Jean McMillan

You're wise to put those 3 months of waiting to good use. it can only help you in the long run. As for why I'm not loving my sleeve, read the post I made on a different thread (see the link I posted above), and then if you still have questions, let me know.

I completely understand why you're worried, but try not to let it take over your life, because anxiety tends to send us to the refrigerator (or bakery, or McDonalds). On the other hand, if you can use the worry to fuel your healthy eating commitment, it can work to your advantage. Thanks for telling others about Bandwagon! Jean

Wow, if medical students had to take a course in Bedside Manner (which they don't), he must have flunked out. And he gets one million extra demerits for the "I don't think this will help" remark. Very little in what he told you is consistent with my understanding of appropriate food choices with the band. And that business about the skins of Beans remaining in the band just doesn't make sense anatomically. No part of any food can make it into your band. The only thing that goes into your band is saline solution. If he meant that it stays in your stoma, that's still a dumb statement. No food should ever stay in your stoma for longer than a few minutes. If it does, something's wrong. If meant that complex carbs like beans offer better satiety because of the Fiber content (which is true for everyone, not just bandsters, and that's because of what happens to them in the intestines, not the stomach), then I don't understand why he thinks that veggie burgers (which contain - hello? - fibrous veggies and (depending on the product) healthy soy protein) are a poor choice. Did anyone in that practice explain all these arbitrary food rules to you before your surgery? Did they tell you that you being a vegetarian was a problem for them? Does he employ a bariatric dietitian? If so, you need to consult with that person, and if you get the same line of crap, it's time to look for another bariatric practice to do your aftercare. Jeez Louise, that p*sses me off. I feel like kicking a dog now, except at the moment they're all being as good as gold.

Why do you say your doctor education before band was crap? If they didn't give you a food plan to follow, did you ask for one? Or ask for a referral to a dietitian?

Ah, the bad old days of Bandster Hell....I don't miss that at all! It often takes several fills for a bandster to feel "restriction". Restriction is a lousy term but it's what we have right now to describe the band's optimal effect: early and prolonged satiety. Once you get there, your band isn't going to sound an alarm to tell you to stop eating. Well, it might, if you go on overeating to test your band. But the alarm system (hard stops such as stuck episodes, PB's/regurgitation, sliming) can trigger complications that you don't want, especially after spending $15,000 on your surgery. So for the rest of your life, you will have to treat your band, and your body, with respect. That includes careful eating, every single day. A surgeon I interviewed when writing Bandwagon told me that his self-pay patients often were very successful with their band because they had paid for it out of their own pocket. Kind of a "you get what you pay for" thing. So maybe if you look at your band as a longterm investment, it will be easier to hang in there until it starts paying some dividends.

You're very welcome!

Lap-Band wasn't approved for use in the USA until 2001. The Realize Band was approved in 2007. So you're not going to find a lot of longterm band veterans active on online WLS forums that were in their infancy in those days. Alex Brecher was banded in 2003 and founded LBT while recovering from his band surgery. Another big WLS support site was founded in 1998. I've belonged to those sites for 5 to 5-1/2 years, and I've found that very few people stay active on a support site for very long. Member turnover is very high for reasons unrelated to the type of surgery they had. They lose weight, get a new job, get married, have a family, travel the world, and other worthwhile things. Or they don't lose weight, or they suffer financial hardship, medical problems, family problems, and other things that can distract even the most dedicated forum visitor. If you want to "chat" with longterm band veterans in other parts of the world, you might find some on LBT's local support forums for British, Australian, or other countries' patients. To do that, go here: http://www.lapbandta...support-groups/ I have an English bandster friend who belongs to a UK-based forum and can get the web address from her if you want. One thing to keep in mind when looking for band vets, though, is that band design and surgical placement techniques have changed a lot since the band was first introduced in Europe in the 1980's, so the patient outcomes from back then may not apply today.

Hey ladies, how about shrugging and moving on now? In a sense, you're both right. I was raised to be courteous and respectful of others, by a mother who valued the truth above all and was very outspoken and by a father who also valued the truth but wouldn't say sh*t if his mouth was full of it. I think I've got some of each parent's traits in me, and at times I've felt pulled in 2 directions when trying to decide the "right" way to act in certain situations. So I can understand both your points of views. Monitoring and adjusting our interpersonal behavior and communication styles is just part of being an adult. It's one of the things that makes life interesting. We don't have to choose between A and B. We don't have to all hold hands and sing "koom-baya", nor do we have to all bash each other with heavy clubs of our personal convictions. We can choose A and B and still be true to our own beliefs. Being challenged to act differently than we normally would doesn't have to start a war. It can be a learning experience, and it doesn't have to threaten our entire world view. That's the way I see it, anyway, and I think I have the advantage of years of living over both of you little whippersnappers!

