It does get better

My friend VA, who had band with plication surgery in June 2012 and has lost 113 lbs so far, gave me permission to share her Before and Now pix, and a great blog entry she wrote a few days ago.

It is hard to really make someone who hasn’t been there yet believe that is does get better.

Most people get to the first few days, think it is too hard and therefore they are doing it wrong and just give up. Well, it IS hard. Sorry, I know that is not the answer you want, but it is the truth.

You just have to remind yourself that the habits you are trying to break are ones that you have had for years – do you really expect to break them overnight and for it to be a piece of pecan pie?

I can tell you though that it is so, so worth it. Once you get past those first few weeks and you are feeling amazing and loving the changes your body is going through, you will look back and thank yourself for pushing forward.

You just need to start. Set small and realistic goals and make one change at a time.

The main reason you should be doing this is for yourself and for your health. There are going to be negative people no matter what you do.  Well sadly you can’t stop them having that opinion, but who cares what anyone thinks.

Make the right decision for you and I wish you all the luck.  

The first line of this entry is very powerful: It is hard to really make someone who hasn't been there yet believe that it does get better.

It's also hard to make others understand that weight loss requires hard work (with or without surgery), but that all that hard work is so worth it. VA's Before and Now pix will give you visual evidence of that. The change in her physical size is amazing, but even more amazing is the avalanche of changes going on inside this wonderful person. You're right, VA, it is so worth it.

    

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.

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.

The Top 10 Things to Know About the Adjustable Gastric Band (according to Jean)

1. You will not wake up in the recovery room at your goal weight. Average weight loss with the band is 1-2 pounds per week, and virtually no one loses weight at a nice steady pace of (say) 1.75 pounds per week. Some weeks you’ll lose, some weeks you’ll stall and some weeks you’ll gain, but as long as the overall trend is downward, you’re doing great!

2. Slower weight loss with the band does not prevent sagging or excess skin. How your skin reacts to massive weight loss depends mostly on your genetics and your age. As we age, our skin loses elasticity. If the possibility of sagging or excess skin worries you, start tossing your change into a plastic surgery piggy bank now!

3. Weight loss surgery (of any type) does NOT cure obesity. Obesity is a chronic and incurable disease characterized by relapse and recurrence. Although bariatric surgery is currently the most effective way of treating obesity, obesity is something you’re going to have to manage for the rest of your life, with or without surgery. For most of us, a tool like the adjustable gastric band makes that a lot easier, but it’s not effortless, either.

4. Many eating problems after band surgery are due to user error, and can be prevented by using good band eating skills. Come back soon to read an article about those skills.  

5. In order to decrease your weight and increase your health, you must decrease your food intake and increase the quality of your food choices and the time you spend exercising. While you may be able to lose weight for a while by just eating much smaller portions of Chicken McNuggets, potato chips, and candy bars, eventually that approach will stop working, and at the same time it will start biting your health in the butt. Though it may be difficult for you to exercise at first, each pound you lose will make it easier, and each additional hour you spend exercising will not only burn calories but improve your physical and mental health. And remember: exercising doesn’t necessarily involve athletic skill or Olympic effort (though it may seem that way at the start).

6. No weight loss surgery procedure will cure eating disorders, eating demons, emotional eating, boredom eating, stress eating, celebratory eating or food addiction. Changing those behaviors is your job. If it’s too hard to tackle yourself, consider getting some counseling with a therapist experienced with eating disorder and WLS patients, and/or joining a 12-step group like Overeater’s Anonymous.

7. The band rarely works without fills. Even if you initially lose weight with one or no fills, sooner or later, you’re going to have to face the fill needle. And if you’re too needle-phobic to tolerate a fill needle, why did you choose band surgery in the first place? But consider this: adjustability is one of the wonderful things about the band.

8. The restriction “sweet spot” is a myth. There is no such thing as “perfect” restriction, or if there is, you can’t count on it to last more than one hour, one day or one week. This is because the band is an inert silicone object implanted in a living, breathing human body that changes constantly in reaction to the time of day, time of month, time of year, hydration, illness, medication, stress, you name it. Restriction variability is part of the gastric band package.

9. There is nothing magic in the band that makes you lose weight. Changing your eating and exercise behavior is what makes you lose weight. All the band does is make that work easier for you by reducing your physical hunger and increasing your satiety (specifically by providing early and prolonged satiety).

10.  YOU are responsible for your weight loss. Not your band, not your surgeon, and not the server at McDonald’s who invariably asks you, “Want to supersize that?”

Band Myth #6

#6 – THE MORE FILL, THE BETTER

I’ve heard bariatric surgeons comment that some band patients seem to be addicted to fills. I can identify with that because I had a good relationship with my band surgeon who not only administered my fills but gave me a lot of encouragement as well as answers to my many questions. I left each fill appointment with a renewed sense of commitment and hope. How can you not get hooked on something good like that? 

The problem with equating fills with weight loss success is that more fill is not always better. In fact, too much fill (which varies from one patient to the next, and also varies in a single patient as time goes on and the patient’s body keeps changing) can be downright dangerous. An overfilled band, and the side effects it causes (see #5 above), can lead to a complication like a band slip, esophageal dilation, or stomach dilation. While complications can come out of nowhere, most bariatric surgeons agree that too much saline in the band puts too much pressure on the stomach. Eventually something’s got to give. That’s often hastened by the patient’s efforts to eat around the problem, and it is absolutely not a guarantee of weight loss. I gained weight several times because of what’s called Soft Calorie Syndrome. My band was too tight and I was dealing with it by consuming mostly soft and liquid calories that offered little or no satiety.  

