure during the holiday shopping season, so I'm going to call Dr. Weaver's office in December to ask them to submit the repair to my insurance company for approval so I can have it done in January 2010.

In the meantime, this last fill is making a noticeable difference in my eating. It's taken 2 weeks to kick in (who knows why?), and I feel I could use another small fill to get back to optimal restriction, but I'm very happy to be hearing from my band again!

A Creature of Habit

I have a lot of excuses for my recent blog inactivity - a new(ish) job in retail (at the start of the holiday shopping season), 19 dogs, 2 cats, medical problems (not band-related), and a tilted port. I don't mind being so busy, and when I worked as a VCASA (volunteer court-appointed special advocate) in child-abuse cases years ago, my supervisor told me, "If you want to get something done, ask a busy person to do it." What I mind about it is the unpredictability. I think part of the reason for my weight loss success with my band is that when I had surgery, I was self-employed and in complete control of my schedule, so I could attend to everything from medical appointments to planning nutritious meals to exercise according to my own preference. Working for someone else sure has put a spanner in my works (to paraphrase PG Wodehouse). I pride myself on my flexibility, but maybe I'm not as flexible as I thought I was.

(Note: a spanner in the works = ruining a running engine by throwing a wrench into it.)

When I was growing up in New England, the makers of Prince Spaghetti ran a series of TV commercials on the theme, "Wednesday is Prince Spaghetti Day." An Italian mama would lean out her tenement window calling her son Anthony to supper. Anthony ran home through the streets of North Boston, happily anticipating his Wednesday Prince Spaghetti supper.

As much as I like spaghetti (it's food, isn't it?), I've never been a Wednesday is Spaghetti Day kind of girl. Or a Meatloaf Monday girl. I've known women who swear by the ease of day-of-the-week meal planning, but I crave variety too much to eat that way.

On the other hand, I am certainly a creature of habit and I love the safety and ritual of my routines (and I'm Episcopalian, too). Laundry on Monday, meal planning on Thursday, grocery shopping on Saturday, and so on. When I was hired at JC Penney this fall, the store manager told me she couldn't promise me a predictable work schedule, and I assured her that was no problem. No, it's not a problem. But it sure is a challenge!

Creamy Date Spread

One of my old favorite treats was a slab of date nut bread covered with a slab of cream cheese. Especially if someone else made the date nut bread, because I'm not much of a baker. I was trying to think of a new dip or spread to go with my afternoon fruit snack and came up with this yummy-licious creamy date spread.

1/2 c. low fat cottage cheese (I use 1%)
2 oz low fat cream cheese (you could use fat-free)
1/4 c. chopped dates
1 tbl Splenda
1 tbl honey (don't skip this - the flavor it adds is worth the sugar calories)
a sprinkle of cinnamon or nutmeg (optional)
a few drops of vanilla, almond, or caramel extract (optional)
2 tbl chopped walnuts (or other nuts)

Put everything except the walnuts in a mini food processor and whiz until well combined. Stir in the walnuts. Spread it on slices of apple, pear, or banana.

I figured out the nutritional info based on the cottage cheese/cream cheese mixture above and compared it to what it would be if you used all cream cheese. Using the cottage cheese/cream cheese mixture saves you 14.5 calories, 1.5g total fat, .9g saturated fat per tablespoon.

Nutritional info per tablespoon:
Calories: 35.7
Total fat: 1.5g
Sat fat: .6 g
Cholesterol: 2.6mg
Sodium: 44.9mg
Carbs: 4.4g
Fiber: .3 g
Protein: 1.7 gram

Half a crab cake? Half?

Last night my husband and I took my friend Elaine out to dinner. Elaine is Chinese, lives in Hong Kong and China, and comes to the States maybe once a year. When I traveled in China on business three times a year, I would spend a lot of time with Elaine, and ate many, many wonderful meals with her. She loves my cooking but since I had to work yesterday, I decided not to try to combine cooking and socializing, so we went out to Sassafrazz, one of our nicer local restaurants.

Elaine and I each ordered the appetizer crab cakes (2 generous cakes) and a half-size house salad. We were served the salads first, and by the time they arrived at the table, I was starving. I hoovered down the whole salad, no problemo (it was quite finely chopped), then thought, "How could I eat that whole thing?" (forgetting the days when I would have eaten a full-size salad and an entree and a dessert).

The crab cakes were marvelous, but I told myself I would eat only one of them and save the other for lunch the next day. Crab cakes are so soft, they really don't count as solid protein, so I didn't expect to feel much satiety after eating the one cake. Surprise! Halfway through the crab cake, I had to stop eating. I heard myself say, "I can't eat another bite." Hurray!

Elaine is a few inches shorter than me and (like all her family) solidly built, but not fat. She told me that she has gained 10 pounds and asked me to guess her weight. I hate that kind of game, but I played along. I guessed she weighs 130 pounds, so I said,"120 pounds."

"No! XXX! I weigh XXX pounds!" [Note: she swore me to secrecy about the actual number.]

I was truly astonished. "But Elaine, that can't be! That's only 10 pounds less than me!"

She in turn was astonished. "No, Jean! I think you weigh 110 pounds."

That was a slight understatement! I laughed, but I was flattered.

Elaine made me promise to follow up with her in a month to make sure she's still working on losing those 10 pounds.

Body Measurements Before & After

Last week when I was organizing some books to donate to the library, I found a list of my body measurements from 1993 (14 yrs before WLS) into a sewing book. I was not at my highest weight in 1993, but I was getting there. I'm not at my lowest weight now, but comparing the before and after measurements reminded me of how far I've come.
1993 2009
Neck 16 13.5
Bust 46 41
Waist 37 34
Hips 46 42.5
Ankle 9 6

You know what impresses me the most? The ankle measurement. When I lost weight after WLS, I was pleasantly surprised to discover that I have nice looking ankles now instead of the tree stumps I had before.

