One Year Later

Today is the one year anniversary of my VSG surgery. The good news is that I've lost 47.2 pounds since then. This morning I weighed 117.6 pounds (14.4 pounds below my weight goal, and 113.4 pounds down from my highest recorded weight) and recently I discovered that I can wear size 7 jeans. I can't remember ever wearing that size before. (I do remember that when I was in high school, I hated that I couldn't shop at a mall clothing store called 5-7-9. For sure, I wasn't smaller than a size 5 then.)

The bad news is that I still miss my band and I'm still finding it hard to live with my sleeve. But in a way, that doesn't matter. I've said in the past that if gastric bypass was the only bariatric surgery available to me in 2007, I would've had gastric bypass surgery despite the risks and compromises it might involve. Similarly, if  I was considering WLS for the first time today and the sleeve was the only procedure available to me, I would have VSG surgery, even knowing what I know now. I feel very lucky that I was able to have Lap-Band surgery. It set me on a path to a life of health and mobility that's more wonderful than I ever could have imagined.

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 #5

#5: NO SIDE EFFECTS MEANS MY BAND ISN'T WORKING

 

Equating side effects with a properly working band is very common, and potentially very harmful. The two most significant signs of the band’s proper functioning are (1) early satiety and (2) prolonged satiety. Those signs are rarely expressed in large, bold, uppercase letters, such as

STOP EATING NOW!

Those signs won’t be accompanied by clanging bells or flashing lights, either. In fact, the less noise and distraction (such as “Why don’t I have stuck episodes?”), the more likely you are to be able to recognize early and prolonged satiety. 

Before I tell you why the no side effects = broken band worry is a sign of mythical thinking, let’s make sure we agree on the definition of a side effect, and how that relates to complications. A side effect is an unintentional or unwanted effect of a medical treatment, and it’s usually exceeded (or at least balanced) by the benefits (the intentional, wanted effects) of that treatment. For example, antibiotics can cause diarrhea. That’s an unpleasant side effect, but an untreated infection can have far worse consequences for the patient. Side effects can often be managed by tweaking or changing the treatment, and they are rarely worse than the original condition.  

 

A complication, on the other hand, is a more acute, serious consequence of a medical treatment, and usually needs a more aggressive approach, including surgery to fix the problem. Now let’s go back to the antibiotic example. An allergic, anaphylactic reaction to the antibiotic can be fatal without prompt medical treatment. That’s a complication, and it’s far worse than the original condition.  

So in the context of all that, it seems strange to me when bandsters long for side effects like regurgitation (PB’s), stuck episodes, and sliming. Instead of looking for more subtle clues from their bodies (like early and prolonged satiety), they go looking for problems, and worse than that, they tend to “test” their band with foolish eating and/or overeating, hoping to provoke a side effect that will signal to them that they really do have a band in there. One of the many problems with that approach is that it can also provoke a complication.

Obey the Stop Signals!

Stop signals aren't there just to make you late for work. They're there for your protection. Some of the worst car accidents in my town happen at a major intersection on a busy road where some drivers seem to be ignoring the stop signals. As those drivers are sped away from the scene in the back of an ambulance, I wonder how badly they're hurt or whether they'll survive. I think it's good that our town has installed cameras at that intersection.

Stop signals are equally important to bandsters. How?

In addition to the 4 signs of restriction explained above, you will also get hints to stop eating that I call "stop signals". As newly-filled or newbie bandsters, we expect our bands to give us good, loud, clear stop signals with clanging bells and flashing lights, but eventually learn (if we work on it) to recognize the quiet stop signals such as mild queasiness, fullness or pressure in the back of the throat, difficulty swallowing, burping (or the urge to burp), sneezing, sighing, hiccups, watering eyes, runny nose, and so on. If we heed those signals, we stop eating before something more drastic and uncomfortable happens. You may not experience any soft stop signals, but don't stop looking for them just because you aren't noticing any; they could sneak past you at any time. And if you experience no hard stop signals (like stuck episodes, PB's, sliming), don't go looking for trouble! The absence of hard stops does not mean that your band isn't working or that you have no restriction. It just means you're doing a good job!