I revised from the band to the sleeve last year. I wrote about my experience on a thread yesterday: http://www.lapbandtalk.com/topic/163124-help-guys-band-or-sleeve-im-scheduled-for-band-feb1/ I had been at my goal weight for just over 4 years when my band was removed. I have excellent insurance, and it paid for my band removal in April 2012 and for my sleeve surgery in August 2012 because my surgeon's amazing insurance coordinator was able to use her skills and my medical records to prove that the surgeries were medically necessary. So if your band troubles have been well-documented (and surely a band slip and removal were well-documented), it's possible that your insurance will cover your sleeve even if you're no longer obese. Although I don't love my sleeve like I loved my band, I strongly believe that revision was the right thing for me to do because I knew I needed a surgical tool for lifetime weight management. I regained 30 lbs in the short time I was trying to wing it on my own. That is really scary, because I wasn't pigging out and eating stupid stuff (most of the time, anyway), and I was still exercising and generally a lot more active than I was when I was obese. Obesity is caused by our conscious eating behavior but also by factors that are outside our conscious control, like genetics, neurological and hormonal dysfunction, etc. etc. So however we lose weight (with or without WLS), weight management is a lifetime project. As for losing too much weight - I haven't seen that happen to a sleeve patient except for a friend who revised to the sleeve when she was at her goal weight, and then lost another 20 lbs she didn't need to lose. But part of her problem was the formation of strictures that made it hard for her to even drink Clear liquids, never mind eat real food. She had the strictures dilated and is doing much better now. Also, although the sleeve has micronutrient malabsorption, it doesn't (as far as we know) involve the macronutrient malabsorption that makes it so some calories consumed "don't count". If you can't eat much at one time, you can keep your calorie intake where it needs to be by adding healthy Snacks to your day. You might need to work with a nutritionist to do that effectively. I lost weight quickly after my sleeve surgery, so that for a while there I wondered if I was going to be able to stop losing weight, but my weight loss slowed because I was able to eat more (a normal consequence of the healing process) and because I was getting lighter so I needed fewer calories. I haven't lost any more weight in 3 weeks so I think I'm where I need to be. Good luck!

You've described what I call the Funhouse Mirror Effect. You can read an article about that here: http://www.lapbandtalk.com/page/index.html/_/support/the-funhouse-mirror-effect-r93 I got to my goal weight in September 2008 - almost 4-1/2 years ago - but my brain still has a hard time catching up with all the changes in my body. Sometimes I catch sight of my reflection in a window and think, "Wow, she looks really familiar. Where do I know her from?" and moments later realize that woman is me. Sometimes at work (full length mirrors everywhere you turn), I see myself in the mirror and think my reflection is a customer walking up to me. It's very startling, especially when I figure out it was an illusion. The mental and emotional WLS journey takes longer than the physical one. For me, anyway.

I've heard of band-over-bypass revisions, but not band-over-sleeve. You'd have to ask your own surgeon about whether the band is a viable option for a sleeve patient. I think it may depend on the size of the person's sleeve. Sleeve surgery removes 75-80% of the stomach, leaving a very small banana-shape stomach. The choice of sleeve size is up to the surgeon, based on the patient's unique anatomy and how much weight they need to lose. The stomach is sized using a bougie, which is a calibration tool shaped like a fat fountain pen. The surgeon passes the bougie through the esophagus and into the stomach, then staples the stomach along the edge of the bulge created by the bougie. After flushing the stomach with Fluid (I think saline) to make sure there are no leaks, the surgeon cuts off the excess stomach. My surgeon used a size 34fr bougie, which is 11.2 mm...only .44" in diameter. As the stomach heals from the surgery, swelling subsides, and time goes by, the stomach capacity may increase a bit, but still....it's less than 1/2 inch. It's hard for me to imagine how adding an adjustable gastric band could improve on that, but it's possible. Edited to add: Part of the band's appetite suppression is provided by its pressure against the vagus nerve in the stomach fundus (the curved portion at the top). The sleeve basically removes the greater curvature of the stomach including the fundus, and I don't know offhand how that affects the vagus nerve and its function. The more like revisional surgery for sleeve patients would be the duodenal switch, which is the most extreme WLS procedure done now. The sleeve started out as the first of a 2-step process for super morbidly obese patients whose health wasn't good enough for them to withstand both steps during one procedure. The switch part involves very drastic re-routing of the intestines, with extreme malabsorption that results in quick weight loss but is also associated with a lot of health problems. And it's no more a permanent cure for obesity than any other WLS procedure. I know a guy who lost something like 300 lbs with the duodenal switch and has regained almost 100 lbs. And he has some very serious medical issues related to his malabsorption. He's reluctant to have a revision to reduce the malabsorption, but since he's alreadty regained so much weight, he's afraid that a revision would send even more excess pounds his way. Revising a sleeve patient to some version of gastric bypass is probably possible, with less malabsorption and (perhaps) slower or less weight loss.

You are so right!

