My 4th Bandiversary Photo!

This photo, taken 6 days after my 4th Bandiversary, is remarkable because I'm wearing a belt! I think the last time I wore a belt was in 1968, when I proudly wore a white patent-leather belt with my bell-bottom jeans. Since then, I've never wanted to accentuate that pudgy middle!

The Big Decision

Deciding to have weight loss surgery, and choosing which procedure to have, is a big deal. The surgery has life-changing potential, and we want our decision about it to yield only the best results: at the very least, weight loss without complications. But like many things in life, the adjustable gastric band doesn’t come with a lifetime weight loss guarantee . That lack, and the fact that many insurance companies cover only one bariatric surgery procedure in a patient’s lifetime, puts even more pressure on us to make the right decision at the outset. Are there ways to make the decision-making clearer or easier beforehand, and/or to reduce the doubt, regret, or second-guessing after surgery?

The answer to that is maddeningly general: it all depends.

First of all, it depends on your unique personality. What type of decision-maker are you? Does your style change (and your anxiety escalate) depending on the nature of the decision? Choosing a $14.99 entrée from a restaurant menu usually doesn’t take as much time and energy as choosing a $14,999 surgical procedure.

Here’s what I mean by decision-making styles. I am a quick, sometimes impulsive decision maker who’d rather make a bad choice than no choice. My husband is a slow, cautious decision maker, one who must carefully consider and discuss every aspect of a situation before making his decision. What could be a potential conflict has turned out to be a useful balancing factor in our relationship. My husband’s cautious nature prevents me from leaping before I look, and my more adventurous nature prevents him from being permanently cemented to a bad patch of road.

Here's a list of common decision-making styles. Which category (or categories) do you fall into?

Agony – agonizing over a decision should perhaps be reserved for a very important decision but can be a waste of energy for less important decisions. Choosing a WLS procedure is important; choosing what to eat for breakfast on Tuesday is less important. I encounter a lot of people who fall into the agony category. They tend to do so much research, thinking, and analysis that they agonize themselves into paralysis. Taking a mini vacation from the decision can help neutralize the pain and paralysis this decision-maker feels, but be careful not to turn into a procrastinator (see below).

Impulsive – Like me, you go with your first or “gut” reaction.

Escapist – You avoid making a decision by creating a false choice. For example, you’re reluctant to decide about WLS, so you escape it by saying, “I’m going to lose weight on my own,” for the millionth time.

Compliant – You let someone else decide for you. Your surgeon says, “You should have RNY,” so you have RNY.

Playing it Safe – You choose the least risky option. Risk might be assessed in terms of surgical mortality (0% for the band) or out-of-pocket cost (you choose whichever procedure your insurance policy will cover).

Procrastinator– You delay your decision indefinitely, so it stays in the background of your life, like mental wallpaper. This might be a wise choice if you truly believe you don’t have enough information to make a good decision. Perhaps the VSG looks good to you, but it’s too new a procedure to have enough studies and data about success and complication rates published about it.

Fatalistic – You shrug and say,”What will be, will be.”

None of these styles are any better or worse than the other. I just want to reassure you (if you’re slow to decide, it’s perfectly okay) and also to encourage you to consider other approaches to the decision-making process. As impulsive a decision-maker as I can be, several times in my life I’ve faced some decisions (especially in business, where the decision involved millions of dollars of my employer’s money) that looked like Mount Everest. A few times, I was fortunate enough to work for a man who was willing to listen to me debate the issue and to ask me things like, “What if you look at it a different way?” His different approach sometimes helped me see a path I hadn’t noticed before, and other times helped me see that a path I’d already considered was actually the best one.

Punkalicious Birthday #58

This photo is supposed to show how punkalicious I look at age 58 (with freshly colored hair in dark brown with light brown and blonde highlights), but someone else managed to take over.

Today I celebrate my 58th birthday. And I do mean celebrate, because even though I'm a creaky old grandmother of 9 dogs and 4 cats, I'm also a much smaller and feistier granny now than I was when I had WLS 4 years ago. I'm not thrilled with my sagging, wrinkly, aging skin or the aches and pains that seem to come with aging, but I'm far happier at age 58 than I was at age 18. Fortunately, I don't suffer from birthday anxiety, not even for milestone birthdays. As I creep toward The BIG 60, I'm proud of my accomplishments and the wisdom I've acquired, and looking forward to my 6th decade. Now that I'm a healthy weight, I have the energy and strength to tackle just about any project. The next life lesson I need to master is how to keep myself challenged but not overburdened. In life as in eating, I'm the type who tends to bite off more than I can chew, so my goal now is to work on creating a better balance of work, play and rest in my life.

