Jean McMillan

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. 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!

Keep in mind that long term weight loss success depends as much on patient compliance (including careful food choices and eating skills, portion control, consistency with aftercare, resisting emotional and other non-physical eating cues) as it does on the surgical procedure. As I told you on another thread, I think you need to choose the procedure that seems best suited to your weight loss and lifestyle needs. I have the sleeve now and it is much harder to live with than my band was. For me, its only advantage over the band is that it doesn't require fills. Since I never found getting fills to be a terrible burden, I'm hard-pressed now to think of something else nice to say about it, so I'll be on my way now.

The adjustable gastric band (Lap-Band or Realize Band) is not all that new any more. The Lap-Band has been approved for use in the USA since 2001, the Realize Band since 2007, and other brands of bands have been used in the rest of the world since the 1980's. I had a band slip (resolved with a complete unfill) and a port flip (corrected with surgery), but I loved my band. You're correct that band surgery is reversible, though I wouldn't recommend doing that unless it was to treat a complication. Just because it's reversible doesn't mean that the band is easy to remove. RNY (gastric bypass) is also reversible, though not easily. VSG (vertical sleeve gastrectomy) is not reversible, and only the "switch" part of DS (duodenal switch) is reversible. Good luck with your decision. It's good that you're doing research. I suggest thatyou carefully weigh what other bariatric patients and a bariatric surgeon tell you, and pick the procedure that feels right for you, to meet your weight loss needs and your post-op lifestyle. Jean

I've been banded and sleeved, but I haven't had both at the same time. But I agree with Elcee, and I think that first, you need to discuss your weight plateau with your surgeon and dietitian.

Can greater eating satisfaction lead to greater weight loss? I CAN’T GET NO! We all want satisfaction, don’t we, in everything we do or experience. As Americans, we consider satisfaction part of our birthright. But does weight loss success require us to eat dull, flavorless food for the rest of our lives? The British want satisfaction too. In 1965, Mick Jagger and the Rolling Stones recorded a song that (among others) I just could not get out of my impressionable 12-year-old head. The first verse is: Can't get no satisfaction I can't get no satisfaction 'Cause I try and I try and I try and I try I can't get no, I can't get no As song lyrics go, that's pretty inane, but as far as I know, Mick Jagger has never claimed to be a poet or intellectual. I now suspect (as I did at age 12) that Satisfaction has a sexual ("I can't get no girlie action") as well as a political theme. Today I'm going to use what you might call my artistic license (that I got by sending an application and $75 to the International Artistic Vehicle Department) and drive Mick Jagger's car down a new road. THE SATISFACTION FACTOR In their book titled Intuitive Eating, authors Tribole & Resch tell us that to overcome our eating problems, we must discover the satisfaction factor. They write: "The Japanese have the wisdom to promote pleasure as one of their goals of healthy living. In our fury to be thin and healthy, we often overlook one of the most basic gifts of existence--the pleasure and satisfaction that can be found in the eating experience. When you eat what you really want, in an environment that is inviting and conducive, the pleasure you derive will be a powerful force in helping you feel satisfied and content. By providing this experience for yourself, you will find that it takes much less food to decide you've had 'enough'. In many ways, I think Tribole & Resch are on target. My weight loss surgery has forced me to take tiny bites, chew very well, and get every molecule of flavor and pleasure out of each mouthful of food, and as a result, I do get a lot more satisfaction out of my meals now. That’s one of the wonderful things about my post-op experience. If you told me that all I could eat for the rest of my life is stale crackers and lukewarm water, I’d be off my bandwagon in one swift leap. But can eating for the satisfaction factor really overcome my eating problems and make them a distant memory? I don't think I overlooked the pleasure and satisfaction from eating back in the bad old days. Rather, I sought it in the wrong places and gave myself such massive daily overdoses of food that it lost its power to please even while it gained more power to drive me. Kind of like an addict needing bigger and bigger doses of a drug to get that precious high feeling: an addict whose hunger for that high drives him or her to a life of crime. I never committed a crime for the sake of food, but otherwise I behaved like an addict. I was ashamed of my food issues and eating behaviors and worked to keep them secret even while even a casual observer could see just from my size and shape that something in me had gone off its track a long time ago. One of the reasons I wanted to hide my food problems was my fear of being judged by others. I don't think I was being paranoid. Even now, I have (slim) acquaintances who react to obesity in others as if it's an awful, shameful crime instead of a chronic disease. They see a super morbidly obese woman heaving herself out of the motorized shopping cart at Wal-Mart and whisper, "How could she let herself get that way?" Well, those “normal” acquaintances (and many others) just don't know the "how" of obesity, do they? But we do. The sight of that obese woman bothers me, too, because I know far too much about what her life must be like, and I'm filled with compassion and pity and frustration when I watch her struggle to reach a package of Double Stuff Oreo cookies on the supermarket shelf. The sight of that obese woman in a motorized shopping cart, and the overfeeding of America is a hot political topic now, but I hate politics, so I’ll pass up that aspect of obesity for now, and just suggest that you give some thought to whether your own healing should involve “becoming normal,” and whether or not WLS will send you down that road and keep you on track for the rest of your life. Me? I feel that I can’t afford to ignore my past as an “abnormal,” obese person, because of that short, fat blonde girl who lurks inside me, just waiting to get out. What do you think?