Getting cold feet before surgery day arrives is quite common, and so is "buyer's remorse" after surgery. You're contemplating a huge change in your life, and making the "right" WLS choice can be overwhelming. Sometimes I think that's aggravated by doing so much research online - you're overloaded with information and it all seems confusing. I've had both the band and the sleeve, so I'm uniquely qualified to respond to this thread. I'm going to quote from a post I made on a band-to-sleeve revision forum recently, but first I want to address a few specific things you said: For as many 'happy' band stories that I read about, I see as many or more disasters: slime, dumping (whatever that is), a lot of pain - Whether eating problems like sliming, stuck episodes, or PB's (food regurgitation) are a disaster is up to the individual. None of those events are life-threatening, so I don't consider them disasters. Unpleasant? Yes. Inconvenient? Yes. Painful? Sometimes. As painful as having your foot cut off? Probably not. We all have differing tolerance for pain. Edited to add: also, most of those side effects can be prevented with careful eating. Dumping syndrome results from rapid gastric emptying in sleeve and bypass patients because the stomach is too small to store and begin digesting food before the food hits the intestines. It causes a rapid rise in blood sugar levels that can cause nausea, vomiting, diarrhea, dizziness, lightheadedness, and a general feeling of being ill for about 30 minutes (in my case). Dumping is more likely to happen when you eat something high in sugar or refined starches, but can also result from eating too fast or overeating. I've never heard of it happening to a bandster, but I guess that's not impossible, especially if the bandster is diabetic and therefore more sensitive to blood sugar fluctuations because their pancreas can't keep up with the food being consumed and digested. slipping, having to get the band removed, etc. Almost all of these disaster people have said they needed WLS, and revised to the sleeve. Every one of them wished they had gone with the sleeve in the first place. I have a strong suspicion that they feel that way because their experience with the band was unhappy, not because the sleeve is intrinsically better than the band. When they had their band removed and revised to the sleeve, the euphoria they felt was a bit like the relief you feel when you stop banging your head against a wall. Now, as I said before, I've had both the band (which I loved) and the sleeve (which I don't love), so here's a summary of my experience so far: I was banded in September 2007. I lost 100% of my excess weight (90 lbs) in one year. I had a minor band slip (cured with a complete unfill and 6-week rest period) and a port flip (fixed with outpatient surgery) and loved my band. When it was properly adjusted, it drastically reduced both my physical hunger and my appetite (desire) for food. Food just did not taste as wonderful to me as it had in the bad old days. I also experienced the early and prolonged satiety that is the band's #1 claim to fame. Unfortunately, I lost my band in April 2012 because of damage from 20+ years of silent reflux, which my band may have been aggravating. My surgeon and gastro doc agreed that my band had to come out, so I opted to revise to the sleeve in the same procedure. That didn't happen because my surgeon couldn't pass the bougie (the sleeve "calibration" tool) through my esophagus because of an undiagnosed stricture, so I was bandless until my 2nd attempt on August 16, 2012. I had thought that the sleeve would be a good 2nd choice for me because I wasn't crazy about the malabsorption aspect of RNY or DS, because one of the best features of the sleeve is that the reduced stomach size drastically reduces production of the hunger hormone, grehlin, and because the idea of a surgery that wouldn't require fills to achieve optimal restriction was appealing. Unfortunately, it didn't work out that way for me. I am now ferociously hungry on an hourly basis no matter what, how much, or when I eat. I have to eat 8-10 times a day in order to keep my blood sugar steady. I've had to start taking metformin for my type 2 diabetes after easily managing it with diet and exercise for 7 years. I've discovered that sleeve patients can dump just like gastric bypass patients. It gives me miserable symptoms of nausea, dizziness, drenching sweats, and fatigue. That happens not just when I eat something with sugar in it but also when I eat so-called healthy foods (Protein bars, milk, cottage cheese, yogurt, Protein shakes, most fruits). I've become anemic and have to take an Iron supplement twice a day in order to give me enough energy to function. Turns out that micronutrient malabsorption isn't unique to RNY & DS patients. Also, since my sleeve surgery I've developed a gastric bleed. When doing an EGD to locate the source of the bleed, my gastro doc discovered a gastric polyp (probably the cause of the bleeding) and duodenitis (inflammation of the duodenum), neither of which were present when I had an EGD 3 months before my sleeve surgery. Finally, I've discovered that sleeve patients can have "stuck" episodes just like bandsters do, and for the same reasons (in my case, careless eating). I'm not able to be objective about my sleeve at this point, and at 5 months post-op, it's probably too early for me to decide it was a mistake. But even if I decide it was a mistake, I'm never going to get that missing chunk of stomach back. It's gone forever. I do know that I absolutely refuse to go back to the land of obesity, and I'm grateful that my sleeve has helped me avoid that. I've lost the 30 lbs I had regained after losing my sleeve, and that is wonderful thing. One difference between my band surgery and my sleeve surgery is that my sleeve surgery was much harder to recover from. My surgeon says that any revision surgery is difficult because she's not operating on a "virgin" belly. I thought that the slow recovery was due to my age (59) because an older friend (age 61) who revised to the sleeve at the same time also found it difficult, but I met a younger woman (mid 30's) in my surgeon's waiting room whose sleeve was her 1st (and we hope last) WLS was also finding it difficult. I think the length and ease of recovery is also related to the patient's age (I'm 59), pain tolerance, general health, and amount of time spent under general anesthesia. My surgeon keeps band patients overnight in the hospital for one night, and sleeve and RNY patients for 2 or more nights. I hate being in the hospital but I was a mess even after 2 nights there. After my band surgery, I felt fine after one night in the hospital and was bored and restless and ready to go back to work (I worked at home then) within 3-4 days. After my sleeve surgery, just lifting a glass of Water to my lips was a struggle. I needed the whole 3 weeks my surgeon insisted on off work, and even then I was dragging. The other thing I want to say is that while my food capacity now is small (depending on the consistency of the food), my desire for and enjoyment of food is like it was before my band surgery. I feel like I get way, way too much pleasure out of eating. I believe that food tastes good for a reason (to keep us eating enough to survive and perpetuate the species), but that extreme enjoyment is a very mixed blessing. I constantly have to fight with myself to not take another bite so as to prolong the pleasure of eating. With my (adjusted) band, I did have some intrusive food thoughts, but nothing like it was in the bad old days. Well, the bad old days are back now. I think about food far too often for the good of my weight management. I wish I had a happier story to report. I've been told that I'm not trying hard enough to like my sleeve because I loved my band. That may be true, but I sincerely wanted the sleeve and sincerely wanted it to work. I know plenty of ex-bandsters who love their sleeves. Ask me again in a year or so, and I may be waving the sleeve banner. And as the advertising hacks would say, "Your mileage may vary." Jean