Using small plates

Yesterday, Lisa posted on Obesity Help about her struggle to accept the small amounts of food she can eat now, and that got me to thinking.

Using small plates instead of big plates is one of the things that has helped me a lot in my WLS journey. It sounds so simple - maybe too simple. Why does it work?

I think that most obese people are accustomed to eating huge dinner plates piled high with food at every meal (plus snacks inbetween). I know I was. I ate the equivalent of Thanksgiving Dinner every night. In some ways, a plate piled high with food is a good thing - a sign of plenty, or wealth, or security, or comfort. Just think of those starving 3rd world children holding up empty bowls, hoping for a few grains of rice. So a steak so big that half of it falls off the plate is good, right?

Not if you eat it all at one sitting.

After I had WLS, and after I had enough fill in my band to truly comprehend how little I could eat, my obese soul rebelled. This could not possibly be enough to keep a body alive! I would eat 4 bites of food, feel uncomfortable, and have to debate: stop now (the sensible thing) or keep on eating (because I "needed" more) and get into trouble? The small portion of food I could handle looked so meager on a dinner plate, but was just right on a salad plate. I still got to eat a full plate of food, so somehow I didn't feel so deprived.

This afternoon, I was thinking about this issue and remembered some of the wonderful meals I've had while traveling in China (too many to count). When I first visited China (in the late 1980's), I rarely saw an obese person. Since then, fast food and other delights of Western civilization have had their effects, and there are more obese Chinese people, but still nothing like what you see here in the USA. A traditional Chinese meal is served in big dishes at the center of the table, with each diner taking one or two bites worth of food at a time, using their chopsticks and putting the food on tiny (smaller than American salad plates) plates. The serving dishes are circulated until everyone has had their fill, but no one takes more than those few bites at a time. The etiquette behind this is: when food is scarce, you share it equally with other community members, so no one goes hungry and everybody has enough fuel to do the next chore to support the community.

I have been to small villages in China where having plates was not a priority. You might be too poor to buy plates, or so rich that you couldn't provide plates for the 800 hungry people that came to your daughter's wedding reception (many of those guests had to walk 5 hours on country roads to get there). The food is served in a big communal bowl, and each person takes 1 bite at a time. You don't pile a big dinner plate with food you don't need, just because you want it or deserve it or whatever. The Chinese people who still observe this tradition are not obese. They feel they have had plenty even when there were only 4 bites to share amongst 4 people.

Fill #2 - again!

On Tuesday I had my second fill - again.

After a rest period of 2 months with no fill, I had gotten a 1 cc fill on August 19. I could tell the difference in my restriction (maybe because I know what to look for now better than I knew the first time around), but it wasn't much. I lost 1 lb in 4 weeks after that, seemingly in one-ounce increments, so I was delighted to get a .6 cc fill this week.

Yesterday I took some leftover cooked turnip greens and a salmon patty to work for my lunch break, which didn't come until 1:30 pm. A few bites of salmon patty went down fine, but one bite of turnip greens did not. I know it's sick to be glad when food gets stuck, but I was so glad to hear from my band again after 3 months of silence! Fortunately, I did not PB or slime yesterday (I was alone in the break room, but with my luck, the store manager would have walked in at the very moment the PB happened). After a few minutes, I felt the food "glug" through my stoma.

Hurray!

Weight Loss & The Green-Eyed Monster

Why is jealousy a monster with green eyes? My husband has beautiful green eyes and not a particle of jealousy in him (that I discovered, anyway). Is it because cats (often green-eyed) torture their prey before eating it? Or because green is the color of unripe fruit that can pain your stomach? I don't know the etymology of the term, but I do know that jealousy is harmful.

Jealousy is one of the things that drove me to have weight loss surgery. It started out as envy of a friend who lost a lot of weight after a gastric bypass. It's natural to compare yourself to others and wish for the things (possessions, advantages, qualities) they have, but when the wish turns into resentment and jealousy, you're focusing on other people rather than yourself and what you need to do to accomplish your goals.

If you can compare yourself to other weight loss surgery patients and emulate their behavior to achieve your own goals, that's cool. But even if the other person is your identical twin (with the exact same genetic curses and blessings), you have band surgery on the same day by the same surgeon with the same size band, get the same fills on the same days, and you both do everything else the same (diet, exercise, etc.), you're not going to get identical results.

When you compare yourself to others, you're needlessly tormenting yourself with the green-eyed monster, like my cat when he catches a baby bunny. He's doing it for fun, or in answer to some instinctual imperative. Judging by the screams, the bunny isn't enjoying it, and then he dies. Do you want the same fate?

My free health club membership

I finally found an advantage to having Type 2 Diabetes. The hospital that runs our local health club has a grant that will pay for health club membership for diabetics who get a referral from their doctor and use the club (and have their blood pressure and weight checked) at least once a week. This is such good news. I haven't earned any money (other than a pittance in royalties) for 9 months and I would really hate to give up that health club membership. This saves me $37/month! I had to play telephone tag to chase down the paperwork from my doctor, but the health club manager called me today to tell me she had received it and I can officially start the program tomorrow morning. Hurray!

Exercise & Mood

As my grandmother used to say, I got up on the wrong side of the bed this morning. I had slept for 7 hours but for some reason didn't feel rested and I was just in a bad, pessimistic mood. I had made all kinds of plans for my Saturday but none of them appealed to me any more. I went to the health club as planned for an 8 am session with my personal trainer. About 10 minutes into the workout, I realized that I felt 100% better than I had when I first woke up. When I left the health club after the workout, I was happy and looking forward to the rest of my day.