Restriction: the bandsters' Holy Grail

Restriction seems to be the Holy Grail of bandsters, a sacred thing that we hunt for with a level of passion and persistence that we may never have experienced before in our lives. In our minds, restriction is endowed with the magical power to make us lose weight. But exactly what is it?

We bariatric patients use the word "restriction" in every other sentence we speak, write, or think, but do we truly understand what it means?
In my 50+ pre-op years, the word restriction basically meant "no can do" or "you can do it, but within externally-imposed limits." To use extreme examples, that means "Thou shalt not kill" (no can do) or "Drive no faster than 55 mph on this stretch of road" (55 mph being the imposed limit).
Keeping those examples of restriction in mind, it's reasonable to say that a restrictive WLS procedure is one that allows you to eat, but in quantities no greater than ½ cup at a time (or whatever your surgeon's food amount limit is). That's clear enough, isn't it?
It's clear, but it's not specific enough to ensure safe and effective use of the "restrictive" WLS tool called the adjustable gastric band. For one thing, it implies that the band comes equipped with a monitoring feature, like the radar guns used by police to measure the speed of passing cars. It doesn't make it clear that the only monitoring feature that will work safely with the AGB is a conscientious, hard-working patient's conscious mind. Surgeons and patients who aren't aware of this aspect of the band are headed for accidents such as stuck episodes, PB's, sliming, esophageal or stomach dilation, band slips, or weight loss failure.

The adjustable gastric band was first approved for use in the USA in 2001. A decade later, we are just now beginning to understand the true function of the band. A decade of struggle and learning has gone by. Ten long years! How could that happen?
When the adjustable gastric band was first marketed in the USA, it was positioned as a restrictive WLS procedure. In the world of marketing, a product's "position" determines how its features and benefits are communicated to customers and how they compare to similar products in the market. When introducing a new automotive vehicle to the market, an automobile manufacturer must present it in a way consumers will understand: Is it a sedan or an SUV? Is it a sub-compact or a full-size vehicle? A car or a truck?
Manufacturers of medical devices like the adjustable gastric band must also educate their customers (surgeons) and end-users (patients) when they market a new product. They ask themselves: Is this a completely new concept? How can we make customers understand it and want to buy it? What other products on the market can we compare it to? In the case of the AGB, Allergan compared it to other bariatric surgical procedures: RNY (gastric bypass, which combines restriction and some malabsorption), DS and BPD (duodenal switch and bilio-pancreatic diversion, which combine restriction and a lot of malabsorption) and VSG (vertical sleeve gastrectomy, considered a restrictive procedure). The AGB doesn't cause nutrient malabsorption, therefore it fell into the restrictive category.
As a result of this perfectly ordinary business approach, thousands of surgeons and their patients were not fully informed about the mechanism through which AGB patients lose weight. It's quite possible that even Allergan didn't fully understand at the start just how the band works. If the makers of medical devices and pharmaceutical products waited until every last detail is known about a new device or a drug, some life-saving products might never reach the people who desperately need them.
So for the last decade, we all believed that the band is supposed to restrict the amount of food we can eat and cause weight loss through reduced caloric intake, but that's changing now. In the past year or so, Allergan has refined the band's market position and has been teaching surgeons that it should not be used as a restrictive device. Allergan, Endo Ethicon, and the bariatric medical community are realizing that a patient who eats until she or he "feels" restriction is far too likely to experience complications. They are coming to the understanding that the band's chief weight loss mechanism is reduced caloric intake through the reduction of hunger and appetite, with early and prolonged satiety after a small amount of food is eaten.

So if the AGB is not a restrictive WLS procedure, what the heck is it? How can we explain it without using the word restriction?
A better term for the true function of the AGB might be something like "optimization" - the process of modifying a system to make aspects of it work more efficiently, use fewer resources, and/or produce the most beneficial results. In a bandster, the system is made up of several important components: the band, the saline fill, the bandster's food choices and exercise level, with a few parts that are so top-secret, nobody knows what they are. Optimization is a clumsy-sounding word, though, and it makes the bandster sound like a machine instead of a human being. For the time being, we don't have a better term than restriction, so we'll go on using it until something better presents itself.