Me, too. I think that's true of a lot of obese people, because we've been seeing, hearing, and feeling criticism from others for a long time, and because we tend to handle that stuff by eating rather than by reacting with anger.

Please don't be put off by some of the responses to your post. I don't think we have enough information about you (yet) to assume that you've been making poor food choices, not practicing good eating skills, tolerating side effects, etc. I do hope you've been to (or will be in the near future) talk with your surgeon about what's been happening. You might just need a slight unfill to make it possible for you to eat healthy, solid food without uncomfortable side effects. Having said all that, I also have to say that it's way too soon in your WLS journey to give up on your band and (more importantly) yourself. In the meantime, my best advice to you is to follow a liquid diet for 24 hours after each stuck episode or other eating problem. That will give your irritated esophagus & stomach time to calm down so you're less likely to have a similar problem the next time you try to eat.

Yeah, the strays do tend to find us, don't they? My husband says that the neighborhood dogs are sending out pee-mails about the nice accommodations at our place. Dr. Sewell's book is absolutely the best and most thorough (aside from Bandwagon) that I've read. You'll make yourself crazy trying to reconcile the differing advice given or published by different bariatric surgeons. The it's-OK-to-drink-while-eating thing is relatively new, but gaining ground in Australia. My original surgeon didn't forbid Snacks between meals. In fact, his dietitian's meal plan included 3 snacks and 3 meals a day. Small ones, of course. My current surgeon forbids bandsters to snack but allows it for other patients. My personal opinion is that if your total daily caloric intake doesn't increase when you add planned, healthy snacks, I have a hard time believing that snacking is harmful. My endocrinologist has confirmed that snacking that way helps keep blood sugar levels steadier, and that in itself helps to manage hunger (even if you're not diabetic). Finally, if I had been forbidden to snack when I was banded, I would have been too hungry come mealtime to make good food choices, practice good band eating skills, and avoid overeating. Edited to Add: Whatever else we believe about the effect of consuming liquids and solids at the same time, I do know that drinking while eating was a bad idea for most of my banded life because when my stoma was busy dealing with solid food, the liquid couldn't drain into my lower stomach and instead backed up my esophagus and spewed out my mouth. Not a good thing.

A prolapse is a kind of band slip. Sometimes it can be treated with a complete unfill, sometimes the band can be repositioned or replaced, and sometimes it just needs to come out. I'm not sure how your surgeon could diagnose a prolapse via upper endoscopy, since that justs shows the inside of your upper GI tract. I've barium swallow x-rays (upper GI studies) done to check the position of the band and condition of my esophagus and stomach. When I had a bad esophageal dilation about a year ago, I first had an upper endoscopy that didn't show dilation at all. I had to insist on a barium swallow, which did show the dilation. I had a complete unfill, and that resolved the dilation. I think the longer you leave the problem untreated, the harder it is to resolve, so whatever the final outcome of this is, it seems to me that a complete unfill would be a smart first step for you. I can remember one bandster who had surgery to reposition a slipped band (her original surgeon was a quack) and ended up revising to the sleeve eventually because of more band-related problems. I hope that's not how your story turns out. When you say you don't have medical insurance, do you mean no insurance at all, or do you mean that your current insurance doesn't cover WLS? If it's the latter, I'd give the insurance folks a call and ask about coverage of corrective surgery, because I've heard of self-pay WLS patients whose insurance did cover corrective surgery (if not revision to a different WLS procedure) because the problem was a threat to their general health. Good luck!

Just don't burn your bridges with the old surgeon until after you've found a new one, if it comes to that.

