Tomorrow is the big day. 16 hours away!! Only my immediate family and my best friend know about this. I'm feeling nervous. A bit overwhelmed by the bad what if's. My doctor is at Riverside Hospital in Columbus, OH. His name is Dr. Sonnanstine. He seems like a great surgeon. His staff just loves him. I can tell it's not fake. Biggest fear with surgery is death, next to that I'd say diminished quality of life. I have 3 daughter's who mean the world to me. I'm doing this not just for me. It's for my family too. With high bp, dislocated disc and knee pain, I feel this is my last resort after many unsuccessful attempts to lose weight, including being put on weight watchers at 8 years old! Please say prayers for me. Prayers for peacefulness and rest. Prayers for the medical staff. Prayers for my family. Thanks all! Jamie
My surgery date is January 6. I am super excited but I am so worried that I can't make the needed changes for this lifestyle. I have never been able to stick to any other diet so why won't this be different? I think that, then I pick myself up and remind myself that I need to be healthy for myself and my kids and I remind myself that I can do this. So, yes, I am nervous that I will fail as that is all I have done in regards to my weight these past fifteen years but I also know that I have accomplished more than I have failed at in everything else so I CAN DO THIS. I WILL DO THIS!!
To tell, or not to tell? That is the question on the lips of many WLS patients. Once again, there’s no one-size-fits-most answer to this question. The decision to tell (and how much to tell) or not to tell is unique to each patients’ unique personality and circumstances.
IN & OUT OF THE WLS CLOSET
I was happy about my decision to have WLS and thrilled when my insurance company finally approved it. I shared this happy news with many friends, acquaintances, family members, and coworkers. I don’t know but I assume that they discussed it amongst themselves to some extent, expressed opinions or concerns, and perhaps worried about my decision, but none of them gave me frankly negative feedback. They might have been thinking it, but they didn’t say it. I very much doubt I would have reversed my decision if someone had said, “That’s too risky/it’s a bad idea/I don’t want you to/you’re crazy/or whatever.”
I’m going to assume that you, the reader of this article, are an adult over the age of 18, with the right to vote, the obligation to serve in the military, and (at some point, depending on your location) the right to purchase and use tobacco and liquor. Unless a judge has declared you mentally incompetent (and that’s harder to accomplish than you’d think), you are the one who’s responsible for your body – for its care and nourishment and any medical treatments or procedures that affect it. So if you’re in the early stages of considering WLS, whose input are you going to trust to inform your final decision? A bariatric surgeon, or your dad? Your primary care physician, or your sister? Your therapist, or your hairdresser? And hey, I’m not slamming hairdressers. Mine could do very well indeed as a therapist, but she has a cosmetology license, not a mental health practitioner license.
Last summer I was startled to hear a 50-something bandster state that she had gotten her husband’s permission to have plastic surgery. His permission? Huh? Does that mean he’s the only adult in that relationship, or what? I’m not against asking permission, mind you. I ask my boss’s permission to undertake certain tasks or projects at work; I ask the State of Tennessee for permission (i.e., a driving license) to drive a car; if I still lived in a suburban development, I might ask the zoning board for permission to add a room to my house; I ask the government of China for permission (i.e., a visa) to travel in that country.
I’m an extremely independent person in many ways, so I have to stop and think carefully about what I might ask my husband permission to do. We have our own separate checking accounts as well as a joint account, so I might ask him for “permission” to spend a chunk of that joint account on a big purchase like a computer or a car. Everything else gets negotiated.
I have a lot of experience in negotiation because of my business career. I negotiated things with everyone from my coworkers to my suppliers. But people who do that kind of thing for a living aren’t the only ones who negotiate, and negotiators aren’t necessarily politicians or manipulators trying to advance some evil cause. My own career as a negotiator probably started when I was a child who realized that good behavior often yielded a treat. My negotiations with my mother went something like this:
It’s 7:00 o’clock on Thursday morning. Mom is brushing the tangled cobweb of my hair in preparation for braiding it. I am sniveling because the untangling hurts. The negotiation begins.