Recently a friend who's about my age suggested that I could ease my burden by dropping some of my activities. I said, "I know you're right, but…if I could just stop getting ideas about things I want to do…!" Later, I mentally slapped myself for that wish, because I don't want to ever go back to the kind of life I had when sitting in a comfy armchair with a book, a dog, and a bowl of popcorn was my only idea of heaven. I love books, dogs, and popcorn, but not for 12 hours at a stretch!

My fashion model persona

My previously unknown inner fashion model had a chance to pose for the camera at the OH event in Bellevue, WA.

Adjusting my mind to a smaller body

I just returned from spending 10 days in the Seattle area, where I attended the OH event in Bellevue, partied with bandster friends in Seattle, WA and Portland, OR, and did far too much shopping. During that wonderful trip, I had an unexpected struggle to adjust my mind to my smaller body. Here in Tennessee, one of the most obese states in the USA, I know I look small compared to many other women, but in the Northwest, I saw far fewer obese people and therefore was surprised several times to learn that I'm considered small there, too.

First, I tried on a body shaper - size small, as recommended by the sales person. The shaper looked like it might fit my old Chatty Cathy doll, but not me. But lo and behold, it fit me and did a great job of smoothing out and containg the belly rolls. So I bought it, mainly out of gratitude.

Then, I tried on a sheath-style dress, size medium (my more-or-less automatic choice these days). I twisted and turned before the dressing room mirror, wondering why the dress didn't look good on me, before it occurred to me to try a size small. And lo and behold, it fit me perfectly (and is shown, in part, in the photo above).

Emboldened by the earlier body shaper experience, I consulted a lingerie associate at Macy's about their body shaper options. I was holding a size large of a style that I liked while we talked. She looked at the garment, looked at me, and said, "You're quite diminuitive" (i.e., short) "And I think you need a size small." So I obediently tried on a small, after first trying the large and a medium version. And lo and behold, the small fit me. I didn't buy it (due to sticker shock), but I was a happy camper as I left Macy's that day!

I can't resist mentioning that the first time I got to my low weight, I wore a size medium or 10-12, and size 7 or 7-1/2 shoes. Three years later, after regaining and relosing 25 lbs, I'm back at the same weight but wearing a size small or 8-10 garment, and size 6-1/2 or 7 shoes. Why the change? I think that the combination of my workout program and perhaps the continuing body changes from weight loss got me here. And I'm very happy to be here!

How to Talk to the Doc

When I was in elementary school, we had Show & Tell Days. Betsy (future veterinarian) showed us her hamster and told us what he liked to eat. Joey (future geologist) showed us a lunk of quartz he'd found and explained how it was formed. Jeannie (aspiring art teacher, future author) showed a potholder she'd made and gave a fascinating and heartfelt lecture on how to weave a potholder. Paul (aspiring magician, future attorney) showed us a card trick he'd learned.

As grownups, when we go to the doctor “presenting” (as the docs would say) with a symptom, we play an adult version of Show & Tell. If we have a rash or a bruise, we can easily show the doctor what’s wrong. But often the problem is invisible, even to x-rays and blood tests, and sometimes a rash is just the tip of the medical iceberg. In that case, the Tell part of our presentation is extremely important. Our doctors are not mind-readers, each patient is unique, and graduating from medical school doesn’t automatically make a person perfect. As far as I know, there are no sensitivity training courses or even bedside manner courses in medical school. So we patients are trying to connect and communicate with a scientist, not a clairvoyant.

Communicating with doctors is a special interest of mine because of the extremely frustrating experiences I had while seeking a diagnosis and treatment for my chronic pain. It seemed to me then that my vaunted communication skills were completely ineffective when I was standing or sitting before a scientist in a white coat. I was told that my pain was all in my head; that my pain was typical of middle-aged women with emotional problems; one guy even said, “What do you expect at your age?” and “I can’t spend any more time with you now; I have sick people to take care of.”

I eventually realized that many of these docs saw me as someone seeking pain killers and/or disability income, not a diagnosis and cure. They distrusted me because I had “inappropriate” knowledge: how to pronounce medical terms, the correct names for various parts of my body; and the names of medications commonly used to treat symptoms like mine. I tried different approaches, different communication styles, as I went from one doctor to the next (which is called “doctor shopping”), but the results were always the same. I had no diagnosis, no cure, and no treatment after 6 months of consultations and tests.