I've never heard of any band coming pre-filled right out of the package. I'd be irritated with your surgeon too. I have to wonder if he or someone else messed up your fill records somewhere along the way. For example: a local acquaintance (banded in 2007) thought she had a 4 cc band and was puzzled because seemingly aggressive fills made no difference to her restriction. Then suddenly some OR notes showed up in her file and the NP who did the fills admitted that she actually had a 10 cc band. I've also heard of fills that didn't get recorded in the patient file at all, fills whose amount was illegible in the handwritten file, fills that missed the port altogether... It's hard to trust medical professionals when something like that happens. Apparently surgeons are human, just like the rest of us, whether they care to admit it or not.

What's the title of the 4-yr-old book you bought? I wouldn't discount the contents just because it's 4 years old. It's true that band knowledge is continually growing and changing, but I can tell you from personal experience that publishing an updated book version every year is a pain in the butt!

WHAT DOES PATIENT COMPLIANCE MEAN? The term “patient compliance” is a funny one for someone like me, who in some areas of her life doesn’t have the patience required for compliance. Maybe that’s just my funny little brain playing with words again. What does patient compliance mean? A compliant patient is one who follows or completes with their physician’s diagnostic, treatment, or preventive procedure(s). For example, John Doe’s blood work shows high LDL cholesterol and triglycerides (diagnosis: hyperlipidemia). He’s a compliant patient because he faithfully takes the medication his doctor prescribed, avoids eating saturated fats, and increases his exercise in order to lose some weight. His mother-in-law has high blood pressure (hypertension) and is recovering from a stroke, so in order to prevent the medical problems that challenge her mom, John’s wife Jane follows her doctor’s recommendation to reduce her own salt intake and join John for a daily walk. Their obese son Mark, who is scheduled to have bariatric surgery in two weeks, is compliant as he carefully follows his surgeon’s pre-op liver shrink diet to prepare for the surgery. Their sun-worshipping daughter Mary just had a suspicious mole removed and complies with her dermatologist’s recommendation to use sunscreen every day and give up the tanning bed. A highly commendable family, aren’t they? What about you? Are you a compliant patient? All the time, some of the time, or none of the time? Compliance is a practice that matters to me…does it matter to you? BARIATRIC PATIENT COMPLIANCE Most bariatric surgeons agree that the #1 cause of disappointing weight loss or other WLS “failure” is patient non-compliance with the surgeon’s protocol. In contrast, many adjustable gastric band patients (the disappointed ones, anyway) agree that the #1 cause of band “failure” (however they experience it) is that the band doesn’t work, no matter what (if any) protocol you follow. How can we reconcile such opposite views of WLS failure? What can surgeons do better or differently to improve patient outcomes? We already know what patient compliance means, so let’s take a look at the term “protocol.” In a general sense, protocol is a set of conventional principles and expectations that are considered binding on the members of a particular group, be it professional, social, or political. It’s also the formal etiquette and code of behavior, precedence, and procedure for state and diplomatic ceremonies. Protocol is a big deal to the British Royal Family, as witnessed by the flutter over the Queen’s order that Kate, the Dutchess of Cambridge must, as a former commoner, show reverence to the ‘blood princesses’. She is expected to curtsey to those born royal, such as Princesses Beatrice and Eugenie – both in public and in private. Although the media did a lot of speculating about Kate’s putative humiliation over this order, the importance of royal protocol can hardly be a surprise to a British citizen who marries into the Royal Family. In the medical world, the term protocol refers to the plan for a course of treatment – a physician’s diagnostic, treatment, or preventive procedure(s) like those followed by John Doe and his family. And like Kate Middleton, a bariatric patient can hardly be surprised over their surgeon’s insistence that they follow that protocol. Any surgeon worth his/her scalpel educates patients about that protocol from the time of an informational seminar to the day of a band patient’s first fill, with updates as time goes on. That’s why I feel impatient when I hear (very, very often) that new bandsters are shocked and vexed over the requirement that they follow a liquid diet immediately before and after their surgery, as well as after fills. “How can that possibly be a shock?” I ask myself. Did the patient sleep through their pre-op education, or were they so focused on the vision of themselves in a size 0 that they forgot the work that must be done to arrive at that size? Or (please say it ain’t so!) did the surgeon or other medical professionals in that bariatric program not spell out the details of their protocol when the patient was preparing for surgery? And then there’s the whole “Why does my surgeon say eat only ½ cup of food when my friend’s surgeon says eat 1 cup of food at a time?” dilemma. As I explained in Bandwagon, surgeons establish (and fine tune) patient protocols based on their own experience with their own patient population. If band manufacturers hired teams of auditors to ensure that every bariatric surgeon in North America used the exact same protocol, no one would be able to afford a gastric band, and very few surgeons would bother using the band for their patients. And a brand-new gastric band sitting in its package is completely useless until a trained and experienced surgeon implants it in a patient. Allergan and Ethicon Endo aren’t surgeons; they’re manufacturers of medical devices. So while speculating about the great variation in WLS protocols might be mildly entertaining, it’s not going to do a whole lot to get you closer to that size 0. If you choose a surgeon you trust and respect, you also choose to abide by their protocol, and enjoying that protocol is beside the point. I spent decades enjoying my own weight loss and weight gain “protocols” so much that by the time I