Mom says: “Jeannie, if you stop whining right this minute, you can have Cocoa Puffs for breakfast.” Jeannie sees an opportunity and negotiates this agreement by asking, “Can I have chocolate milk on my Cocoa Puffs?” Mom sighs and yanks at a hank of hair. Jeannie snivels a little bit more. Finally Mom says, “Yes, you can have chocolate milk on your Cocoa Puffs.” Jeannie instantly shuts up. Negotiation over. It’s a win-win situation. Everybody’s happy… for maybe 15 minutes. In 15 minutes, Jeannie’s hair is finally tamed into two narrow braids and it’s time to choose an outfit for school. This time Jeannie begins the negotiation. “Can I wear my pink dress to school?”
Mom says: “That dress is brand new. We’re going to save it for church.” Jeannie says: “I promise not to get it dirty.” And so on and so forth.
Well, that’s enough time spent traipsing along Memory Lane. My point (and, like Ellen Degeneres, I do have one) is that the “yes or no” WLS decision is yours. Everything else (how to make it work best; what your family can do to help you; how much to tell your nosy coworker) needs to be negotiated with (or modulated by) the people who will be involved in your WLS journey on a daily basis and possibly renegotiated as time goes on and your needs change. The negotiation may be simple (“Will you take the kids to McDonald’s for lunch if I pick up your dry cleaning?”) or complex (“Let’s talk about how we’ll handle Thanksgiving dinner this year”) or downright messy (“I feel like you’re trying to sabotage my weight loss.”). That’s life, isn’t it?
BE CAREFUL WHAT YOU ASK FOR
Getting feedback from others is usually a mixed bag experience. It’s wonderful to get the positive stuff and uncomfortable to get the negative stuff. It’s also very frustrating when your announcement elicits no response at all. What if you tell your sister, “I’ve decided to have weight loss surgery,” and all she says is “Oh.” What’s that all about? She’s shared her thoughts about your hairstyle, your boss, your kid’s struggles with math, your parents’ new car, your high blood pressure and now she has nothing to say about something as momentous as weight loss surgery?
If you’re like me, your mind gets busy filling in all the empty spaces with scenarios and speculation. My own little mind is always full of running commentary (most of it – well, some of it – never uttered aloud). When I’m exercising, I’m planning what to wear to work that day. When I’m driving to work, I’m considering the best way to write the first or fifth or fifteenth sentence of my next article. When I’m driving home at the end of that day, I’m replaying a conversation I had with a coworker and fiddling with what I could have said better. So when I encounter my complete opposite (someone who has nothing to say on a matter that’s important to me), I cast my fishing net into my teeming mental pond, scoop up a dozen squirming fish, and off I go into Wonderland. “Wonderland” as in the land where I wonder, and wander, on an endless circular track. Around and around Jean goes, and where she stops, nobody knows, least of all Jean.
The official term for that is “projection”. You project your own internal drama onto someone else’s blank white movie screen without having the first clue about what’s really going on behind that blank screen. You’ve known your sister all her life, ever since she supplanted you as the baby of the family. That’s what, 35 long years? After 35 years together, you might think you could predict her reaction to almost anything, but it’s also quite possible that you cannot correctly read her mind. Your suspicions about her reaction to your weight loss surgery announcement may be accurate, but you’ll never know that unless you specifically ask her.
That’s more or less what happened to me when I first began discussing weight loss surgery with my husband. We had been married for 20 years, so he had two long decades of experience with his wife launching herself into risky situations (be it a new job, an overseas trip, adopting a pet, redecorating a house, taking fen-phen). He had been amazingly patient through all of that, not just because he loves and supports me but also because he knows that hell hath no fury like Jean with an obstacle in her path. So when I said, “Today I made an appointment to go to a bariatric surgery seminar,” and he said nothing in response, a dozen things ran through my mind. He thinks I should be able to lose weight by dieting. He doesn’t want me to lose weight because he likes fat girls. He thinks this is another of Jean’s wild goose chases and if he leaves it alone, she’ll get over it and move on to some other project…and so on and so forth.