I CAN’T GET NO! We all want satisfaction, don’t we, in everything we do or experience. As Americans, we consider satisfaction part of our birthright. But does weight loss success require us to eat dull, flavorless food for the rest of our lives? The British want satisfaction too. In 1965, Mick Jagger and the Rolling Stones recorded a song that (among others) I just could not get out of my impressionable 12-year-old head. The first verse is: Can't get no satisfaction I can't get no satisfaction 'Cause I try and I try and I try and I try I can't get no, I can't get no As song lyrics go, that's pretty inane, but as far as I know, Mick Jagger has never claimed to be a poet or intellectual. I now suspect (as I did at age 12) that Satisfaction has a sexual ("I can't get no girlie action") as well as a political theme. Today I'm going to use what you might call my artistic license (that I got by sending an application and $75 to the International Artistic Vehicle Department) and drive Mick Jagger's car down a new road. THE SATISFACTION FACTOR In their book titled Intuitive Eating, authors Tribole & Resch tell us that to overcome our eating problems, we must discover the satisfaction factor. They write: "The Japanese have the wisdom to promote pleasure as one of their goals of healthy living. In our fury to be thin and healthy, we often overlook one of the most basic gifts of existence--the pleasure and satisfaction that can be found in the eating experience. When you eat what you really want, in an environment that is inviting and conducive, the pleasure you derive will be a powerful force in helping you feel satisfied and content. By providing this experience for yourself, you will find that it takes much less food to decide you've had 'enough'. In many ways, I think Tribole & Resch are on target. My weight loss surgery has forced me to take tiny bites, chew very well, and get every molecule of flavor and pleasure out of each mouthful of food, and as a result, I do get a lot more satisfaction out of my meals now. That’s one of the wonderful things about my post-op experience. If you told me that all I could eat for the rest of my life is stale crackers and lukewarm water, I’d be off my bandwagon in one swift leap. But can eating for the satisfaction factor really overcome my eating problems and make them a distant memory? I don't think I overlooked the pleasure and satisfaction from eating back in the bad old days. Rather, I sought it in the wrong places and gave myself such massive daily overdoses of food that it lost its power to please even while it gained more power to drive me. Kind of like an addict needing bigger and bigger doses of a drug to get that precious high feeling: an addict whose hunger for that high drives him or her to a life of crime. I never committed a crime for the sake of food, but otherwise I behaved like an addict. I was ashamed of my food issues and eating behaviors and worked to keep them secret even while even a casual observer could see just from my size and shape that something in me had gone off its track a long time ago. One of the reasons I wanted to hide my food problems was my fear of being judged by others. I don't think I was being paranoid. Even now, I have (slim) acquaintances who react to obesity in others as if it's an awful, shameful crime instead of a chronic disease. They see a super morbidly obese woman heaving herself out of the motorized shopping cart at Wal-Mart and whisper, "How could she let herself get that way?" Well, those “normal” acquaintances (and many others) just don't know the "how" of obesity, do they? But we do. The sight of that obese woman bothers me, too, because I know far too much about what her life must be like, and I'm filled with compassion and pity and frustration when I watch her struggle to reach a package of Double Stuff Oreo cookies on the supermarket shelf. The sight of that obese woman in a motorized shopping cart, and the overfeeding of America is a hot political topic now, but I hate politics, so I’ll pass up that aspect of obesity for now, and just suggest that you give some thought to whether your own healing should involve “becoming normal,” and whether or not WLS will send you down that road and keep you on track for the rest of your life. Me? I feel that I can’t afford to ignore my past as an “abnormal,” obese person, because of that short, fat blonde girl who lurks inside me, just waiting to get out. What do you think?