was 54, I needed weight loss surgery. So whose protocol is healthier or more effective, mine or my surgeon’s? I lost 92 pounds by following a surgeon’s protocol. Is there a problem with that? I think not. OK, hang on a second while I climb off my soap-box. Ah, that’s better. Here I am again, standing on the ground, surrounded by living, breathing (if distant) WLS patients. It’s not fair to generalize about any of us, is it? But generalize I must in order to make a few more points. THE DOUBTING THOMAS I think some of us are by nature more likely to ignore, question, or defy authority figures, while others accept authority without voicing or even thinking a question. In the former case, we need to cultivate trust in the doctors who want to help us, while in the latter case, we need to cultivate enough trust in ourselves to dare to ask those authority figures for better or more detailed explanations of their instructions. I’m more on the defiant, or Doubting Thomas, end of the patient spectrum, but a few years ago I read a statement that struck me (out of the blue) as very true: SOME THINGS MUST BE BELIEVED TO BE SEEN I extrapolated that statement from a religious context into the context of my WLS journey (at that point in my life, I could extrapolate almost anything into the context of my WLS journey). When I had Lap-Band® surgery, I was convinced that I was a total failure at weight loss. Going into that operating room, I had to believe something I’d never seen myself do: that with the help of my band, I could succeed at weight loss and maintenance. And I did. Because truth can take a while to reveal itself, I think people like me need to ask ourselves, “What possible harm could befall me if I do follow an instruction whose proof of efficacy I can’t see right now?” Let’s go back to a previous example: your doctor tells you not to eat more than 1 cup of food at a time. You know you can easily eat 2 cups, so if you really want (or think you need) to eat all that, and no immediate negative consequences result from doing that, why shouldn’t you just go ahead and do it? Why should you blindly follow your doctor’s seemingly arbitrary and unreasonable instruction to stop eating after you’ve consumed 1 cup of food? It’s your doctor’s job to explain the “why” behind that instruction, but if she/he hasn’t done that to your satisfaction, and he/she isn’t sitting at the table with you and that plate of delicious food, I suggest that you consider what terrible thing would happen if you put away the extra cup of food for now. Will you starve to death? Really? What else might happen? Will you surrender your liberty, be forced to vote for your doctor’s favorite presidential candidate, or (worse) be compelled to clean his toilet every Saturday for the next 20 years? Oh, no. No, no, no. He’s your doctor, not your teenaged son, so let’s consider another, quite serious consequence of following his instruction. Maybe, just maybe, nothing bad will happen at all. Maybe even something good will happen. Just because your compliance doesn’t yield an instant reward doesn’t mean it won’t yield a future reward. What might that reward be? How about weight loss and the avoidance of side effects or complications? Doesn’t that sound good to you? Sure sounds good to me. I do much better at following instructions if I understand them, but I’m here to tell you that in almost 5 years of banded living, I didn’t truly begin understand my surgeon’s and dietitian’s protocol until I’d been following it for 6 or so months, and the scope of my comprehension expanded more over the next few years. In the meantime, I lost those 92 pounds I mentioned earlier. The lesson there is that you don’t have to completely understand or believe in a protocol for it to work, as long as you follow it as best you can. THE BELIEVER Now I want to talk to the folks at the other end of the patient spectrum, the obedient ones who wouldn’t even think of defying the advice of an authority figure. Their WLS journey can be bumpy too, even when they slavishly follow their doctor’s protocol, and here’s why. One of the problems with blindly following instructions that you don’t understand is that sooner or later you’re going to find yourself in a situation no one thought to warn you about. You won’t instantly know what to do, and you may waste precious time on unnecessary blood, sweat and tears. You may even end up doing something harmful. Without at least an inkling of the principles behind your doctor’s protocol, you’ll have a hard time coming up with a stopgap measure to help you survive a surprising and stressful situation. If you worry that any decision you make on your own will be the wrong one, ask yourself: “What’s the worst that could happen if I do nothing right now? What will happen if I do the ‘wrong’ thing?” Will you die? Surely not. If you’re able to breathe, ambulate, drink water, state your name and what year it is, and blood isn’t pooling in your shoes, you’re going to survive at least long enough to call your surgeon, leave a message, and wait for a call back. So unless the decision requires someone to dial 911 to speed you to the emergency room (if you can’t breathe, move, swallow, talk, remember your name or the year, stop the bleeding, or if something else life-threatening is happening), take a deep breath! And another one, and another one. Ah, that’s better! People on the Believer end of the patient spectrum are often reluctant to ask questions of their doctors because they’re afraid they’ll look stupid or make the doctor angry. I can only repeat the old saying that the only stupid question is the one you think but don’t ask. It’s extremely unlikely that your doctor is going to spank you if you ask (again), “Why can’t I take ibuprofen for my headache?” If your doctor seems irritated by a question like that, it may be because you’re trying their patience, or it could be because they’re having a bad day (worried or annoyed about something completely unrelated to you or their job, wishing they hadn’t eaten the whole pastrami sandwich for lunch, didn’t sleep well last night, etc.). It could also be because their bedside manner needs work. If that’s the case, you can set out in search of another surgeon, put up with the original surgeon’s rudeness, or do your part to lead that doctor towards kindness. If the answer to your question starts looking like a time-consuming project that your doctor doesn’t have time for right now, it’s