How will you recognize restriction? If you were hunting for the Holy Grail, you could equip yourself with a picture of a chalice to guide you, but there's no picture of restriction. Don't kid yourself into thinking that a fill under fluoroscopy (x-ray) is going to yield a picture of your very own restriction. That x-ray image is just a snapshot of part of a living, breathing, changing human body, and while it might illustrate a theoretically good fit on the band on the stomach, it cannot illustrate what's happening in your nervous system. It can't track the production of hormones that triggers hunger or satiety messages between your brain and your body.
To recognize, utilize, and safeguard your restriction, you're going to have to start paying attention to dozens of things that you took for granted or didn't even know existed before. I don't go on and on about eating slowly just because it helps prevent unpleasant side effects, but because it's mighty hard to pay attention to your body's signals when you're gobbling your meal.
I didn't realize this until perhaps 6 months post-op. Until then, I was eating carefully only to prevent stuck episodes, PB's, and sliming. Very gradually, over the next 6-12 months, I learned to listen to my body, not just when I was eating but between meals. It wasn't until after my 15th fill, at almost 3 years post-op, that I had mastered mindful eating enough to actually enjoy my experience of restriction. Three years is a long time, but don't let that scare you. I lost 100% of my excess weight with far less "restriction" than I have now. And when you remember that I spent over 50 years eating carelessly and excessively, changing my eating in only 3 years is pretty good!
So, what signs of restriction you should be looking for?
1. Early satiety after eating a small portion of food. You lose
interest in eating, feel that another bite would just be too
much, and/or feel a sudden distaste for the food.
2. Prolonged satiety after eating a small portion of food. You
are not physically hungry, and have no appetite (desire to
eat) for several hours after you eat. How many hours? It's
going to vary by person, and will be affected by many factors,
such as food choices (solid versus liquid, for example). For me,
3-4 hours is a very long time to experience satiety and I'm
delighted by that. Another person might not care to eat again for 5-6 hours after a meal.
3. Reduced appetite. You're just not as interested in food as you
used to be. You think about it less and you might even forget
to eat. The food may not even taste as wonderful as you
remember it.
4. Reduced physical hunger. You're just not as hungry, and not
hungry as often, as before.

All that sounds marvelous, doesn't it? A dream come true! It is indeed, but it's also very complicated because the human body and human behavior are very complicated. We're constantly changing, in changing circumstances. While our unconscious brain and body are trying to communicate hunger and satiety, our conscious brains and our lifetime habits are also at work. So even though you weren't especially hungry for that chicken dinner at 6 pm, it's quite possible that a phone call from a troublesome family member will trigger some comfort eating at 6:15 pm, or that boredom will send you looking for snacks at 8:00 pm, or that craving will send you looking for chocolate at 9:00 pm.

Jean's Band Story - the short version

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

Today I'm 57 years old. I'm 5'2-1/2" tall, weigh 135 pounds, wear misses size 10 clothing and a size 7 shoe. Aside from a chronic pain problem, I'm disgustingly healthy. I enjoy exercising 5 days a week, work a part-time job as a bra fit specialist at JC Penney, plan and eat healthy meals about 90% of the time, and will do almost anything for a laugh. Born in Massachusetts, I now live in Tennessee with 10 dogs, 5 cats, and a sadly neglected husband.

I've written four books and published two so far: a novel, No Ransom, and Bandwagon, a self-help book for adjustable gastric band patients. I'm working on several Bandwagon follow-up projects and also publish a free weekly e-newsletter, Bandwagon on the Road (to subscribe to it, click on the envelope image in the brown box at the left side of the blog page).

I'm also a collage artist with an online gallery at: artofcollage.blogspot.com. There aren't enough hours in the day for me to accomplish everything I want to do. My chronic pain makes it impossible for me to sit for longer than 5-10 minutes, but so far, that's not a big problem because I'm so busy running around and catching up on all the things I missed out on when I was a morbidly obese couch potato.

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

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

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

the 16th fill

16 fills in three years? That sounds kinda scary, doesn't it? But it doesn't scare me. The port is designed to withstand thousands of sticks when the fill person uses a non-coring Huber needle - and even the necessity for a Huber needle isn't proven. And optimal band restriction requires fine-tuning. It is not a one-stop shopping experience. And thank goodness for that!