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!

Great topic! Some of my favorite NSV's are: I can cross my legs; I can shop for clothes in regular size departments/stores; I don't have to use the handicapped stall in public restrooms; there's plenty of room in airplane and theater seats now; I can sit on the floor and get up again without needing a crane to lift me; I wore a bathing suit in public while on vacation; I bought my first short skirt in 30 years and even wear it in public; people I tell about my weight loss say, "I never would have guessed you were ever that big."

Can you talk to your doctor in a way that makes your needs clear and that helps you understand what you need to do to take care of them? LET ME MAKE THIS PERFECTLY CLEAR… Or maybe not so perfectly. How about adequately? It should come as no surprise when I tell you that I love languages, especially English. My mother was an English teacher who once told me she'd rather I become a streetwalker than misuse the English language. I'm sure I'd have earned a whole other maternal lecture if I had become a streetwalker, but Mom's insistence on clear written and spoken communication was one of her greatest gifts to me, not just in my writing but also in my business career and social relationships. Despite all that, I've had many frustrating encounters with other English speakers who couldn't seem to grasp my meaning no matter how plainly I felt I had expressed it. That's because effective communication involves more than facility with words. This truth came home to be during a lengthy, complicated business negotiation with the owner of a Japanese manufacturing company from which my employer bought steel components. Mr. Hota brought his own translator, but I suspected that he understood a fair amount of English because he sometimes replied to me (in Japanese) before his translator had begun to translate what I'd said. Mr. Hota was calm, his face perfectly blank, he spoke no English, and I spoke no Japanese; we met in my company's conference room, not his; and yet somehow he was gaining the upper hand in a negotiation worth $3 million. When I told my boss, "I can't communicate with Mr. Hota," he said, "Yes, you can, but not necessarily with words." Communication can be difficult even amongst people who share a native tongue, be it English, Japanese, or Urdu, with results that range from comical to frustrating. When the other person is your doctor and 5 minutes of his/her time cost $200-$300, and your own most puzzling questions or symptoms are the topic of discussion, frustration can turn to fury. But what do you do with that fury? The doctor is an authority figure, an expert whose advice or care you urgently need. You could say, "That's it. I'm outta here!" and flounce out of the office. If the doctor were an automobile mechanic, it probably wouldn't be too difficult to find another mechanic to help you, but finding another doctor who's qualified, accepts your insurance plan, is taking new patients, and can give you an appointment sometime in the next decade….? That's not so easy. WHERE DO WE GO WRONG? Because of my interest in communication and my part-time retail job, I could tell you dozens of stories about communication problems. While I began this article complaining about people who can't seem to understand even the simplest sentence I utter, I could also complain about people who can't seem to make me understand the sentences that they utter. The fact that I'm hearing-impaired makes clear communication all the harder, but I can provide living, breathing witnesses to some of the funny and frustrating encounters I've had with customers at the department store where I work. I’ll do almost anything for a laugh, but when the communication is between you and your doctor and your health is at stake, the miscommunication story is not so funny, is it? So just whose fault is the failure to communicate? Yours, mine, your doctor’s, or Alexander Graham Bell’s? SHOW & TELL Back in the Stone Age when I was in elementary school, we had Show & Tell Days. Betsy (future veterinarian) showed us her hamster and described what he liked to eat. Joey (future geologist) showed a large piece of quartz he'd found and described what he'd learned about how it was formed. Jeannie (aspiring art teacher, future author) showed a potholder she'd made and gave a fascinating and heartfelt lecture on how to weave a potholder. Paul (aspiring magician, future attorney) showed us a card trick he'd learned. As grownups, when we go to the doctor "presenting" (as the docs would say) with a symptom, we play an adult version of Show & Tell. If we have a rash or a bruise, we can easily SHOW the doctor what's wrong. But often the problem is invisible, even to x-rays and blood tests, and sometimes a rash is only the tip of the medical iceberg. In that case, the TELL part of our presentation is extremely important. Our doctors are not mind-readers, their patients are each unique, and graduating from medical school does not automatically make a person