What was actually going on in his head was probably more like, “I wonder if there’s more rice in that saucepan, but if Jean forgot to buy soy sauce again, I won’t have another helping because I can’t eat rice without soy sauce. If Jean has weight loss surgery, will we ever get to eat rice with soy sauce again? Will we be living on warm Water and melba toast? Did I remember to fill the cat’s water dish before I came in the house? We really need to get the cat fixed but I don’t want another argument about whose turn it is to take a critter to the vet. Oh no, Georgie’s puking in the living room again. If I ignore it, can I get Jean to clean it up? I’m going to write SOY SAUCE on the grocery list in big letters so Jean won’t forget to buy it. Maybe if I ignore the weight loss surgery thing, it’ll disappear, like Georgie’s puke”…and so on and so forth.
I’m not trying to make my husband’s thought processes sound asinine (for a taste of truly asinine thinking, you really need to listen to a few minutes of my own stream of consciousness). I’m just making the point that our minds are full of stuff that may be worthwhile or interesting to us but doesn’t necessarily have to be shared in detail with everyone around us, and that nobody but the Amazing Kreskin can hear someone else’s thoughts. When my husband finished his dinner (without a second helping of rice) that night without making any response to my bariatric ambitions, I asked him, “So what do you think of the idea of me having weight loss surgery?” And he said, “I’m not crazy about it, but if you really believe it will help you, I’ll do my best to support you.”
And what did I say to that?
All I said was, “Thank you.”
I could have said a lot of other things. I could have said, “Why aren’t you crazy about the idea?” I could have quizzed his knowledge about weight loss and weight loss surgery. I could have asked him if he would still love me and desire me when I was thin. I could have gone on and on for hours, while adding to my own anxiety and creating a host of brand new anxieties in his poor head. But instead I said, “Thank you,” because his promise of support was all I needed to hear at that time, and we had a lifetime of conversations ahead of us. And I said “Thank you” because when I’m in the planning stages of something big that will require a group effort, I try not to invite discussion that will derail the whole project even before its engine starts. You may have a different style, and you may think I was postponing a discussion that should be tackled immediately, but my approach is: one step at a time. I don’t try to build Rome in one day. I pick up one brick, walk it over to where I want the wall, put it down, and go back for another brick. Eventually the wall (or Rome) gets built.
IN & OUT OF THE BAND CLOSET
My feelings about sharing my WLS journey with other people have changed as time has gone on. For three months before and about 18 months after my band surgery, bariatrics was the #1 subject in my mind at least 75% of the time. I had to exert effort to not talk about it constantly. If I hadn’t discovered online WLS forums, where I could talk about it constantly with other people who talked about it constantly, I think my head may have exploded.
I didn’t talk about WLS with every single person in my everyday circle of friends and acquaintances (for example, I decided not to tell my church friends about it, mostly out of laziness), but most of the people who knew me as obese also knew about my surgery. When I had lost my excess weight, the focus of my life began to shift to other things. Yes, bariatric surgery was still important to me, and so fascinating that I wrote a 500+ page book about it, but as my interests and activities grew and changed, I acquired a whole new set of friends, acquaintances, and coworkers who had never known Fat Jean. It didn’t occur to me to tell them I’d had WLS any more that it occurred to me to tell them I’d had a hysterectomy or hemorrhoids. If the subject of weight loss or dieting or exercise came up, I was willing to talk about those topics, but not necessarily in the context of weight loss surgery. I guess you could say I was in the band closet then, though I won’t admit to hiding in there. I still wanted to talk about bariatric topics, but not with the general public. I made two new friends during that time who know about my band surgery. One of them had heard about it from her mother (a former coworker of mine) and the other heard about it from me. Otherwise I was kind of enjoying being perceived as a “normal” woman by people who couldn’t even imagine me as a fat woman.
But one day my feelings changed. I opened the door of my band closet and peered out. It was time to get out of there. Here’s what happened.
During an exercise class at my fitness studio, another (naturally slender) student began making fun of fat people, and a few more people there chimed in. They just couldn’t imagine how someone could “let themselves go” like that. It sounded to me like these well-meaning people were saying that obesity is a choice – that the fat people had made a conscious decision to overeat, under-exercise, and gain an unhealthy amount of weight. It sounded to me like these well-meaning people were saying that fat people don’t have the willpower or intelligence to maintain a healthy weight. And suddenly I heard myself say out loud, “Those people aren’t proud of their fat. Don’t be making fun of them.”
