KAATNS

great article
i think the majority of the people know what is wrong with their (diet)..
they seem to be hung up on (i am on a diet) .......i blame that on the past diets we all most likely did...over and over with the same results....lose, gain and lose and gain until we sought medical intervention.....i think many people also just eat the wrong things (easy, processed, fried, high calorie) in amounts their body cant burn off and it turns into fat.....that is what happened to me.....i do not diet..i eat what i like....but i take and am responsible for what i do eat and make better choices....sure i divert off path but am right back on it......and then some who have a WLS to help them just dont....
we have to make the choice to do the best we can with what we have (or dont have) and then do it without saying what am i doing wrong and start saying i am doing GREAT ...

While most of us knew all about the physical side of Weight Loss Surgery, many people have no idea about the emotional ride they're about to face. This article discusses all aspects of the "emotional roller coaster" from the moment you first decide on having bariatric surgery all the way up to the maintenance phase of your weight loss. It's a wild ride baby!


When was the last time you were on a roller coaster? If you’re like me, it’s been a while. In fact, the last time I was on a roller coaster I was 310 lbs and could barely fit into the seat. The restraint almost didn't go around my tummy. I was squeezed in like Cinderella’s step-sister’s foot must have tried to squeeze into that tiny shoe. Yep. I was Drizella’s foot and the coaster seat was the glass slipper. I’m sure it was a comical, if not sad and pathetic site, for those around me. It was embarrassing to me, to say the very least. But I laughed it off and went on, as I tended to do.
That roller coaster was a wild ride. It had huge climbs, steep drops, loop-de-loops, sharp turns, and at one point it feels like you’re lying on your side. Honestly, it’s a wonder I stayed in the coaster even with the restraint!! The end of the ride was abrupt - it felt like my insides were coming out of my mouth when it stopped short back at the beginning of the track. When it was over, I felt accomplished, in a way. I’d survived that coaster ride, wild and uncomfortable as it was.
Many people don’t realize that life before, during, and after weight loss surgery becomes a roller-coaster ride of it’s own. It has the huge climbs of elation and joy and excitement, the steep drops into anxiety and depression, and the loop-de-loops, sharp turns, and lying on your side moments of uncertainty, worry, and fear. Here are some of the emotional dealings that will occur before, during, and after surgery that you might not know.
1. Pre-Surgery Elation. This happens when you are finally approved for surgery. It’s going to be a reality! You are going to get a brand new lease on life! The period of life where you are having to go through diet after diet is finally coming to an end! You might tell everyone you know or you might decide to keep your secret to yourself. Regardless, you are excited and ready to go!
2. Pre-Surgery Blues. This is when you realize that you are going to have to say good-bye to one of your best friends ... Food. You come to the realization that there are some favorites that you are just not going to be able to eat anymore. Depression sets in slightly, and you might even go on a food bender - similar to what an addict might do. At this point you might even question your decision to go through surgery.
3. Day of Surgery. You’re going to be going through a myriad of emotions during this time. You’ll feel excitement, anxiety, apprehension, and impatience all at the same time. You’ll be worried because, after all, it is a major surgery you’re about to go through. But at the same time, you’ll be excited at what’s about to happen. When you wake up from anesthesia, you might be scared, especially if you’re having a rough transition out of anesthesia. You might be a little confused, wondering where you are. When your body settles down a bit and you remember where you are and what just happened, you might feel a little concerned. "Did everything go okay?" "Is this going to work?" "Did I just make the biggest mistake in my life?" On the other hand, you might wake up beautifully, singing the praises of your surgeon and his/her team, excited to begin your new life. These feelings and emotions will likely cycle throughout the day as you’re getting used to the idea of what just happened and your body relaxes and comes out of shock from surgery.
4. Going Home. When you’re finally released to go home, you’ll either be excited or scared. Thoughts might rush your brain like “will I be able to do this on my own?” and anxiety might set in again. You might, again, question your decision to undergo surgery, especially once the monotony of the liquid diet phases set in. The first few days might be easy, and the next might be excruciating. You’ll be in some discomfort because of incisions and if the surgeon inflated your abdomen with gas prior to surgery (commonly done in laparoscopic surgeries), and this might heighten your doubts and anxieties. You might begin to worry about issues such as leaks, slippage, or staples coming loose.
5.The first few months. You will be going through a mourning period at some point, and for some that occurs during the first few months after surgery. You no longer are able to lean on food for emotional support, so you might feel sad. You might even go through a type of “withdraw” from food, similar to what an addict might be going through their first few days in rehab. You’ll be able to eat more some days than others, and that will lead you to worry if your surgery is working or if there’s something wrong. Some days you’ll be jealous of watching everyone around you eat foods that you once loved. Others, you’ll be glad you can’t/don’t eat those things anymore. By the time you've finished all of your phases and are on to real food, you’ll be relieved and excited, and likely worried and anxious as well. Whereas before, you were relying on liquids for sustenance, now you’re on your own and have to rely on figuring your food choices out for yourself.
6. The losing phase. From the moment you leave the hospital until you reach your goal you are considered to be in the losing phase of surgery. For the purposes of this article, we’re going to call the losing phase the time period from month 3 (about the time you transition into full solids) to the point where you reach your goal. There will be many frustrations, joys, and concerns in the months ahead. Some days you’ll forget everything you were taught about nutrition and make yourself sick on something you shouldn't have eaten. Other days you’ll be 100% on track. You’ll have moments of pride and joy, and moments of shame and weakness. You’ll revel in finding out you can eat something as simple as asparagus and despair over not being able to eat rice pilaf. You’ll finally reach your “groove” point sometime during month four or five, and things begin to go well. You’ll reach a stall or two (or five ...) and wonder if you’re doing something wrong or if you've messed up your new tummy. You’ll marvel over losing 10 lbs in one week. You’ll wonder why you only lost 2 lbs the next week. When your loss starts to slow down, you’ll worry that you’re not exercising enough, that you’re eating too much or too little, or worry that your surgery is beginning to fail. You’ll relax more when you are consistently losing, even if it has gone down to 1-2 lbs a week.
7. The maintenance phase. When you reach your goal weight, you will have reached what is called “maintenance”. This is the final stage that you will likely be in for the rest of your life. Here, you will change your diet slightly in order to not lose or gain any more weight. You will get frustrated a time or two - especially the first time you gain a few pounds. You will marvel at what you've lost, but are concerned with the way your body looks now. You will have loose skin, which may cause body image issues. If you’re single, you might notice more possible suitors paying more attention to you. You might fall from one addiction (food) into another (sex). You might also be tempted into other addictive substances or habits such as alcohol, cigarettes, shopping, or pornography. Alternatively, you may look back at your loss, as meaningful and inspirational. You might revel in the way your life has changed and be happier than you have ever been and be ready to branch out and help others succeed in their bariatric surgery journeys.
Tips on Riding the Roller Coaster
Knowing that these emotions are possible doesn't mean they will happen for everyone, and doesn't mean you can’t get through them. The following tips will help you stay on the road to success and prevent you from falling off the wagon and into an abyss of self-doubt and depression:
1. Support. This is the number one most important thing for WLS patients. Even more important than food is support. Support can be found at home, through friends and family, in a hospital or surgery center support group, or even online forums such as Bariatric Pal.
2. Stick to the plan. As tempting as it might be to veer off and eat something you’re not supposed to, stick with your doctor or nutritionist’s eating plan as closely as possible. This will ensure that you continue to lose steadily, decrease the length and amount of stalls you’ll experience, and will speed up the healing process.
3. Vitamins. It sounds very cliche, but remember to take your vitamins! Focus on Iron and B Complex vitamins especially.A vitamin deficiency can result in depression, physical weakness, and poor sleep habits.
4. Speaking of sleep ... Make sure you’re getting plenty of it! At least 8 hours a day for an adult! Lack of sleep can lead to fatigue, weight gain, and (you guessed it!) depression!
5. Remember that “this too shall pass” ... These stages of emotional turmoil certainly won’t last forever. You’ll get over them as quickly as they overcame you. And keep in mind that each stage after surgery only lasts a short time in the grand scheme of things. Most eating phases last, at most, a month. After which you’re on to the next phase.
6. Keep a plan handy. Know that you will likely feel some unpleasant emotions or feelings and plan for them. Know what you’re going to do when you get upset, depressed, feel head hunger, or even feel physical pain from surgery. Have a list of friends to call at the drop of a hat, have a bottle of water ready to sip on at all times, or have your doctor’s phone number on speed dial. Know that these feelings will likely happen at some point in time, and be ready to deal with them when they do.
7. Remember that everything you’re going through is completely normal and OKAY. It’s important and helpful to know that everyone goes through a stall at some point. Everyone has pain during the first couple of weeks after surgery. Everyone eats something they shouldn't at some point. Whatever it is you’re going through - someone else has likely gone through it!
8. Finally, DON’T GIVE UP! Remember that this is a journey. As the old saying goes, “It’s a marathon, not a sprint.” There will be ups and downs on this wild roller-coaster ride. There will be twists and turns and loop-de-loops and there will be many moments when you feel like you’re laying over on your side. But, in the end, it will all be worth it. Your health, your life, and YOU ARE WORTH IT!!