For me, the main benefit of exercise is not what it does for my weight. The main benefit is what it does for my mood.

The payoff

Before (May 2009) After (August 2009)

When I started working with my personal trainer, and putting extra effort into strength training, I hoped to develop muscles and muscle definition, but I didn't expect to reduce my batwings - I figured that skin was stretched out for good. But when I compared before and after photos of my arm, it looks like the muscle definition has increased and the batwing area has decreased. I realize that my arm is bent at a different angle in these photos, but it looks a lot better to me now. I'm thrilled with this payoff for all my hard work!

Band Failure?

Every single thing I have read (or heard) that was written (or spoken) by a bariatric medical professional confirms that patient non-compliance is the most common cause of band failure. That failure can take many forms, anything from disappointing weight loss to serious medical complications. If you don't follow your surgeon's and nutritionist's instructions, don't return to your surgeon for follow-up visits and fills, ignore negative symptoms, don't change your lifestyle, and don't address the things that made you fat in the first place, you are setting yourself up for failure.

Despite careful patient screening, pre-op education, and post-op education, sometimes the band just doesn't work. This can be a function of unrealistic expectations, inability to make lifestyle changes, failure to participate in aftercare programs, and plain old bad luck. A solution is to revise to a different weight loss surgery procedure, but if you can't or won't do the hard work of following up with your surgeon and changing your behavior, you might be disappointed once again.

Getting strong!

I had a personal training session last night. As usual, it was hard...not because the moves or weights were totally beyond my capacity (as they were when I started with my trainer 2 months ago), but because I'm getting stronger and Crystal is challenging me more. More weight, more repetitions, more exercises. On a machine where I could barely manage 6 repetitions with 10 lbs of weight, I can now do 12 repetitions with 40 lbs of weight - and do that three times - a total of 36 repetitions. I can actually see muscle definition now, in my legs but even more in my arms. Unfortunately the batwings remain and probably always will, but I can live with that. It would be nice to have arms (and other parts) like the woman in this photo, but she is a bodybuilder who makes a business out of muscles. I just want to be strong, and I'm getting there slowly but surely. The other day I had to pick up one of our puppies (part Rottweiler - weighs about 45 lbs) and didn't have to struggle to do it (other than dealing with his vigorous efforts to escape).

Lean Jean

Like most of us, I've acquired a lot of nicknames in my life, including:

Miss Green Jeans (from the Captain Kangaroo kids' show)

Jeannie Beanie (from the Beanie & Cecil cartoon that was popular when I was a kid)

Jean Jean the Dancing Machine (from Gene Gene the Dancing Machine on the Gong Show)Randy, a guy who works at my health club, knew me when I was obese (we both used to work for the same company), but he didn't recognize me when I first joined the club. Later when he realized who I was, he exclaimed, "You're THAT Jean?!"

For several months now he's been calling me "Mean Jean." He thinks it's funny. It does make me wonder if I have a sour expression on my face every time I walk through the door. Today he said, "It's really Lean Jean now, not Mean Jean, isn't it?"I smiled. "Lean Jean. I like the sound of that."

Though I'm a pretty mean dancing machine, too.

Does a fill hurt?

I've had 15 adjustments in 2 years, and none of them hurt. A few times I went away with a bruise, but so what?

If a fill hurts you, ask for a numbing shot (or spray) the next time. In my experience, the numbing shot hurts worse than the adjustment needle, but again, so what?

And doesn't the pain of a fill compensate for the pain of all your medical problems?

Would you enjoy giving yourself insulin shots 4+ times a day?

What could be worse? How about chemotherapy? How about a broken leg? Or a brain tumor that makes your body disobey the most basic commands?

A band adjustment takes maybe 10 minutes. Your life takes you maybe 87,000 minutes? That works out to .000149 minutes per adjustment. A small price to pay.

Jean

My upper GI

On Tuesday I had an upper GI study done to determine if my band has slipped. Unfortunately, my band's position is not mentioned on the radiologist's report (even though "band slip" was written on the doctor's order as the reason for the test) except for the information that I gave the x-ray tech. So I'm in the middle of a ridiculously difficult battle to get an amended report. Since the radiologist for some reason won't talk to me directly about the findings and my PCP says, "If your band wasn't mentioned on the report, it's safe to assume that it's OK" (huh?!), I went to the hospital and got my own copy of the report plus the x-ray images on a CD.

As frustrated as I am with this situation, it's really cool to have these images. A lot of them don't make sense to me, probably because the shots were taken at many different angles and locations as I turned over and over on the x-ray machine. My port shows up clearly in several shots. I could only find my band in 2 shots, and in one of them, it looks like the band is too far up - sitting on my esophagus instead of my stomach.

The first image posted above shows my port and tubing at the lower lefthand corner. The second image shows my band at the lower righthand side.

Now I'm waiting for an amended radiologist's report that at least describes the position of my band.

Lessons learned from working with a personal trainer

When I first started working with my personal trainer in June, I had been doing aerobic workouts for 14 months with very occasional free weight work. I could barely manage the smallest weights on each Cybex machine. Three-pound free weights were my limit. But Crystal kept pushing me to do more reps, more weight, and I managed to do far more than I ever would do on my own. Even when I was repeating the workout by myself during the week, I would hear Crystal's voice saying, "Three more, two more, one more."

In 6 weeks, I've come a long way. I have gained weight and inches...not my intention! Crystal says that's muscle gain but I know in my heart that it's plain old fat because I've been eating so much more since my unfill. The gain is inches is in my abdomen and hips, where fat so often goes in women my age. But I'm still very pleased with my progress, because I'm beginning to see real muscle definition in my arms and legs, I can handle 3-4 times the weight, and my endurance is better.