My first dozen or so fills and unfills were done in my surgeon's office without any numbing medication, and none of them hurt. My new surgeon always administers a lidocaine (numbing) shot before doing a fill. The lidocaine stings. But since many of the fills (or fill attempts) I've had in the past year required a lot of poking (because my port flipped), I'm glad for the lidocaine.

While sitting in the waiting room, waiting for my turn, I listened to 3 other patients talk about their WLS experience. Were all AGB patients, and all 4 of us were delighted with our surgery.

My 3rd bandiversary

Today is my 3rd bandiversary.

In the past 3 years, I've had many gains & losses, ups & downs, and I'm STILL happy to have my dinky old 4 cc Lap-Band (with 2.7 cc in it today).

I lost: 90 lbs, 34.25", 3 shoe sizes, 6 dress sizes, my co-morbidities, my CPAP, my original bariatric surgeon (not my decision), my PCP (my decision), a closet full of fat clothes, one cat, my mother, my old job, approximately 50% of my fear of change, 6 band unfills.

I gained: a love of exercise, a new job, a closet full of cute small clothes, 7+ dogs (they come and go), 3 cats, a new bariatric surgeon, a new internist, many new friends & a great online community OH, 15 band fills, and the confidence to tackle new projects and activities I never would have considered before.

The downs: a band slip (probably caused by my hiatal hernia, quickly cured by an unfill), a flipped port (fixed with repair surgery), a year of undiagnosed & untreated chronic pain (with an eventual diagnosis of fibromyalgia and myofascial pain syndrome), losing my mother, and pain when I sit for more than 30 minutes (so my reading hobby is pretty much gone).

The ups: overcoming the downs, writing my band book (Bandwagon), being offered opportunities to work as a band educator and cookbook author, a long life ahead of me with plenty of energy to devote to my writing, artwork, family & friends, a vacation in St. Lucia, 2 trips to Seattle to visit a special OH friend, meeting a dozen or more OH friends in person, treatment that reduces the chronic pain, and an improved relationship with my difficult (that's saying it mildly) brother.

Achievements: body fat dropped from 51.3% to 29% (or 20% by the caliper method), published my band book (Bandwagon), became a certified professional bra fit specialist at JC Penney (with lots of opportunities to help obese women), published 17 newsletters for my 9 Dogs Howling fans, created 64 art collages and sold 16 of them (room for improvement there!), and wrote 4 blogs.

The future holds: at least 2 more band books, a book about the life lessons I learned from my mom, a book about my world travels, at least 33 more years of healthy living with my husband, more travel, and participation in art shows, probably more cats & dogs (and food & vet bills), and…well, who knows?

On my first bandiversary, after 17 months of concentrating on getting and succeeding with my band, I asked myself, "What's next?" The answer for me (and maybe for you) was, "Life is next."

Falling in love with my band all over again

It may sound sappy, but I'm falling in love with my band all over again.

For breakfast this morning I made my usual cottage cheese & Greek yogurt with berries. Had to stop eating after 2 bites, so I think I'm going to have go back to Click protein shakes for breakfast and save the cottage cheese & yogurt thing for lunches.

I didn't cook any supper last night because I had to work from 3:30 - 9:00 pm. When I started getting hungry for lunch at 11:30 this morning, I looked in the fridge and remembered that we had finished all the leftovers of this and that yesterday. Finally I found a small container of chickpea, broccoli & feta salad - about 1/2 cup. I ate that (slowly and carefully), thought, "That wasn't enough to feed a gnat," and promised myself that I could eat some grapes and cheese for a snack mid-afternoon. Well, mid-afternoon came and went. At 4:00 pm I fed the dogs and realized I had completely forgotten about my snack. Bells went off in my head: I FORGOT A SNACK! I asked myself, did I want to eat the snack now? No, not especially. At 5:00 pm I started supper: a batch of eggface's cottage cheese pancakes, some cucumbers in vinegar, a lemon caper sauce made of Greek yogurt, and some smoked salmon. I had planned to eat two pancakes, 1 oz. of salmon, 1/4 cup of cucumbers, and 1 tablespoon of sauce. I ate all of that (slowly and carefully), but I was TOO FULL TO EAT BOTH PANCAKES!

I feel like telling my band: "It is wonderful to be reunited with you! I've missed you so much! I almost forgot what a dear friend you are!"

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.

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!

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.

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!

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.

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.