Happy Valentines Day! From gift cards to candy hearts, boxes of chocolates to tender letters, acts of kindness, and thoughtful expressions surround this mid-winter holiday. For some, reaching out to their valentine it is just an expectation that they grudgingly fulfill. For others,


Happy Valentines Day! From gift cards to candy hearts, boxes of chocolates to tender letters, acts of kindness, and thoughtful expressions surround this mid-winter holiday. For some, reaching out to their valentine it is just an expectation that they grudgingly fulfill. For others, it presents an opportunity to share genuine love and care for a cherished relationship. I am grateful and very blessed that my husband Roger is the latter. He is beyond kind, and always and completely acts out of love. He makes decisions based on what is best for those involved, and spends his days in service to others. An incredible man to be sure.
And, Roger cooks! He is a great cook and loves to prepare wonderful meals. You see preparing good food is how he shows his love for his family. And feeding me, is how he shows his love for me. Hmm, to be honest, sometimes, that is a challenge for me. Meals are one thing, but the homemade cinnamon rolls, baked bread, fudge (and you know about me and fudge) and especially the chocolate mint on my pillow each night are quite another. So kind, so thoughtful, yet so full of calories I simply cannot afford! But I can’t say anything, can I?
Years ago I came across an article by Gayle Andrews, PhD entitled “Intimate Saboteurs” Dr. Andrews included several case studies in which people who loved and cared very much about their WLS patient unknowingly ( though sometimes deliberately) sabotaged their weight loss success. Showing love with food is common. Many of us were raised that way. (See I Love You, Have a Cookie ).
So what’s a person to do? Well, for myself, I sometimes secretly throwing things out. Not always mind you, but more than once, after raving about Roger’s homemade cinnamon rolls, I have taken a bite and thrown the rest down the disposal. Not always, but sometimes the mint on my pillow ends up in the garbage. Or sometimes those extra lovin' spoonfuls go to my dog! You see, it’s just best that way. I could ask him to stop, and I have tried but I have come to realize that it is so very important to him to share his love and talent that way. So, I manage one delicious, caring calorie at a time.
When it comes to our weight management - what's love got to do with it? Well, I believe everything. There are so many people in our lives who love us with food. Each of us must find our own way to deal with "the love" in a way consistent with our commitment to both our beloved supporters and with our Success Habits.