At the same time I have learned not to overdo it. There is indeed such a thing as too much exercise. When I overdo it, my body hurts, my energy flags, I feel like crap, and the fun goes out of it.

McDonald's Sausage Biscuit

I had to fast for (routine) blood tests this morning. I knew I would be starving so I made a protein shake (experimental recipe with oatmeal in it - an idea I got from looking at recipes at sparkpeople.com) and stuck it in my tote bag. The instant I walked out of the lab, I grabbed that protein shake and - blech! Even though I had put everything in the blender, the oatmeal was still grainy and the texture of the shake was just disgusting. So this, and my unfilled band, was the perfect excuse to go to McDonald's for breakfast instead of dutifully driving home and fixing myself something healthy. I got a Sausage Biscuit with Cheese, my first in about 2 years. The first bite was divine, the second bite was very good, the third bite was good, the fourth bite was fair...but I kept on eating, because I was DETERMINED to ENJOY myself. Well, the fifth bite was...blech! Suddenly the doughy biscuit and greasy sausage were totally unappealing, and I threw the rest of it away. I used to be able to eat two of those, plus one or two hash brown potato thingies.

It's so interesting to be unfilled now after all that time - although I can basically eat anything in any quantity, my band eating skills are sticking with me, especially the part about paying attention to the experience of eating. If I hadn't been paying attention while eating that McDonald's breakfast, I probably would have plowed throught the whole thing without noticing how sickening it was until it was too late.

Fat lady in a restaurant

I used to travel to Atlanta twice a year to attend the Gift Show. My employer's travel guy negotiated deals with various hotels there and I had a choice of two. After some housekeeping issues with one of the hotels, I switched to the other hotel, in a less convenient location but a lot cleaner. I would eat breakfast in the hotel restaurant every morning. The food and the wait staff were good, but single diners were routinely seated at tiny tables for two lined up along the walls, with a long banquette seat against the wall and regular chairs opposite. These tables were jammed in close - maybe 10" apart from each other. The chairs had arms, making them a tight fit for a fat lady, and I don't like to sit with my back to the dining room anyway, so I would sit on the banquette seat. In order to do that, I would have to move the table enough to allow me to squeeze through.

One morning, the hostess smiled brightly and led me to one of these tiny tables that was sandwiched inbetween tables already occupied by other diners. To get into the seat, I would have had to ask the other diners to get up so I could move their tables (which were loaded with coffee, juice, and other things that could spill). And no way was I going to draw attention to myself that way. So I said to the hostess, "You're going to have to seat me at another table. I'm too big to get into the seat at that one."

"But it's the only one available," she said. The place was busy and all the small tables were full, but there were several tables for four available. I pointed at the nearest four-top, said, "I'll sit there", pulled out a chair, and sat down before she could protest.

"Oh, okay," she said, and set the menu down in front of me.

As I was leaving the restaurant after eating my breakfast, the hostess approached me again and said, "You're not that big, you know." I think she was trying to be nice. I hope so. I was too embarrassed to speak. I just nodded and hurried out.

The next morning, I wanted to hide in my room and eat a room service breakfast, but my employer would not pay for a room service meal unless the hotel restaurant was closed, so I went back to the restaurant. The same hostess seated me at a four-top without having any discussion of where the fat lady could or could not fit.

The Good Teacher

When I was in high school, I had an English teacher who gave me writing critiques that I felt were harsh and unfair. This was in a class where we had to read our writing aloud to the rest of the class. Once I said to this teacher, "Why are you so hard on me? I'm the best writer in this class!" (and so modest, too)
She said, "Yes, you are. And that's why I expect more of you. I'm hard on you because I know you can do so much better if you tried harder."
This was both humbling and inspiring to hear.
And this is one of the reasons I'm hard on fellow bandsters. I may be the best writer (we could argue that point). I'm not the best bandster. I don't pick on other bandsters because I think I'm better than they are, but because I think they could do a lot better if they tried harder. Getting an "A" grade for underachievement will not help anybody achieve their goals. In my opinion.
Let me use another analogy. When I was active in Overeaters Anonymous, I picked a sponsor who had several years of "abstinence" from compulsive overeating and who inspired me. She was unlike me in many ways, but I wanted to live my life with her combination of sober sanity and wild enthusiasm. One of the things she required me to do was call her every morning and commit my day's food plan to her. She didn't care what specific food plan I followed, she just wanted me to commit to following it for one day. The next day, I would tell her if I had lived up to that commitment. It was disconcerting to hear her say things like, "How could you have made a better choice in that situation?" But if all she had said was, "Oh, poor Jean, it's so tough to say no to Twinkies when you're so stressed out," she wouldn't have been teaching me anything I needed to learn.

Band unfill progress report

The bad news is: I can eat anything and everything, in any quantity, and the hunger is awful.
The good news is: I can eat anything and everything, in any quantity, and the hunger is awful. Did I really mean that? Yes.
So far, it's kind of nice to be on "bandcation". I can eat an egg on toast for breakfast! What a treat! I think I might even go wild and try a Subway sub.
There's certainly a potential for weight gain here. I cannot get by on the small amounts of food I was eating before this unfill - I'd end up chewing my own arm off. But I'm glad to have this reminder of how much my band was doing for me before that I had come to take for granted. So often I've thought, Why am I so hungry? Why does the band banish hunger for some people but not me? Now I realize that my band WAS reducing my hunger (I'd say by 50%).

What could cause my band to slip?