perfectly okay to say something like, “Is there someone else in the office who could work with me on that?” or “Would it be better to make another appointment to talk about this?” THE DOCTOR Doctors, like other people, come in all shapes, sizes, and temperaments, and with varying communication skills. They’re not all made from the eternally patient, smiling, avuncular Marcus Welby mold, and not all of them are motivated solely by the desire to help other people. They’re often just as fascinated by science as by altruism. Like you and me, they work to earn money, and if their pay seems ridiculously high, just ask one of them how much money they borrowed to get through medical school, and how much they pay each year just for medical malpractice insurance. In many ways, I’m a “you get what you pay for” kinda gal. If 3 doctors quoted band surgery at a total of $13,000 to $15,000, and a 4th doctor quoted only $4,000, I’m not sure I’d feel safe with a bargain basement surgeon (nor would I assume that the $15,000 surgeon was the best). Last I heard, no courses in Bedside Manner or patient communication are required of, or even offered to medical students. Doctors must exchange important information with patients whose own communication skills vary greatly, and they must take a patient’s measure, choose a treatment plan, and explain it to the patient using a minimum of enigmatic medical terms, all within a matter of minutes before they rush off to the next patient or task. Doctors must rely on support staff to do hundreds of things to keep the doctor’s boat afloat, and it’s entirely possible that they have no idea how rude or careless or wonderful some of those people are because so much of that goes on in a way that’s invisible to the doctor. And which would you rather your surgeon focus on: the ink cartridge for the Xerox machine, or the pain in your abdomen? In medical folklore, surgeons are infamous for possessing a God complex, with big egos, enormous self-confidence, and an excess of superiority. When you think about it, it does take a lot of chutzpah to cut into another human’s flesh and fiddle with their innards in the effort to fix a problem., so it doesn’t surprise or bother me much that some surgeons have a hard time coming down to the lowly level (perceived or real) where their patients trudge through the mud of ordinary human existence. In many types of surgery, that’s not a big problem because the surgeon sees the patient maybe 3 or 4 times: the initial consult, the surgery, and 1 or 2 post-op follow-ups. Then the patient goes on their merry (we hope) way and the surgeon scrubs up and dashes into the operating room to cut into someone else’s medical problem. General surgery is usually a fix-it-and-go thing. If your diseased gall bladder gets tossed away and forgotten, do you really care if that also means your abdominal pain is also a thing of the past? But bariatric surgery, which treats a chronic and incurable disease that’s a highly complex tangle of physical, behavioral, and emotional problems, is a different matter. Successful bariatric surgery is not a fix-it-and-go proposition (and that’s reason #99 that I would hesitate to ever have surgery outside the United States, knowing that I have no local surgical back-up or support). Bariatric patients need far more education, aftercare and support than most other types of patients. I’m convinced that one of the causes of WLS failure (however you define failure) is inadequate patient education, aftercare and support. And on top of that, adjustable gastric band patients need even more education, aftercare, and support than most other bariatric patients. While I believe that too many general surgeons have been jumping on the gastric band-wagon without fully understanding the needs of those patients, it’s not fair to say that they’re all being careless or negligent when they fail to give patients what they really need. Unless they’ve had bariatric surgery themselves, they just don’t know what it is to walk in our shoes. They might consider the implanting of a gastric band to be an interesting and possibly lucrative addition to their practice without realizing that surgical expertise is only part of what the band patient needs. Doctors and other people with very high self-esteem can be hard for us ordinary mortals to deal with, but it’s a mistake to assume that they’re looking down on us. They may not be looking at or thinking about us at all, not because they don’t care about us but because their minds are so enthralled by and preoccupied with medical science. My father was a brilliant scientist whose head was so far up in the clouds that I often wondered what planet he was on. At the same time, I know he loved me when he noticed me (and I know now that nothing I could do would change that). In a sense, doctors who get heavily involved with their patients are doing those patients a disservice. The Hippocratic Oath exhorts doctors to “do no harm,” not to mop up your tears or hug you when things go wrong. If that seems harsh, consider this: doctors actually need to keep some emotional distance from their patients in order to treat them well medically. Without that distance, it would be very hard for them to make rational decisions about patient care. That’s why it’s considered poor practice for doctors to treat themselves or their loved ones. I’m not saying that it’s okay for doctors to be cold and heartless and should be excused for bad behavior. None of them are perfect (and neither are we, the patients) and you won’t find me worshipping at the altar of the AMA or the ASMBS. I’ve encountered some wonderful doctors and surgeons in my lifetime, and some bad ones too. The average American bandster might see 3-4 doctors on a regular basis (a few times a year): a primary care physician, a gynecologist (if you’re of that persuasion), a dentist, and maybe a chiropractor or a specialist like an eye doctor. The average American bariatric surgeon probably sees 20-30 patients a day (perhaps a few thousand per year). Since I’m not a mind-reader, and no one cares as much about my weight loss journey as much as I do, I figure it’s my responsibility to refresh my doctors’ memories each time I see them. I might wish that I didn’t have to repeat over and over again that (for example) I’m hearing impaired and need my doctor to look at me when he speaks, but that’s a minor issue compared to some of the bigger ones I face as a mature adult.