"no active processes" in the brain??? I was told that my whole life by people who were not Dr.'s and didn't need an MRI to prove it....

I haven't had any more significant issues since the one time.
My PCP looked over the brain MRI, and found "no active processes"....whatever that means.
Now I'm scheduled for a consult with a neurologist on the 13th....they looked over the MRI as well and weren't in any hurry to schedule me. So I'm not sure what we will do next.....stress test maybe.
Thanks for checking on me, my bestie!

How are you feeling?

Thanks for the reply! Yes, my PCP is going to send me to a cardiologists if the results of the MRI don't show any concerns. "Just to be on the safe side."
My BP is usually in the 110/70 - 120/80 range now.
I have checked it AT HOME with one of those cheapo wrist things from walgreens at 80/50 a few times last year when this issue came up.
My sister being an RN, suggested a tilt test....amongst every other test she could think of...gotta love your baby sister.

your in my thoughts/heart my friend........always

After weight loss surgery, you need to plan your meals ahead of time. You always want a high-protein, low-calorie option to be available at meal time. You might find yourself carrying your own prepared food with you to be sure that you have the food you need. Sandwiches are good “go-to” option, but not just any old sandwich will do! This article can help you build sandwiches that are good fits for your meal plan.


What is Wrong with the Sandwiches You Used to Eat?
A typical workday might have started off with a trip through the drive-through for a breakfast burrito or sandwich, or a bagel and cream cheese sandwich at work. Lunch could have been a brown bag peanut butter and jelly sandwich or a trip to a nearby restaurant for a sandwich, burrito, or burger. Where might these options leave you?
Sausage, egg, and cheese croissant or biscuit from a drive-through (600 calories with 42 grams of fat)
Bagel with cream cheese (500 calories with 70 grams of carbohydrates)
Peanut butter and jelly sandwich (600 calories and 40 grams of sugar)
Club sandwich (1,000 calories and 2,500 milligrams of sodium)
Chicken patty sandwich (60 grams of carbohydrates and 1,100 milligrams of sodium)
Beef, bean, and cheese burrito (900 calories and 40 grams of fat)

Your breakfast and lunch sandwiches could have added up to over 1,500 calories. Add in beverages, sides (hash browns, fries or chips, anyone?), and snacks, and you could have been at 3,000 calories by lunchtime!
These Choices Don’t Work After Weight Loss Surgery!
Needless to say, these options do not fit into your weight loss surgery diet.

First, some of those sandwiches have more calories than you are supposed to be eating in a day, not to mention that some also contain more saturated fat, sodium, and sugar than you should have in a day.
Second, those sandwiches emphasize starchy breads and fatty condiments, not the lean proteins and nutritious vegetables you need to stay full and nourished after weight loss surgery.
Third, they can cause complications. Doughy bagels and fried chicken, for example, can cause obstructions in lap-band patients; fatty sausage and sugary jelly can cause dumping syndrome in gastric bypass patients; and these low-nutrient foods can fill you up and cause malnutrition.

Luckily, this does not mean that you need to give up the convenience of sandwiches and the pleasure you get from biting into one. There are plenty of ways to make sandwiches that are weight loss surgery-friendly: low-calorie, high-protein, convenient, and delicious!
Protein Fillings for WLS Sandwiches
Start by choosing a lean source of protein, just like you do when you plan all of your meals. These are some healthier options compared to what you might have chosen before weight loss surgery. Don’t forget to measure your portions if you are making your own sandwich, or eyeball your portions if you are ordering in a restaurant.
2 scrambled egg whites (30 calories)
2 ounces of canned light tuna (60 calories)
2 ounces of chicken breast, lean ham, turkey breast (80 calories)
2 ounces of fat-free cheese (90 calories)
½ cup cooked beans or 1 vegetarian burger (120 calories)
2 ounces of turkey or vegetarian bacon or breakfast sausage (130 calories)

Load up on Vegetables and Fruit
Vegetables and fruit are the next food groups to add to your meals. Vegetables especially are low-calorie, so add more if you want a bigger sandwich. Try classic combinations, or get creative. You can also experiment with herbs such as fresh cilantro, basil, and dill. These are some ideas.
Lettuce and tomatoes with meat and cheese
Grilled eggplant, zucchini, and/or bell peppers with beans
Cucumbers and sprouts with fat-free feta cheese
Diced celery, carrots, onions, and water chestnuts with tuna
Spinach and mushrooms with egg whites
Pear or apple with fat-free cheddar cheese
Cantaloupe with ham and/or fat-free cheese
Blueberries with egg whites

Breads and Alternatives
Most bread is high in carbohydrates and low in protein – clearly not what you need for your nutritious weight loss surgery diet. Besides adding calories and carbs, bread can cause obstructions in lap-band patients and make gastric bypass patients sick or overly full. When possible, skip the regular bread.
Bagels
Tortillas
Subs
Croissants
Biscuits
Regular sliced bread

Instead, choose whole-grain, high-fiber, low-calorie breads, and consider open-faced sandwiches, with the filling on 1 slice of bread, instead of regular 2-slice sandwiches. These are some good options.
Reduced-calorie bread (45 or fewer calories per slice)
Light English muffin (50 calories per half)
Mini whole grain bagel (60 calories per half)
Low-carb tortilla (50 calories per small tortilla)
High-fiber, light wrap (90 calories per wrap)
Also, look for creative, non-bread alternatives.
Lettuce leaves to make lettuce wraps or cups
Egg roll or wonton wrappers
Sheets of dried seaweed
Grilled eggplant
Your fork (skip the bread and just eat the filling)