Close to the point of giving up entirely and sinking further into despair, I made two more appointment: one with my counselor, the other with an internist who’d been recommended by a local nurse. My counselor assured me the pain was not all in my head (some maybe, but not all). The internist turned out to be a treasure, willing to listen to my whole sad story, asking me questions, and somehow able to believe my tale of woe. If Dr. H. held any opinions about my sanity, he kept them to himself. He diagnosed fibromyalgia and myofascial pain syndrome, contradicted other doctors who’d told me I exercise too much, and prescribed medications to help me sleep and to manage the pain. He didn’t cure me, but he offered a treatment plan that worked well enough to improve my daily functioning and give me hope for the future. And hope is a very powerful medicine.

During that long medical ordeal, I learned a few things about successful communication with a doctor. Solely for sake of simplicity, I will refer to the doctor as “he” (and at any rate, I think I may be the only feminist in the state of Tennessee).

1. Tell him why you’re there, as simply as possible and without extraneous information that may be important to you but probably has no value to the doc. “After lunch at Wendy’s the other day, when I was driving down Main Street on my way to pick up a ceiling fan at Lowe’s, I had to turn onto First Avenue and stop the car because I felt like I was going to vomit…” would be better said as, “On Tuesday afternoon, I regurgitated some chili about 30 minutes after eating it, and since then I haven’t been able to keep any food down.” When I met Dr. H., I wanted to tell him about every little physical and emotional hurt I’d experienced for the past 6 months, including derisive commentary on the medical professionals I’d dealt with. That approach probably would have set me up for another “neurotic middle aged woman” label. So I kept it short and pithy.

2. Avoid self-diagnosis. If your research has led you to what seems like a clear diagnosis and you start out by saying, “I have a band erosion,” (something even the doctor can’t definitively diagnose without doing an upper endoscopy), you will erode your credibility as well as your band. Frame it this way instead: “For the past week, I’ve been having these symptoms [list them] that make me worry that I have a band erosion.”

3. One thing at a time. When you make an appointment when your list of concerns has more than 3 items on it, tell the scheduler that you might need extra time with the doc because you have a lot of concerns to address. Repeat this at the start of your conversation with the doc. Then do your best to present each concern as a stand-alone issue, starting with the one that bothers or worries you the most. It’s up to the doc, not you, to make connections between your different symptoms. If you absolutely must point out a connection that’s obvious to you, frame it this way, “I’m wondering if the pain at my port site could be related to my difficulty swallowing.”

4. Show & tell, using clear, descriptive language. “My stomach hurts” is not clear enough. Pointing at your port site (which is on your abdomen, not your stomach) and saying, “It feels like someone is pressing a hot poker into my right side,” is better. Be sure to tell the doc how long you’ve had the symptom, if they’re constant or intermittent, if anything (time of day, body position, medication, etc.) makes them better or worse, and if you can reproduce the symptom. For example, can you trigger the abdominal pain by bending at forward at the waist, or is does it occur at random?

5. Just the facts, ma’am. Keep it drama-free, don’t exaggerate, don’t embellish. I have a habit of hyperbolic (wildly exaggerated) expressions. It entertains me, sometimes it entertains others, it’s my personal style, but it’s wasted on a scientist who yearns for precision. So I have to rein myself in, at least at the start of a relationship with a doctor, and say, “Since I’ve been taking this medicine, my mouth is always dry,” instead of saying, “My mouth feels like the 101st field artillery just marched through it.” When a symptom is worrying you, it’s tempting to verbally paint it in vivid colors, but if you use that same extreme style for everything that happens to you, you may end up as the little boy who cried wolf so much, no one paid any attention when the wolf finally ate him.

6. Ask for feedback. If your doc’s response to your show and tell is unsatisfactory because it seems that he’s not taking you seriously enough, or he’s misunderstanding you, or he’s in too much of a hurry to give you the attention you need, don’t sulk in silence. Speak up now. Remember, your doc is not perfect, he’s probably very busy, and he may be distracted by the fight he had with his teenaged son, or his worry about a patient he just admitted to the hospital. Bring his attention back to you by saying, “Have I described everything clearly enough?” or “I feel like I haven’t explained this very well,” or “What are your thoughts about this?” or “What is the next step in taking care of this problem?” or even, “You seem in a hurry today. Would it be possible for me to come back tomorrow (or whenever) to discuss my problem(s) in more depth?”

7. Establish a timetable. If the doc doesn’t say, “I want to see you again in a week (or whenever),” or “We’ll get you in for an upper GI study this week,” or “Call me if you’re not feeling better by Wednesday (or whenever),” ask the doc to establish a timetable, keeping in mind that he’s probably not the one who manages his appointment calendar or schedules medical tests.

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!