After a minute or two of mumbled objections, those well-meaning people fell silent, and soon the conversation took a new direction.
Months later, when I was about to publish Bandwagon Cookery, my friend, instructor and personal trainer, Caroline, suggested holding a book-signing event at the fitness studio. At first I was wary of the idea. It would require me to step out of the band closet and expose my bariatric secret to a community of people who had never known Fat Jean. It would require me to step out of my comfort zone and into the limelight. I’m not afraid of public speaking – I actually enjoy it in most circumstances – and I’ve told my WLS journey story plenty of times, but mostly to bariatric patients and professionals.
At Caroline’s loving insistence, we hosted the book signing, which was well-attended by women for whom weight management was an interest but for whom obesity was not an issue. One of them had a sister who was banded, but the rest of the guests were blank slates when it came to bariatrics. I want to share with you what I told this audience after announcing that I had weight loss surgery, something that I felt they needed to hear before I could tell my nitty-gritty obesity story:
“I need to talk about the elephants in the room. The elephants are the beliefs that many people have, that obesity is a moral failing and that weight loss surgery is taking the easy way out. Obesity is not a choice, nor is it evidence of inadequate willpower. It’s a chronic and incurable disease caused by a combination of genetics, environment, and behavior. Weight loss surgery is the only effective long term treatment for obesity available in the United States today. And weight loss surgery is by no means the easy way out. Weight loss is hard work with or without the help of surgery. Has my weight loss been easier because I had bariatric surgery? Of course it has. That’s one of the reasons I chose surgery – because without it, my previous weight loss attempts had been so difficult and so ineffective.
“I’m glad to have my Lap-Band, but it’s just a little piece of plastic, a tool that reduces my appetite. When I stick my hand in a bag of potato chips, my band doesn’t yank it out again. When my alarm goes off in the morning and I want to roll over and go back to sleep, my band isn’t what gets me out of bed, into workout clothes, and into this fitness studio. When I’m thinking that I need a 2nd helping of mashed potatoes, my band doesn’t shout, “Don’t do it, Jean!” When I’m sad and thinking that buying and eating a gallon of ice cream would make me feel so much better, my band doesn’t hide my car keys on me.
“I am the one who makes decisions about what I eat and how I exercise. I am the one who’s responsible for making good food choices and changing my eating and exercise behavior. So I get the credit for my weight loss, and I’m the one who has committed to maintaining that weight loss for the rest of my life.”
Looking back, I’m not sure how much of an impact that speech had on any of my listeners, but it had an impact on me. Hearing myself say those words affirmed my important and life-changing decision to have bariatric surgery. Whatever you do as you go forward on your weight loss journey, be proud of what you’re doing. It’s a courageous thing. If no one else congratulates you for the undertaking, you should still pat yourself on the back for it.
It’s Friday night, and your long-awaited bariatric surgery is scheduled for Monday morning. Ahead of you are two days of the freedom to eat anything you want, in any quantity. You’re supposed to be on a pre-op liquid diet, but when you walk into Cheesecake Factory with your friends, your resolution to order Soup goes down the drain (literally as well as figuratively). You grasp the menu in sweaty hands. What to order, what to order? You’ll never be able to enjoy food like this again, you think. Don’t you deserve to order one of everything on the menu? After all, it’s your last meal!
Sound familiar? Last Meal Syndrome is very common among people facing weight loss surgery, and chances are you've already suffered it sometime in your life, perhaps the day before you started New Diet #832. Since New Diets almost always start on a Monday (there may be a law of nature covering that), you spent every minute of Sunday gorging on all the foods you could no longer eat come Monday morning. You ate so much that you made yourself slightly ill, and you probably didn't taste half of that food in your haste to cram it into your mouth.
Overeating because of anticipated deprivation is an old, old habit. Until the earliest humans learned to plant seeds and cultivate their own food supply, nutrition was largely a matter of opportunism. If you caught a big fish or felled an animal by heaving a rock at it, you ate it all because you didn't know when another meal would swim, crawl, walk, or fly by.