Keeping Condiments Under Control
The condiments that you add can make or break your sandwich, both in terms of nutrition and taste. Skip the full-fat mayonnaise, dressings, dips, sour cream, and butter, and be wary of high-sugar jam, barbecue sauce, and honey mustard. Instead, consider the following condiments.
Salsa
Fat-free mayo, dressing, dip, or sour cream
Regular mustard
Plain, non-fat Greek yogurt
Hot sauce
Shredded fat-free parmesan cheese
Reduced-calorie, trans fat-free margarine

Some Breakfast Sandwich Ideas to Start Your Day Off Right
Egg whites scrambled with spinach, mushrooms, and fat-free feta cheese on ½ English muffin
Cottage cheese and strawberries wrapped in lettuce leaves
Shredded fat-free cheese and lean ham toasted on a slice of reduced-calorie, whole-wheat bread and topped with salsa and tomatoes
Egg whites cooked with turkey bacon and broccoli in a small, high-fiber wrap
½ whole-grain mini bagel spread with fat-free cream cheese and topped with canned salmon with diced celery and water chestnuts

Lunch Sandwiches
Lettuce wrap filled with diced chicken breast, bean sprouts, mushrooms, and bell peppers, and soy sauce or light Asian dressing
Dried seaweed sheet rolled around tuna salad made with fat-free mayo, chives, and celery
Pinwheels made by layering slices of turkey breast, lean ham, and fat-free cheese slices, spreading them with mustard, and rolling them
Bean burrito with black beans, fat-free cheddar cheese, salsa, and fat-free sour cream on a small, high-fiber tortilla
Chicken breast with sliced apple and light vinaigrette between slices of grilled eggplant
Tomato sauce, fat-free mozzarella cheese, and mushrooms on a light English muffin
Toasted Rueben sandwich with low-fat Swiss cheese, shredded cabbage or sauerkraut, lean corned beef, and fat-free Thousand Island dressing on a light English muffin

Are You Ready for Some Sandwiches?
You can eat these sandwiches at home, or make them ahead of time and carry them with you in a reusable container. As a weight loss surgery patient, you should own plenty of reusable containers with tight-fitting lids. If you do not already have some, they are worth the investment so that you can carry healthy foods with you wherever you go.
We hope that you enjoy these sandwich ideas and that you are inspired to make some of your own healthy, high-protein sandwiches!

The thing about torrid love affairs is they never end with a clean break. Sure, you have every reason to think it’s over. You changed your phone number, attended a weekly support group, burned every picture of the two of you together and started dating a healthier, saner person - one your friends actually like. But passionate romances don’t die until the second or third bullet. There’s always at least one steamy reconciliation before the thing is finally stone cold dead.


You’ll run into your ex at the store and go a little weak at the knees, or you’ll send a gushing e-mail on a lonely Friday night, or you’ll decide that avoidance is childish and the grownup thing to do is at least be friends. Before you know it, you’re right back where you were, and after the initial exhilaration dies you realize your mistake. Nothing’s really changed and you’ve wasted time and emotion yet again on someone who isn’t and never will be good for you.
An unhealthy relationship with food is eerily similar.
You may be stunned to learn that you’re so in love with the simple act of eating. One of the most common things bariatric surgeons hear on follow-up visits is, “I never realized what a relationship I had with food”. You thought your weight problem was from ignorance over what to eat, or faulty childhood messaging, or not making time to care for yourself, or your grandmother’s genes. That may be where it started, but that’s not what kept it going.
After surgery, you figure out the truth. You’ve been embedded in a romance as sticky and hard to leave as Richard Burton and Elizabeth Taylor’s on-again-off-again love affair.
Just like lovers in a doomed romance, you’ll be tempted to drift back into your old relationship with food. And it’ll sneak up on you when you’re most vulnerable, right when you think you’ve got the whole thing whipped.
Here’s what happens. Your surgery gave you a massive head start. It forced you to change your eating habits, it did away with your hunger pangs and allowed you to drop weight at breathtaking speed. You got positive reinforcement from the immediate success of your new behavior and from the fact that you just flat out felt better. Every week contains a little drama in the form of unaccustomed praise, changed relationships, different activities, and new clothes.
But the excitement will wane. Life will settle down, just like someone who’s had a thrilling engagement with lots of gifts, a fabulous wedding, an extended honeymoon, and the first couple of scary post-marriage fights and rapturous make-up sessions, but now has to get used to day-to-day married life with the spouse who leaves a trail of potato chips in his wake and the mother-in-law who calls three times a day. In other words, life will become normal, and, at times, even mundane.
Even more sobering, your body will adapt over time. You’ll be able to undo the straitjacket put on your system by the surgery.
For those who had a gastric bypass or vertical sleeve operation, two things come into play that will test your resolve. First, you’ll get hungry again. Even though the surgery bypassed ghrelin, the hunger hormone, other hormones will ramp up to fill the void, and most patients will start feeling hungry again, anywhere from six to twenty-four months after the surgery.
Second, your new stomach will adjust and toughen up, just like babies’ feet callous as they learn to walk. It will expand a bit, and its cells will change to create more and thicker mucus which cushions the food you ingest, making it easier to eat bigger quantities and varieties of food.
If you had the gastric bypass surgery, a third issue will come into play. The dumping syndrome that’s kept you from eating sugar will disappear in most patients. So the piece of cake that would have made you violently ill six months ago won’t cause a problem now.
For lap band patients, two issues can lure you back into your old lifestyle. First, you’ve figured out how to cheat, and you’re familiar enough with the band that you’re no longer worried about hurting yourself if you thwart its restriction. You can drink high calorie milk shakes or put your favorite food in a blender and eat as much as you want.
Second, you rely on the lap band to limit your food intake like a surgical shock collar rather than taking control of your own behavior, creating a negative reinforcement method of diet control that starts to grate on you. You have your surgeon decrease the saline in your lap band for special occasions, like Thanksgiving, and then put in enough saline “to make me throw up” when you want to lose more weight instead of taking the steering wheel and driving your own eating and exercise plan. Over time, you’ll begin to resent the choke hold the band has over your body and you’ll grow tired of the twice-monthly maintenance visits to your doctor.
That’s why the first six months after your operation should be treated like a sprint, wringing every benefit you can from the surgery while you’ve got all its mechanical and behavioral benefits going for you – the compliments, the falling scale numbers, the lack of appetite, and the physical inability to eat too much. This time won’t last forever, and those six months will be the best shot most people ever get at losing their excess weight.
You’ll learn to listen to your body to tell you when you need food. You’ll figure out what it feels like when your glucose is low, which means you need energy and should put some fuel in your tank. You’ll be able to tell the difference between real hunger versus head hunger, between needing energy and just mindlessly following an eating habit, between desiring food versus needing food.
There is no finish line. There is no moment when you can say, okay, I’ve won that battle and I can forget about it. Like a recovering alcoholic has to pay attention to what he drinks for the rest of his life, you’ve got to be vigilant about diet and exercise for the rest of yours.
But, you say, that sounds depressing. Surely life wasn’t meant to be quite so restrictive. That’s just too hard.
Actually, it’s not. It’s just conducting yourself in a fashion that’s consistent with your goals, something you’ve been doing your entire life with your job, your marriage, your family, and your friends.
Think about it.
The things you’re proudest of in life are the things that have required the greatest work and sacrifice - your education, your children, your marriage, your career. Maintaining a healthy weight is no different and it’s something you should pat yourself on the back every day for doing.
You’ve tasted what life is like without the suffocating excess weight. Your new habits are far less restrictive than the physical, social and emotional limitations your old weight burdened you with.
It’s time to kick your dysfunctional romance with food out of your life forever.