After a week of band misery that I thought was caused by a bad pollen allergy attack, I went to see the NP at my new bariatric surgeon's office, who said, "Sounds like a band slip" and took every last drop of fluid out of my band. I have to get an upper GI x-ray and let my stomach rest for 6 weeks before they will consider gradually re-filling me.This wasn't good news, but the unfill instantly relieved my symptoms (I'm maybe 95% better now - and the 5% is probably due to irritation).
Band slips can be caused by vomiting, overeating, failure to follow the post-op recovery diet, poor eating skills, a band that is too tight, or a combination of those things. None of them apply to me. So that happened? I think the culprit is my untreated hiatal hernia. I've had it for years. Dr. Argotte (my original band surgeon) said it was "too small" for him to repair it during my band surgery, and I haven't worried about it since because the weight loss alleviated its symptoms (left upper abdominal pain and an awful feeling of "strangulation" when my innards slid through the hernia). But lately it has been bothering me again, and from the research I've done while writing my book about the adjustable gastric band, untreated hiatal hernias pose a risk of band slippage.
I'll ask my new surgeon, Dr. Weaver, about the hernia when I see her in 6 weeks. Since she's not the one who put my band in there and has never laid eyes on my hernia, she may not be willing to attribute the slip to the hernia. But I'm betting that's what did it. And if that's the case, I want the danged thing fixed so this won't happen again!

What's good about an unfilled band?

Because of the many problems I've been having (probably triggered by pollen allergies and mucus drainage), the NP at my new surgeon's office completely unfilled my band yesterday and ordered an upper GI x-ray to make sure my band hasn't slipped. I have to wait SIX LONG WEEKS before they will start to gradually re-fill me.

Not good news. The unfill instantly relieved my symptoms (reflux, heartburn, coughing, vomiting), but by 10 am today I felt like a raving maniac. Hunger! And I can eating anything! How I will even maintain my weight now, never mind lose weight? It's hard to find something good in this situation, but I did manage to do that.

What's good about an unfilled band? It makes you appreciate everything your band was doing for you before that you took for granted!

Allergies and the Band

I'm still figuring all this out.

For the past few days, my band has been extremely tight. I mentally reviewed all the usual causes: Stress? not really. Pollen allergies? no; in fact, my allergic rhinitis has been better recently. And so on.

This morning when I woke up, my right eye was very irritated, and it got much worse as the day went on despite frequent application of eye drops. I looked at it in the mirror several times, wondering if the corneal cyst I had removed a few years ago had returned, but I couldn't see anything. No cyst, no eyelash, no foreign object. I hadn't worn eye makeup for several days. By 1:30 pm, the irritation was so bad I wanted to pull out my eyeball. It felt as if someone had scored my eye with a razor, then sandpapered it. I called my eye doctor and got a recording. Finally I called my husband's eye doctor and was told to come right over. This doctor (with the unfortunate name of Bugg) carefully checked my eye, found no foreign object, no injury, no infection, but some scarring of my conjunctiva, probably due to allergies. He prescribed Prednisone drops and cold compresses, gave me a bottle of lubricating eye drops and told me to come back if it wasn't better by Monday.

On my way home (3:45 pm by then, after waiting for the prescription to be filled) I was miserable. My eye was so painful I could hardly see to drive and my band was so tight I could barely drink water. Then I passed a blooming tree that my husband and I call Mimosa (we have no idea if it's really Mimosa) that gives us both allergic misery every year, and suddenly it all clicked: the eye irritation, the tight band, the Mimosa pollen. No wonder! Physically I don't feel any better - I still want to pull out my eyeball, and could barely eat 3 bites of tofu for supper - but mentally I don't feel as confounded and defeated.

What reflux means to a bandster

Gastroesophageal reflux (GER) is a condition characterized by the abnormal movement of stomach contents (with acid) up into the esophagus, causing heartburn, chest pain, regurgitation, coughing, sore throat and/or swallowing problems.

The adjustable gastric band can decrease reflux by acting as a barrier to the stomach contents. When reflux occurs after AGB surgery, it needs prompt attention because it is often caused by a too-tight band and can be associated with band slippage, dilation of the esophagus and/or stomach, or a hiatal hernia (one that was unrecognized at the time of band surgery, or that developed post-op). Hiatal hernias (especially if larger than 1-1/2") increase the risk of band slippage, but can usually be repaired with laparascopic surgery.

The standard advice for reflux is to avoid eating before bedtime, sleep with the head of the bed raised, avoid caffeine, chocolate, acidic fruit, spicy or fatty foods, and take acid-blocking medication. These steps may alleviate the symptoms of reflux but do not cure it. It's not going to get better by itself and the longer you ignore it, the worse the damage. Reflux can cause esophagitis (inflammation of the esophagus), bleeding, ulcers, and Barrett's esophagus (which can lead to esophageal cancer), to say nothing of the threat to your band.

If you experience reflux more than twice a week, do not just live with it. Call your surgeon. You may just need a small unfill, or you may need and upper GI x-ray or endoscopy.

Physical Fitness

I've had my lap-band for over 20 months now, and have been obsessed with weight loss surgery for maybe 2 years. But once you get weight, and how to live with the band, under control....then what?

I've been writing a book about how to succeed with the adjustable gastric band, but even that project isn't going to last forever (I sincerely hope).

I've decided that my new project is going to be physical fitness. This is not something I have ever cared about before in my life - in fact, I assiduously avoided it. My parents didn't care about it, I hated exercise, I wasn't good at sports, so I just didn't do it. However, I have discovered that I enjoy exercise now. It improves my mood enormously. I like feeling stronger. It's a pleasure to be able to pick up something heavy without groaning because finally my arms (and back) are strong enough. I like seeing the muscles emerge from the flab. So I'm going to try to get good at physical fitness. I don't care about being an athlete or a bodybuilder, I just want to know that I'm as strong as I can possibly be.