Sometimes a good cry is just what the doctor would've ordered if he/she had only thought of it. I'm glad your WW group responded well to your meltdown. We all need lots of support in our fight against obesity, no matter how we choose to lose the weight. Congrats on getting the insurance OK for the surgery. February 1st will be here before you know it!

Well said!

I'd like to tell you to forget what that person said, but I've been cyber-stalked for almost 5 years by a sick person I met on a WLS support site and I'm not able to easily shake that kind of thing off. It's scary. I guess my best advice for you is to use the block feature and remember that you are well loved and well respected by many members of LBT.

OK, here's my speech. My background: I lost 100% of my excess weight with my band but had to have it removed at 4-1/2 yrs post-op because of problems caused by a 20+ year history of silent reflux that apparently my band was aggravating. A few months later, I revised to the sleeve and since then have lost the weight I regained after losing my band. So I'm speaking from personal experience with both WLS procedures. My opinion is that slow weight loss is not a good enough reason to remove your band unless you have very serious comorbidities that need to be resolved quickly. Aside from that consideration, additional surgery is probably riskier to you than the sIow weight loss. That's because all surgeries of all descriptions are risky. I won't quiz you on whether or not you've done your part to lose weight. You must've been doing something right to lose the 30 lbs. Your slow weight loss could be due to a dozen things, some of them not within your control. My greater concern for you is that you haven't been able to tolerate fills because of reflux. I've encountered quite a few bandsters who had the same problem and eventually revised to a different WLS procedure because of it. Medically, that makes sense to me, because reflux can cause serious damage to the esophagus and stomach. Remember what I said about needing my band removed? It's because decades of reflux had caused esophageal stenosis (thickening of the walls) and dysmotility (my esophagus couldn't move food down into my stomach very well). According to 2 gastro docs who treated me earlier this year, those problems can eventually cause serious malnutrition because the patient can hardly even swallow Protein shakes. Also, reflux can lead to a pre-cancerous condition called Barretts Esophagus. So I'm glad your surgeon is taking your reflux seriously. Is the sleeve a good option for you? Maybe, maybe not. Before you roll into an operating room for that procedure, you need to know that reflux is extremely common in sleeve patients. The ones who had before surgery find it's a LOT worse afterward, and most of us need to take meds for it (I take omeprazole) indefinitely. Some find that even the meds don't control it. I thought that the sleeve would be a good 2nd choice for me because I wasn't crazy about the malabsorption aspect of gastric bypass surgery, because one of the best features of the sleeve is that the reduced stomach size drastically reduces production of the hunger hormone, grehlin, and because the idea of a surgery that wouldn't require fills to achieve optimal restriction was appealing. Unfortunately, it didn't work out that way for me. I am now ferociously hungry on an hourly basis no matter what, how much, or when I eat. I have to eat 8-10 times a day in order to keep my blood sugar steady. I've had to start taking metformin for my type 2 diabetes after easily managing it with diet and exercise for 7 years. I've discovered that sleeve patients can dump just like gastric bypass patients because the small sleeve can't hold food for long and therefore "dumps" it quickly into the intestines, causing miserable symptoms of nausea, dizziness, drenching sweats, fatigue. That happens not just when I eat something with sugar in it but also when I eat so-called healthy foods (protein bars, milk, cottage cheese, yogurt, Protein Shakes, most fruits). I've become anemic and have to take an Iron supplement twice a day in order to give me enough energy to function. Turns out that micronutrient malabsorption isn't unique to gastric bypass and duodenal switch patients. Also, since my sleeve surgery I've developed a gastric bleed. When doing an EGD to locate the source of the bleed, my gastro doc discovered a gastric polyp (probably the cause of the bleeding) and duodenitis (inflammation of the duodenum), neither of which were present when I had an EGD 3 months before my sleeve surgery. Finally, I've discovered that sleeve patients can have "stuck" episodes just like bandsters do, and for the same reasons (in my case, careless eating). I'm not able to be objective about my sleeve at this point, and at 4 months post-op, it's probably too early for me to decide it was a mistake. But even if I decide it was a mistake, I'm never going to get that missing chunk of stomach back. It's gone forever. I do know that I absolutely refuse to go back to the land of obesity, and I'm grateful that my sleeve has helped me avoid that. My main reason for telling you all this is to warn you that there is no such thing as a risk-free, effective WLS tool. Every surgery has side effects, risks, and lifestyle effects to consider. It is always OK to quiz your surgeon about those issues, and if he/she doesn't respond to your satisfaction, I think you need to get a 2nd opinion. Good luck! Jean