The human body is an incredible organism, capable of amazing feats of growth and healing that we take mostly for granted, but it’s not endlessly forgiving. Too much fill in your band, too many eating problems, too much inflammation and irritation in the upper GI tract, can compromise your body’s ability to recover from a complication like a band slip. Sometimes a complication can be treated conservatively, with an unfill and rest period, but sometimes it requires a surgical fix, including removal of the band. And after all you’ve gone through to get that band wrapped around your stomach, shouldn’t you be doing your utmost to treat it (and your body) with respect? 

Finally, the fill myth can cause us to overlook a very important guest at your WLS party….you. If you are going to succeed with your band, lose weight and keep it off and keep that band safe and sound inside you, sooner or later you will have to take personal responsibility for your success. Expecting your band alone to carry you to your goal weight is like expecting your car to safely deliver your child to school without anybody in the driver’s seat. And I sure hope that you are a very important person in your life!

Band Myth #4 - The Sweet Spot

 

Band Myth #4 – TO LOSE WEIGHT, YOU HAVE TO FIND YOUR SWEET SPOT

I used to wonder how the Sweet Spot Myth could survive in the face of so much clinical evidence against it, but last year I heard the “you gotta find your sweet spot” claim uttered by a bariatric dietitian, so apparently this is a myth being validated by medical professionals who ought to know better.  

Instead of the sweet spot, Allergan (the first to introduce the band in the USA) uses a zone chart to illustrate band restriction, with not enough restriction in the yellow zone, good restriction in the green zone, and too much restriction in the red zone. In other words, restriction happens in a range of experience, not at a single static point. That experience changes over time as we lose weight, deal with ordinary processes such as hormonal fluctuations, hydration changes, stress, medications, time of day, and so on. It’s also affected by our food choices (solid vs soft/liquid food). 

In my banded days, I traveled through and around a sweet spot many times. It might last for 30 minutes, 3 days, 3 weeks, but it never stayed exactly the same, and yet I still lost weight! I don’t actually want to stay exactly the same for the rest of my life (throat wattles notwithstanding). As any Parkinson’s disease patient will tell you (if they’re able to speak), a body that gets stuck in time is a very big problem (and with my luck, I’d get stuck in the worst sinus infection or case of the flu of my life). Some people who are very sensitive to their band and its fills find sudden or unexpected changes in restriction to be very, very frustrating, and I wouldn’t wish that on anyone, either.  

To read more about the sweet spot, click here to go to an article, The Elusive Sweet Spot.

http://www.lapbandtalk.com/page/index.html/_/support/post-op-support/the-elusive-sweet-spot-r59

Does the Adjustable Gastric Band Really Work?

My friend Karrie has graciously provided these photos of her weight loss journey. She has lost 130 pounds in a year and is doing great. Oh, did I mention that she has an adjustable gastric band? Sure looks like it works for her!

Does the Band Really Work?

Recently a person who had attended a weight loss surgery seminar the previous night asked if I could help her make sense of what she heard there. The surgeon who spoke was very anti-band. He said the band is fickle, he would never perform band surgery, and he believed that in 10 years, the band would be obsolete in the US. The person who listened to his anti-band tirade was very discouraged about the band when she left the seminar. When she got home and researched the band on the internet, she found that it has only a 55% long-term success rate. She doesn't want her stomach and intestines cut up and rearranged, she's willing to make healthy diet and physical activity changes, but when she sees others struggling to work the band and hears a surgeon say it's useless, she doesn't know what to think.

Here's what I told her. I don't know the source of the 55% long term success rate you quoted, and since the surgeon who spoke at the seminar refuses to perform band surgery, you're not going to get any accurate info from him. From my own research, I learned that long term success with the band is about the same as with gastric bypass - 65% at 5 years post-op.

Why isn't that figure 100%? Because obesity is a chronic disease and no bariatric surgical procedure can cure it. Why does the bypass seem to work "better" than the band? Probably because of the malabsorption feature. Since you've decided you don't want your intestines re-routed, that leaves the band or the sleeve as your WLS choices. If you don't want your innards cut up permanently, that leaves the band as your only WLS choice.

The band worked for me because I was a volume eater and because I was committed to making the lifestyle changes needed for long term success. My surgeon told me at the outset that if I lost only 50% of my excess weight, he would consider my band surgery to be successful. You might think, "Why would I go through all of this just to lose 50% of my excess weight?" Well, consider the alternatives...disease, disability, death. When I had lost "only" 50% of my excess weight, my co-morbidities were all either gone or under control, and I felt great - I felt very successful!

Just because a statistic indicates that 100% weight loss and lifetime maintenance aren't guaranteed doesn't mean that the weight loss and maintenance are impossible. I don't pay much attention to statistics any more. I don't want numbers to run my life, and as an old boss of mine used to say, "Figures can lie and liars can figure."

That anti-band surgeon could be right. In 10 years, gastric banding might disappear forever as a treatment for obesity. In 10 years, someone might have invented a non-surgical cure for obesity. In 20 years, someone might have invented a vaccine that prevents obesity from ever happening. And that would be wonderful. But in 20 years, I'll be 77 years old. If I had put off obesity treatment that long, I probably wouldn't have lived long enough to benefit from the treatment. So I decided to make the best of the surgical treatments available now so that I can make the best of the next 20, 30, or 40 years of my life.

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.

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.