Although I sometimes joke that being self-employed as a writer is terrifying for me because it's a hand-to-mouth existence, at no time in my middle-class American life have I ever been truly threatened by significant food deprivation. My repeated bouts with Last Meal Syndrome have been caused mostly by my emotional over-attachment to food. When starting a new weight loss diet, or contemplating my coming bariatric surgery, I was terrified not that I would starve, but that I would suffer from emotional pain, boredom, or stress unrelieved by my usual comfort: whatever food I wanted, when I wanted it, in any quantity I wanted. Intellectually I knew that I would be able to eat small amounts of healthy foods and thus lose weight and gain better health, but the spoiled, petulant child within me feared and hated the very thought of that.
A few days before I was banded, my husband asked me, "Are you going to have anything special to eat before your surgery?"
I said virtuously, "I'm on a clear liquid diet for the next three days. I can't eat anything at all, never mind something special." My surgeon had told me that if my liver wasn't in good shape (that is, having a manageable size and texture), he would bail out of my surgery. After all I had gone through to get to the operating room, I wasn't going to blow it, and it wasn't (as I reminded myself) as if I would never be able to eat again in my entire life. I was facing food deprivation, yes, but for a matter of days, not years.
Now, let's get one thing clear here: I'm not claiming superiority over pre-ops who give in to Last Meal Syndrome and Celebrate their own private food festival a day or a week before their surgery. My compliance with my surgeon's instructions was driven by fear, plain and simple. I wasn't (then or now) a paragon of virtue. But in the last 4-1/2 years, I've learned something important that newbies and wannabes may not realize about the adjustable gastric band. And that is:
The only food deprivation you will suffer after band surgery involves the QUANTITY, not the quality or nature of the food you eat. With a properly adjusted band, you should be able to eat a wide variety of foods you like. You don't have to give up Cheetos or Haagen Daz or McDonald's or prime rib of beef forever. All you have to give up is eating those foods in excess. It's true that when your daily calorie budget is limited, your health will depend on your making the best possible food choices - eating a piece of cheese instead of the Cheetos, a Skinny Cow ice cream bar instead of a gallon of Rocky Road, a Happy Meal instead of a quarter-pounder, two ounces of prime rib instead of the whole cow. You and your band will still be able to tolerate just about anything, so when you look down the road that your bandwagon will travel, you should see plenty of nice places to stop and eat instead of a dry, barren desert in which you'll have to subsist on stale melba toast and lukewarm Water.< /span>
That's the good news. Now here's the bad news:
After band surgery, you'll be able to eat a wide variety of foods you like. Yes, I know I already said that, up there in the good news paragraph. But the tolerance of almost any food you can imagine means that you will have to exert some self-control to avoid overindulging. Now you may be thinking, "If I had any self-control, I wouldn't need weight loss surgery." If the need for self-control is a deal-breaker for you, maybe you should consider a different bariatric procedure, one that will allow you to eat anything at all and lose a pound a day. I'm not convinced that such a procedure exists, because I've heard too many gastric bypass (and even duodenal switch) patients moaning about significant weight regain, but by all means give the Magic Weight Loss Surgery a go. Maybe self-control will never be an issue for you again.
My thoughts about self-control would fill up another whole article, so right now I just want to reassure you that eating with your gastric band is not necessarily going to involve an endless series of bland, dreary meals. It's not going to be like the mysteriously popular diet that requires you to eat nothing but cabbage soup three times a day. It's going to involve eating like a normal person who enjoys food but has a small appetite. Depending on your experience of restriction after each fill, you may have to forgo certain foods at times, but just because you can't comfortably eat a bagel with cream cheese today doesn't mean you'll never again be able to have a few bites of toasted bagel. Your food tolerance is going to depend not only on your fill level but also on your eating skills. The day after my first fill, I suffered my first stuck episode after taking a huge bite of a grilled cheese sandwich. A year later, with a lot more fill in my band, I could eat that same sandwich for lunch because by then I was used to eating slowly, taking tiny bites and chewing the food very well. I probably wouldn't eat the whole sandwich because I'd get "full" so quickly, and that's a good thing!