The world of bariatric surgery is full of myths. Every time myths are repeated, they gain strength and credibility (deserved or not), so it’s important to look at them closely before accepting them as true.


TIME TO THROW OUT SOME OLD MYTHS
It’s time to throw out some old myths about the adjustable gastric band, but before we start flinging those myths around, let’s all agree on what a myth is.
The traditional definition is that a myth is an ancient story of unverifiable, supposedly historical events. A myth expresses the world view of a people or explains a practice, belief, or natural phenomenon. For example, the Greek god Zeus had powers over lightning and storms, and could make a storm to show his anger.
If you think myths are dry stuff found only in schoolbooks, think again. They surround just about every aspect of our lives, and travel much faster now, in the age of technology, than they did in the dusty old days of ancient Greece and Rome. They’re a way for us to make sense of a chaotic world, both past, present and future. They affect thoughts, beliefs, emotions and assumptions in our everyday lives, coming alive in our minds as we, and the people around us, seem to act them out.
Some myths are helpful because they give us a shared sense of security and express our fundamental values and beliefs, but some myths are just plain wrong and can be harmful to us and to others. A good example is the myth that having weight loss surgery is taking the easy way out. Every time I hear that one repeated, I want to laugh and scream at the same time. If you’re a post-op, you know why. Weight loss is hard no matter how you do it (surgery, diet pills, prayer, magic cleanses, and so on). On the other hand, WLS is supposed to be easy, compared to the dozens or hundreds of weight loss attempts in our past. Why on earth would I put myself through a major surgery if it wasn’t going to help me lose weight and keep it off?
Now that we’ve shared a little laugh (or scream) over a WLS myth we can all agree upon, let’s test out some band myths whose validity may not be as clear. This kind of examination can be uncomfortable, but believing in a falsehood is almost guaranteed to make your WLS journey bumpier than it needs to be.
Let’s start with the myths that are easiest to digest and end with the ones that can be tougher for a bandster to swallow.
#1 – THE BAND IS THE LEAST INVASIVE WLS PROCEDURE
I believed this one at first, mainly because I knew little about the other WLS procedures back in 2007. It’s still a widely-circulated myth, one that even my surgeon’s well-intentioned dietitian endorses. So, what’s the truth according to Jean? Face it: any surgery done on an anesthetized patient, during which a surgeon cuts into the belly in several places, does some dissection (more cutting) and suturing (stitching) of the internal anatomy, and implants a medical device (the dreaded “foreign object”), is invasive. It is true that band placement generally involves less internal dissection and suturing than other weight loss surgeries, but neither is it on the same level medically as having your teeth cleaned. So while the invasiveness of a surgery is worth considering, you do yourself a disservice if you let that override other considerations. A bariatric surgery might last 45-60 minutes, with recovery lasting a week or so, but its effect on your health and lifestyle last a lifetime. Or I sure hope it does.
Some people associate invasiveness with irreversibility. Although the band is meant to stay put once clamped to your stomach, it can indeed be removed if medically necessary. Gastric bypass (RNY) surgery can also be reversed, while the sleeve (VSG) cannot and only the “switch” (malabsorptive feature) of the duodenal switch (DS) can be reversed. Removal or reversal is not as easy as operating on a “virgin belly” (as my surgeon so colorfully puts it), so it’s important to weigh the benefits against the risks of reversal or revision surgery.
#2 – BAND WEIGHT LOSS TAKES TOO MUCH WORK
Aside from the desire for instant and effortless weight loss (which is a fairy tale if I ever heard one) that so many obese people share (me among them), this is a myth that often turns people away from the band and towards other WLS procedures. While this myth may be true in the first 12-18 months after surgery, eventually everyone ends up in the same boat, rowing hard against the powerful tide of obesity.
Weight loss and weight maintenance is hard no matter how you achieve it. A dietitian who spoke at a band support group meeting I attended a few years ago said that while band patients must change their lifestyle immediately in order to succeed, every WLS patient must do that sooner or later. It’s a pay-me-now or pay-me-later deal. You can slice it, dice it, sauté it and serve it on your grandmother’s best china. However you serve it, weight loss and maintenance is a lifetime project because obesity is a chronic disease with no cure. No matter how successful we are as new post-ops, all of us must face the possibility of regain. That’s why I cringe when someone proudly crows, “XXX pounds gone forever!”
#3 – THE BAND’S SLOWER WEIGHT LOSS PREVENTS SAGGING SKIN
This is a fairy tale. According to several plastic surgeons I’ve heard speak on the subject. The effect of weight loss on skin depends mostly on your genetics and your age (because skin loses elasticity as we age). Other factors can be how obese you were, how long you were obese, how you carried your weight, and how much (and how) you exercise as you lose weight.
I’ve heard women say that they’d rather be obese than have sagging or excess skin. To my mind, that’s a sad statement, because I’d rather have sagging or excess skin (as long as it didn’t interfere with my ambulation or activities) than excess weight. Don’t get me wrong: I loathe the excess flab on my midsection (whose nickname is “The Danish Pastry”) and I’m not thrilled about my batwings, throat wattles, or anything else that’s happened to my skin in the past few years (during which I’ve undergone the double-whammy of weight loss and the fast approach of my 60’s). On the other hand, I think I look pretty good for a woman my age, especially when I conceal my figure flaws in flattering clothing which, I might add, no longer needs to be purchased at Lane Giant.
#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
#5 – NO SIDE EFFECTS MEAN 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. And that brings us to the final myth in today’s article:
#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!