Every bit counts as exercise

So far today I have burned 1574 calories (according to my BodyBugg), 360 of that while scrubbing the bathroom floor on my hands and knees with a scrub brush (what a life of domestic bliss I lead). That's more calories than I burned at the health club yesterday (300)!

Lowest sustainable weight?

I have been at the same weight (with daily fluctuations up and down) for two months now despite increased exercise and reasonable eating. I'm beginning to wonder if this is my lowest sustainable weight. It's as if my body prefers this weight. My brain does not prefer this weight because it's 14 lbs higher than my lowest weight since my band surgery. But I'm happy with my appearance (except for the thick middle, which I had even at my lowest weight), I'm wearing the same clothes despite the additional weight and I feel great. Should I put my energy into accepting this instead of struggling with it?

I need a pep-talk

I need a pep-talk.

Last night I went to Pilates class. I've done this class several times before and it never seems to get easier (I guess I need more practice). And last night two young girls - very young, skinny, pretty chickies -were there who made me feel like a gargantuan sea slug. I know it is useless to compare my 55 year old body to their 17 year old bodies.

After class, I had my second personal training session with Crystal (age 21, skinny, pretty). this week we did a different assortment of exercises (mostly weight machines, some free weights, some time on the treadmill), and she made me use much heavier weights and an extra set of repetitions for each exercise. It was brutal, and I felt even older and more inept. But I'm glad I did it. There is no way I would ever challenge myself that way.

I was exhausted when I got home at 9 pm. When I got up at 5:30 this morning, my left hip was very stiff and I thought, "No way am I going to survive aerobics class this morning." By 7:30 I felt a bit more limber so I went to class and survived it, but it was a struggle.

Meanwhile, my weight is stuck even though I'm working out more. I know, I know, I'm building muscle. But I'm beginning to wonder if I'm not eating enough. I'm eating an average of 1400 calories a day and according to my BodyBugg, I'm burning an average of 2000 calories a day. In theory, the 600 calorie deficit ought to produce weight loss of 1.2 lbs/week.

I am scared to eat more than I already do. It was a big deal for me to eat 1/3 cup of scrambled eggbeaters this morning instead of 1/4 cup, but I have got to get over it.

QOTD: what is restriction?

Restriction is a catch-all term for the feelings that limit how much a bandster can eat. What those feelings are varies greatly from one person to the next. Some bandsters experience restriction as a lack of appetite or interest in food, but for me, restriction is related to eating. It can be as specific as discomfort in my abdomen, a feeling of pressure in my chest, or a choking sensation in the back of my throat, or as general as a strong conviction that I absolutely cannot and must not eat another bite of food.

Hungry?

There's a weight loss surgery myth that goes: I WILL NEVER BE HUNGRY AGAIN.

This is a falsehood.

I’m talking about physical hunger here. The kind of hunger that makes your tummy growl. (Mouth hunger and head hunger are a whole other topic.)

Fighting Weight, Khaliah Ali’s book about her weight loss surgery experience, proclaims that the adjustable gastric band procedure “eliminates hunger – forever”. If that’s true in her case, I’m happy for her, but as successful as I consider my lap-band, I still get hungry.

Everybody reacts to the band differently. Some people get a break from hunger for a while after surgery because of surgical swelling. Every now and then I hear someone say that they rarely feel hungry after they’ve gotten a few fills. But I was starving hungry the day after my band surgery and I’ve been hungry ever since then. The greatest benefit I get from my band is portion control. A secondary benefit is that my small meals keep me feeling full longer – but sooner or later, I get hungry again. Even with great restriction, I find that I get hungry every 2-3 hours (and even if I don’t experience hunger then, I start feeling faint because my blood sugar has dropped). Others might be able to go 4-5 hours.

Eat Your Veggies!

My mother did right by me in many ways. For one thing, she taught me to eat my veggies and like them. Fifty years later when I was trying to serve her a meal that included (turnips or something), she confessed that she actually hates all vegetables except fresh tomatoes in the summer. She was LYING to me all those years! This news was more startling to me than discovering (when I was 11-12 years old) that my father had been previously married, had romanced Mom before he was divorced, and that the man I called Uncle Andre was actually my step-brother.

But I still love veggies. And how can you not love them when you see a display of them like in this photo taken in Seattle by my friend Lisa?

It's not a magic trick!

I'm writing a book about strategies for success with the adjustable gastric band, and I'm strongly tempted to title it, IT'S NOT A MAGIC TRICK!

There is nothing about the band that makes you lose weight. What it does is make it easier for you to eat less and therefore burn off stored fat. It is not going to do all the work for you. It is not going to make good food choices or exercise for you. It's not going to stop you from grazing on potato chips all day long. It's not going to erase the thought that a bag of cookies would make you feel better after a long, hard day. It's not going to take responsibility for your bad habits and unhealthy lifestyle.

It's just a piece of plastic, folks. It's not a magic trick!

Sure don't miss the extra chin

For months after my band surgery, every time I looked in the mirror, I saw the same old fat girl. I had to look at photographs, comparing current shots to before shots, in order to comprehend the change in my body.

Yet when I was obese, I didn't see a fat girl when I looked in the mirror (probably protecting myself from the awful reality). I would look at photographs of myself and think, "Surely I'm not as big as I look there!"

I found this today when looking for a photo of one of our dogs, and thought, "Oh yeah, I was big."

I took the photo into the bathroom and checked myself in the mirror. What a relief: that extra chin is gone!

QOTD: am I too young/too old for weight loss surgery?