Do you know when to call it quits? To quit a meal, that is?


It’s 12:15 pm. Sad to say, your meal is over now.

I used to work with a recovering food addict (I'll call her Wendy) whose work station was about four feet away from mine. We both went to lunch in the company break room at noon every day.

Wendy had lost over 100 pounds in a 12-step program, but food was still of paramount importance to her. At 11:45 every morning, she would announce hopefully, "It's getting close to lunch."

At 11:55, she would announce ominously, "It's getting dangerously close to lunch."

At 12:00, she would announce triumphantly, "It's time for lunch!", spring out of her chair, and head for the break room.

At 12:15, came the final, regretful announcement, "Lunch is over."

Our coworkers found this daily ritual both amusing and annoying. Only another food addict (like me) could understand what was going on in Wendy's head as she looked forward to her noon meal and then mourned its passing.

What's the take-home message from this story?

Lunch is over. It has to be over. You must put down your fork and stop eating when your planned portion is gone or the instant you get a stop message. But what if there's still food left on your plate? What about the children in Armenia (all starving, according to my mother)? What about that leftover food?

1. Get up from the table (say, "Excuse me" if it seems indicated).
2. Put the food in a storage container, and put the container in the refrigerator, or throw the food away (down the garbage disposal, where you can't get at it, is best).
3. Take your plate to the sink and rinse or wash it.

Did I say "throw the food away"? In spite of the starving Armenian children? I sure did. I'm not going to tell the World Health Organization that you threw out the extra food. You can donate money to a food charity to help feeding starving children (you'll be able to afford a few bucks for charity because you won't be spending $50 a month on soda). God will not strike you dead for this, I promise.

Remember what Rhoda Morgenstern said to Mary Tyler Moore as she tore into a chocolate bar back in 1973 (or thereabouts)?

"I don't know why I'm eating this. I should just rub it directly on my hips."

So look at that plate of leftover food and ask yourself, "Should I roll in it, or throw it away?"

Lunch is over!

You weigh and measure yourself, don’t you? It can be such a gratifying way to see your progress towards your weight goal. But do you weigh and measure your food as well? No? Despite the potential for that practice to help you lose weight?