Surgeons’ and insurance companies’ age policies vary. While most won’t accept a patient under age 18, there are some surgeons who specialize in younger patients (frankly, I wasn’t mature enough at age 17 to deal with something like weight loss surgery, though it would have been nice to grow up without an obesity problem). Some won’t accept a patient over age 60, but I’ve encountered any number of older people (into their 70’s) who’ve done very well after weight loss surgery.

Muscle vs. Fat

I often wonder about the muscle vs. fat thing, especially when I hear people say, "I'm afraid to exercise because it'll make me gain weight."

While one pound of muscle weighs exactly the same as one pound of fat, in theory it takes up less space. If you measure these substances by volume - packing one measuring cup with, say, chicken fat, and another measuring cup with, say, chicken meat - and then weigh them on a scale, the fat will weigh less than the meat (muscle).

I've been distressed about having gained 10 lbs in the last six months (largely the fault of overeating when my band was unfilled in December 2008), but I've been exercising a lot and I realized yesterday that I'm still wearing the same clothes. In the past, a 10 pound weight gain would have meant going up a size.

So I think it's entirely possible that I have gained muscle mass, and that's a good thing!

Acai berry progress report

Well, so far so good. It's been a week

since I've been taking the acai berry

supplement and I've lost 1 lb!

More About Mederma

I continue to be amazed by the way Mederma is improving my scar.

After 2 days of using it, the scar, which was rough, ragged, and raised before, is completely flat and smooth. Instead of being angry red, it's pale pink.

Mederma Testimonial

When I had my breast reduction, my plastic surgeon recommended using Mederma to reduce my scars. I bought a Walgreen's version of it that worked quite well. I didn't need to use it on my lap-band scars because they disappeared so quickly on their own. Later I used it to reduce the appearance of a scar from a mole removal.

Recently one of my puppies scratched the top of my hand badly. Even after it healed, it was fierce-looking. I don't mind scars where my clothing hides them, but this one is very noticeable. I had used up my original tube of scar gel, so on Saturday I went to get another one. I couldn't find a "generic" version, so I bought the real Mederma (it ain't cheap). I applied it to the scar on my hand on Saturday night and forgot about it until Sunday morning. Literally overnight, that scar had been transformed from this angry red, raised, gaping gash to a faint pink, flattened mark. I was amazed.

So I would have to say that in the case of Mederma, it really is worth paying extra for the real thing.

Fat Look, Thin Look

I'm on a million mail order mailing lists, and I know why. I used to work for a mail order company and remember well how the mailing list manager would specify customer characteristics when renting other companies' mailing lists: the customer must live in one of these zip codes, have ordered at least $50 worth of merchandise in the past 6 months, not have a (fill- in-the-blank ethnic) surname (sorry, but it's true), and so on.

I was on the mailing list for every catalog of fat girls' clothes in the United States. Fat look? We got it.

But in the 6 months or so, I've begun receiving new catalogs. Thin look? We got that, too.

This morning I threw out a Victoria's Secret catalog that had entertained my husband more than it did me (I have never, ever bought anything from VS). This afternoon I received an Intimate Apparel catalog from Old Pueblo Traders, which sells what my New England friends call "Meme" clothes (in Tennessee, that'd be "Meemaw"). I had to laugh at the contrast between the 2 catalogs.

Victoria's Secret swimwear is promoted with phrases like "Beach Sexy", "Very Sexy", and so on.

Old Pueblo's swimwear is promoted with phrases like "Chlorine Resistant", "Modest", and "Camouflages Hips".

I don't think either look is quite right for me. What do you think?

QOTD: what if band surgery doesn't work for me?

If it doesn't work - your body can't tolerate the band, you have serious complications, or you don't lose enough weight - you can have the band removed. You can also have additional , revisional surgery to a different weight loss surgery procedure.

But:

1. Your insurance might pay for band removal due to serious complications, but probably not just because you changed your mind and wish you had chosen a different procedure in the first place.

2. I think I've said it before, but I'll say it again: NO weight loss surgery procedure of any description is going to work magic for you. So give it your best shot.

What is the BMI and why does it matter?

The BMI was developed by a statistician as a method of determining obesity based on the height and weight of the individual. It does not take into account muscle mass, bone density, gender, or age, so all it does is provide rough measure of body composition. It has been an international standard for obesity measurement since the 1980’s and, accurate or not, the medical and insurance communities use it to qualify patients for weight loss surgery. Some medical professionals believe that your body fat percentage is a better way of judging your obesity and the attendant health risks. Even a "skinny" person can have high body fat percent (the fat can lurk in your viscera where no one can see it). The distribution of your fat is also important. In overweight people (BMI 25+), a high waist circumference is associated with an increased risk for type 2 diabetes, dyslipidemia, hypertension and cardiovascular disease. If you are overweight (BMI 25+), an unhealthy waist circumference is (as a general rule) above 35 inches for women, or above 40 inches for men.

A woman named Kate Harding has done a study of people of all shapes and sizes. The photographs (with BMI captions) on her site will make you think twice about whether BMI is a good measure of obesity. Check it out at: http://kateharding.net/bmi-illustrated/ .

Acai Berry?

The acai berry seems to be everywhere these days - there's an ad for something with acai berry in it on just about every website I cruise past - even our local Starbucks knock-off serves an acai berry smoothie. I hadn't paid much attention to it, but today the aesthetician who does my facials told me that her daughter, who is a nurse practictioner, recommends acai berry to patients who are trying to lose weight because it seems to increase your energy and boost your metabolism. I did a little googling looking for side effects or other reasons not to try it and didn't find much other than a warning that not every acai product sold on the Internet actually contains enough properly-processed acai to be helpful.

So I got a bottle of the brand this nurse practictioner recommends (Natrol). You take one 1000-mg capsule twice a day. It's a huge capsule so I opened it up and dissolved it in my Crystal Light (couldn't taste it).

If I had my druthers, as my mom used to say, I'd get a fill instead of taking acai berry, but my original bariatric surgeon is out of business (long story) and the earliest appointment I could get with another surgeon isn't until July 29th (which seems like it's 12 years away).

Stay tuned for progress reports...

QOTD: Can I lose 100% of my excess weight with the band?

You sure can.

Don't be put off by the common saying that you'll only lose 50% of your excess weight with the band.

It's more accurate to say that losing 50% of your excess weight qualifies you as a weight loss surgery success.

Your chances of losing that much weight without surgery aren't great. I read recently that only half of the participants in a study lost as much as 5% of their body weight through diet alone. So if you had 100 lbs to lose, with a starting weight of 250 lbs, you might lose 12.5 lbs through diligent dieting, or 50 lbs through weight loss surgery. Sounds good to me.

Some people lose no weight, and some people lose 100%+ of their excess weight with the band.

And even losing just 12.5 lbs could have a great benefit to your health.

QOTD: will I have excess skin after I lose weight?

It's really hard to predict how your skin will respond to massive weight loss. While it's commonly thought that slower weight loss (with the adjustable gastric band versus gastric bypass) is easier on the skin, but the real factors are genetics and age (skin loses elasticity as we age). Exercise certainly helps tone your muscles (and burn fat), but it won't restore stretched out skin.

When I got to my goal weight, a year after my band surgery, I had some problem areas: chicken neck, a sagging belly, bat wings on my upper arms, some of sagging on my lower arms, and slightly droopy thighs. A year later, everything has firmed up a bit, as if my body had been rearranging itself. I still have the sagging belly and my neck and thighs aren't perfect but they're better. I have more muscle definition on my arms now, but I don't think that excess skin is going anywhere soon. Here's what it looks like now (20 months post-op). I'm OK with it. I'd rather have excess skin than excess weight any day.

How could I possibly gain 4 lbs overnight?!

I suppose this could be the question of the day (QOTD).

How could I possibly gain 4 freaking pounds overnight?

Why don't I ever LOSE 4 pounds overnight?

It's got to be fluid retention. It's happened to me so many times I've lost count, but every time I freak out. This is just not right. It makes me want to go out and buy a new bathroom scale. Then I think, "What if the new scale measures even higher?"

QOTD: will I have scars after band surgery?

Maybe.

Some people scar more easily than others, in that their scars are more noticeable or take longer to fade, and some people develop keloids (overgrowth of scar tissue).

I had 5 incisions from my band surgery, and can only see 1 of them now - my port incision, which you can see on the righthand side of this photo, which was taken 11 months after my surgery. The other scar (north of my belly button) is from a mole removal that was done a few months before the photo was taken.

The other thing this photo shows you is that you may have excess skin (or flab, in my case) even after you reach your goal weight.

QOTD: is band surgery painful?

Is it painful? Sure. But the pain doesn't last long and you'll probably be given some decent painkillers. It's just a few tiny incisions plus a bigger one for the port (my port incision is about 1-1/2" long).

Everybody's pain tolerance varies. I'm a real baby about pain but I found my band surgery to be far less painful than other surgeries I've had (dental surgery, a hernia repair in my groin, an abdominal hysterectomy, a breast reduction, shoulder surgery). The gas pain (from the gas they pump in during surgery) lasted longer than the incisional pain. My port area was tender for 2-3 weeks (it's hard to turn over in bed, or get in/out of a chair, without using your abdominal muscles), but it wasn't crippling. My husband took time off from work to "help" me after my band surgery and by the time I'd been home for about 9 hours, I felt like he was underfoot and needed to go back to work.

If you're a woman who's delivered a child (whether naturally or by C-section), you've probably experienced worse pain than band surgery.

After Lap-Band Surgery

And this is a photo of me taken 19 months after lap-band surgery, wearing the first mini-skirt I've owned in 30 years. Maybe a woman my age doesn't need to be wearing a mini-skirt, but I just couldn't resist it.

Before Lap-Band Surgery

This is a photo of me taken the week before my lap-band surgery. I look like a bowling pin.

QOTD: Can you feel the band?

I can't feel my band, though I've heard a few people say they can.

I'm aware of my band when I get food stuck in it (in the stoma, actually - the small opening between the upper and lower stomach pouches). Then I feel major pain and pressure in the center of my chest. Occasionally I can feel food moving through my stoma - a weird sensation, but not painful. I don't feel the physical presence of this plastic ring in there.

I do feel my port sometimes when I bend at the waist, and I can palpate it by pressing on my abdomen near my port incision with my hand. It's a hard lump. I kind of like feeling it and knowing that it's there, ready to do its job.

A short fat girl

I've lost 90 pounds since my 1999 driver's license photo was taken, thanks to my lap-band. When I went to renew my license in August 2008 (11 months after weight loss surgery), the clerk at the motor vehicle department exclaimed, "You look like a different person now!"

I am different now in many ways. I am lighter, thinner, healthier, happier, and more energetic. I no longer live to eat...I eat to live.

I'm still a writer, artist, seamstress, wife, daughter, homemaker, dog-lover, and more. I still love to laugh and love to cook. The old Jean is still in there, somewhere.

My mother, who is short and struggled with obesity most of her life, used to say that there was a tall, thin blonde inside her just waiting to get out. I will always have a short, fat blonde girl inside me just waiting to get out. But having weight loss surgery has given me some wonderful tools for lifetime weight management.