Tell me why you don’t weigh and measure you food before putting it on your plate. Is it painful? Surely not. Is it impossibly difficult? No, I can’t believe that either. Or do your cups, spoons, and scale gather dust simply because they remind you too much of…gasp!!...dieting?
Dieting…one of the most hated words in the vocabulary of every obese person who hated dieting, and failed at it so often, that she or he finally got fat enough to qualify for weight loss surgery. I completely understand. I’ve been there, done that, and got the size 3X tee-shirt. Yet still I’m going to insist that you give the practice of weighing and measuring food a try, because it’s one of the things that has made me a WLS success and because I can think of 9 (count 'em - NINE) excellent reasons for you to do it too.
1. It will prevent you from consuming more calories than you can burn each day, thereby helping you lose weight. Me, I’m terrible at eye-balling food amounts, even after years of practice. I cut myself a piece of chicken that I think weighs 2 ounces, and find to my surprise that it weighs 4 ounces. I spoon myself a modest mound of veggies that I think measures ¼ cup, and discover that it actually measures ½ cup.
2. It will make the data you enter in your food log more accurate so you’ll know how much you’re really consuming and whether you’re eating appropriate amounts of proteins, carbs, and fats each day, not just for weight loss but for good nutrition. You do keep a food log, don’t you? Did you know that scientific studies have shown that people who keep a food log lose more weight than people who don’t?
3. It will help give you a sense of control and mastery over food and eating, which will be very welcome and empowering after years of feeling that food and eating controlled you.
4. Weighing, measuring, or counting out 10 potato chips or 14 M&M’s will give you a chance to think one last time about whether that stuff will meet your nutritional and health goals as well as temporarily scratching the itch of a food craving.
5. It will slow your progress from stove to table, thereby reducing your risk of inhaling your food without even tasting it. You do sit at the table to eat, don’t you? It’s not true that calories eaten while standing up at the counter (or in your car or at your desk) don’t count!
6. The ceremony of weighing and measuring will help you appreciate the sensual delight of food, and that will increase your satiety (the sensation of having eaten enough food, which by the way is quite different from feeling “full”).
7. Until you learn what your satiety or “stop eating” signals are, you’ll have no way of knowing if you’ve eaten too much until it’s too late. And stopping eating too late can translate not only into disappointing weight loss but into unpleasant side effects like PB’s (regurgitation), sliming, foaming, and stuck episodes.
8. It will prevent you from consistently overeating, thereby preventing you from experiencing not just the side effects mentioned above but also some unwanted and potentially irreversible medical complications, like a band slip, a dilated esophagus, and/or a dilated stomach pouch.
9. If you give it an honest try for at least one week – just 7 days – and it doesn’t help, you’ll have the pleasure of saying that you proved me wrong. That’s highly unlikely, but hey, give it a shot!
Oh, one last thing (for now). I know some highly successful bandsters who never weighed and measured a single morsel of food. They ate small amounts of foods they liked, lost weight, and maintained that weight loss. But they’re in the minority. And I, the World’s Greatest Living Expert on Everything, who slacked off on food vigilance after I reached my goal weight, have found that one of the quickest and easiest ways to get my eating back on track and nip weight regain in the bud is to go back to weighing and measuring. At the same time, I’m able to eat small amounts of foods that I like – just like the ones who don’t weigh and measure. The fact that my food has been weighed and measured doesn't make it any less delicious!
If it makes the practice easier for you to bend your stubborn mind around, tell yourself you’ll just do it just for this one week, or one day, or one meal. Sometimes the WLS journey has to be taken one tiny baby step at a time. And that’s perfectly okay, because hundreds of baby steps can add up to hundreds of pounds and inches lost, and a lifetime of weight maintenance. Isn’t that what you want, in the end? Yeah, me too.

Are you afraid of an unhappy outcome of your weight loss surgery? You're not alone. Use your fear to conquer obstacles rather than letting it conquer you


For most of us starting a WLS journey, bariatric surgery is vast, uncharted territory, full of unknowns. We long for a happy outcome – maximum weight loss with minimum problems. We listen to stories told by other patients with a combination of hope (to be as successful as they’ve been) and fear (that we won’t experience the side effects or complications they talk about).
No one wants to be haunted by the specter of anxiety and dread, but I think a little bit of fear is a good thing. I don’t want fear to dominate my life, but without it, I’m likely to become complacent about my weight loss success and/or revert to the old, all-too-comfortable ways that made me obese in the first place. In small doses, fear keeps me on my toes.
Like pain tolerance, fear tolerance varies from one person to the next. Perhaps I’m able to tolerate and use fear because my childhood and adolescence were so full of fear-provoking experiences. By the time I was in my late 20’s, I actually got a little thrill out of fear, possibly because it stimulates adrenalin production. There’s nothing quite like a knife coming at you to activate your fight-or-flight system, causing a perverse fear “rush”.
At the same time, prolonged exposure to fear has also taught me to respect it. I don’t play with fear the way daredevils like Evel Knievel did, risking life and limb for the brief thrill of jumping 14 buses at a time with his motorcycle. But I do like the way fear can clear my mental field, forcing me to draw a line between important and unimportant. When the choice is survival or surrender, I’d rather choose survival. I’m not a quitter. When challenged, I’m going to fight back, especially if something precious like my health is at stake.
If fear tends to paralyze rather than mobilize you, you may have to use your own compass to navigate a problem, or play follow-the-leader (provided you have a trustworthy leader) instead. Whatever you do, don’t give in. Giving in turns you into a victim (click here to read an article about victim mentality: http://www.lapbandta...-of-obesity-r79), which is not a position of strength in any battle worth fighting. And your health is worth fighting for, isn’t it?
So, how can you make fear a working partner in your WLS journey? Let’s take a closer look at two of the more common faces of fear.
FEAR OF FAILURE
Somewhere between my first, mandatory pre-op educational seminar and my pre-op liver shrink diet, I became uncomfortably aware of a shadow that followed me everywhere. It was dark and scary, and even bigger than I was. It was my fear of failure. After decades of struggle – diets, weight loss, weight gain – I felt that WLS was my absolute last chance to be healthy. And after slogging through all those pre-op tests, evaluations, consults and procedures, I danged well was not going to fail this time.
Since I had to admit that my weight management skills were sadly lacking back then (as amply proven by the number on the scale and the numbers in my medical files), the only option available to me was to become the most compliant patient my surgeon ever had (click here to read an article about patient compliance: http://www.lapbandta...g-deal-abo-r112). I had to believe that he and his staff knew what they were doing and would guide me well. I’m a very curious and often mouthy person, so I asked a lot of questions and did my best to understand what was going on in me and around me, but I spent very little time trying to second-guess the instructions I was given. That approach freed up a lot of time and energy that I was then able to devote to changing my eating and other behaviors in ways that helped my weight loss.
FEAR OF COMPLICATIONS
Compliance served me well I this area also. I can’t claim that I was never tempted to cheat on my pre or post-op diets or to test my band’s limits. I can’t claim that I believed I’d be forever exempt from the side effects and complications I heard about from other WLS patients. But when my dietitian told me (for example) that I’d be mighty sorry if I accidentally swallowed a wad of chewing gum and had to have it scraped out of my stoma, I quickly lost my interest in chewing gum. When I observed that many bandsters experienced certain types of side effects and complications after engaging in certain types of risky behaviors, I resolved not to follow them down the road of no return.
Eventually I discovered that life after WLS can deliver some unpleasant surprises, just as in every other aspect of life. I had to learn some things the hard way, like: If you swallow a large antibiotic capsule that can’t pass through your stoma and slowly dissolves into a corrosive mess, you will end up in the ER thinking you’re having a heart attack (and end up with a big unfill). And no, liquid antibiotics don’t taste good, but they taste a lot better than the weight I regained after that unfill.
Most of the mistakes I made were the result of impatience or carelessness, but I did my best to learn from those mistakes and keep moving on. A handful of mistakes was about all it took for me to decide not to challenge the validity of my surgeon’s and dietitian’s instructions, and that kept me trudging along the bandwagon trail, getting ever closer to my weight goal. And once I reached that wonderful place, I was determined to stay there!

How do you like your band? Tight? Tighter? Tightest?


MORE, MORE, MORE

Americans love MORE: more of anything and everything. More food, more fun, and (for some of us) more fill in our bands. But striving for maximum fill in the effort to achieve maximum weight loss can be a terrible mistake.

Fat folks become obese enough to qualify for bariatric surgery because we’ve been eating more, more, more, so it’s not surprising that bandsters long for more, more, more fill. The tighter the band, the better, right?

Wrong. Here’s why: tighter doesn’t automatically yield more weight loss. It can cause eating problems, side effects and complications that none of us want. It can compromise our quality of life. It can make us miserable when all we hope for from bariatric surgery is a better life.

You’re not impressed by all that? You’re willing to risk everything in the pursuit of skinny? Then try this on for size. A tight band doesn’t guarantee weight loss. Just the opposite: it can stall your weight loss or even make you gain weight.

Do I have your full attention now? Good. Listen up and I’ll explain why tighter isn’t always better.


THE RESTRICTION FALLACY

Traditionally, the adjustable gastric band has been considered a “restrictive” weight loss surgery. Bandsters were taught to look for signs of restriction: the proofs that their bands were working. Instead of paying attention to her own eating behavior and lifestyle, the bandster waited impatiently for the flashing signs, ringing bells and slamming doors that would stop her from overeating. The idea was that the small upper stomach pouch would “restrict” food intake and result in weight loss. Sound familiar?

That was well-intentioned thinking, but it was wrong. In the past 5 or so years, band manufacturers and bariatric surgeons have come to believe that it’s a mistake to eat and eat until you set off your band’s emergency warning system, for the reasons mentioned above. Unfortunately, the re-education process is slow going, and in the meantime, the restriction fallacy lives on. Even now, approximately every third word out of a bandster’s mouth is “restriction”. It’s a catch-all term for the feelings that limit how much a bandster eats. Post-op band life tends to become a quest for enough fills to reach the Holy Land of Restriction. Next stop: Skinnyland.

Or not.


HAZARD AHEAD! THE DANGERS OF SOFT CALORIE SYNDROME

Soft Calorie Syndrome is one of the least publicized dangers of a band that’s too tight. Psychologists would call it a maladaptive behavior, that is: a nonproductive behavior that prevents you from adapting to situations, or changes in yourself or your environment, in a healthy way. It can begin as an attempt to deal with or avoid an unpleasant experience but it does not solve the original problem and eventually becomes dysfunctional. You can read more about maladaptive eating behaviors by clicking here: http://www.bariatricpal.com/page/articles.html/_/healthy-living/is-your-eating-maladaptive-r50
A bandster experiencing Soft Calorie Syndrome is responding to the unpleasant experience of eating with a band that’s too tight by eating the soft and liquid calories that slide most easily past their gatekeeper band. Instead of eating the healthy and solid foods (like dense animal protein, veggies, fruits) that provide the most satiety (both early and prolonged), that person favors easy-to-eat food that’s often junky and high in calories (for example: potato chips, ice cream, milkshakes). Even healthy foods( like yogurt, cottage cheese and, fat-free/sugar-free pudding) can fall into the soft calorie category, and they don’t provide any better satiety than the junky stuff. The net result is that you end up consuming more calories than you need because the soft stuff doesn’t provide enough early and prolonged satiety. And the result of that is a weight loss plateau, or even weight gain.

I discovered the perils of Soft Calorie Syndrome for myself when I traveled to New York City to attend a trade show when I was about 8 months post-op. I had gotten a fill the day before I left, and by the time I got to New York I had realized that my band was too tight for me to tolerate. I couldn’t eat any solid food, so I spent the next 3 days eating soft, high-calorie, low-satiety foods like creamy soups, milkshakes, and ice cream. I was just trying to survive long enough to go home and get an unfill. My maladaptive eating behavior achieved a temporary goal (comfortable survival) while sabotaging my long term goal of losing weight. In fact, I gained weight during that trip and ended up feeling disappointed in myself. I promised myself no more fills on Fridays and no more fills the day before a business trip. I called my surgeon’s every time I suspected my band was too tight and found that even tiny unfills could make all the difference in my quality of life as well as my weight loss.

I know I’m not the only person who’s discovered the perils of Soft Calorie Syndrome. I also know that you’re not alone in believing that more fill is better and that unfills will slow or stall your weight loss. A few months ago I talked about this with a smart and successful bandster named Denise. When her surgeon reacted to her too-tight band by suggesting an unfill of .5 cc, her dazed and frightened face made him reassure her that she could start being re-filled in a month. The month ahead scared her, but she agreed to the unfill, and discovered that rather than returning her to Bandster Hell, it had restored sanity to her eating life. She said, “I was able to eat again. Solids went down easily. Bread was on my menu. Meals lasted me several hours. I didn’t snack because I was able to eat enough to keep me satisfied.”

When Denise went back to her surgeon a month later, he was delighted her hear her say that she didn’t even need a re-fill. She told him, “I can eat anything, but I’m not eating everything.”

And that, my friends, is what healthy eating is all about.