perfect or infallible. As far as I know, there are no sensitivity training classes or even bedside manner courses in medical school. So we patients are trying to communicate and connect with a scientist, not a fortune teller. Communicating with doctors is a special interest of mine because of the extremely frustrating experiences I had while seeking a diagnosis and treatment for my chronic pain. It seemed to me then that my vaunted communication skills were completely ineffective when I was standing or sitting before a scientist in a white coat. I was slow to realize that many of the docs I consulted viewed me with suspicion because of my communication style. They distrusted me because I had "inappropriate" knowledge: how to pronounce medical terms, the correct names for various parts of my body, and the names of medications commonly used to treat symptoms like mine. I tried different approaches, different communication styles, as I went from one doctor to the next, until finally I found one who was at least willing to hear me out before passing judgment, and whose subsequent treatment of my pain has been very effective in no small part because of the way we interact. WHEN YOU TALK TO YOUR DOC On the face of it, communication is a simple process. It consists of a message, the sender of the message (who encodes the message), and the receiver of the message (who decodes the message and gives feedback about it). All three of those components have to be functioning in order for communication to take place. This is why I once got spanked for asking my father for $5 while he was asleep, then helping myself to his wallet: he neither heard my message (he was snoring too loudly) nor gave me feedback about it (permission to take the $5). While communication is a two-way process, you can only control part of it, so when you talk to your doc, it’s your responsibility to phrase your message clearly (and politely). If you have trouble expressing yourself to your surgeon, consider bringing a more eloquent friend or family member with you to appointments. When you think of questions in between visits, write them down immediately, and bring your list to your next appointment (or telephone conversation). It is always OK to ask members of your bariatric team about anything at all about your weight loss surgery (questions, concerns, problems, symptoms, side effects, complications, frustrations, and even opinions), but don't expect answers to things like, "Are you a Republican or a Democrat?" If you're not sure if your question is related to weight loss surgery, go ahead and ask anyway. I always preface this kind of inquiry with, "I'm not sure who I should talk to about this, but maybe you can point me in the right direction." I know that not every medical thing in your mind is easy to say out loud, but while the issue burning in your mind might be embarrassing to you, you're not going to get very far with it if you hold it inside. Your doctor isn't going to laugh at you or tell your next door neighbor what you said. What's the worst he/she could say? "I don't know"? Don't dwell on whether he/she thinks you're an idiot for asking this question. You have no control over other people's thoughts, only your own, and you're not a mind-reader either. If you are truly the most challenging patient your doctor has ever had, you may actually be fulfilling a medical school dream of his/hers. If you need to make a critical comment, phrase it carefully and constructively. For example, instead of saying, "I'm sick of having to wait three hours to see you every time I come here," consider saying, "Could I avoid a three hour wait to see you if my next appointment is in the morning instead of the afternoon?" If that doesn't produce a satisfactory response, proceed to the next level with a stronger statement, like, "I'm extremely distressed about having to wait for three hours every time I come to see you." But don't burn your bridges with threats and accusations until you have another doctor lined up. Finding a new surgeon can be a time-consuming and expensive process (take it from one who knows that firsthand), so give your doc a chance to help you before you march out of the waiting room door and step alone into the big, bad bariatric world!

I had a port revision because my port flipped over after 2-1/2 years of no problems. I didn't even know it until my surgeon and her NP began having trouble accessing my port. My surgeon didn't know what could have caused it to flip, partly because she's not the one who did my band placement. She says it could have been a failed suture, or stress on the abdominal fascia during a workout. Anyway, after the revision it stayed put and since she relocated my port deeper (so I no longer had a bulge there) and away from my waist (where it used to rub against my clothes, kitchen counter, etc.) I was happy with the results. I can't comment on the 1% chance of needing a port revision because I'm not a statistician or medical professional, and not inclined to believe statistics anyway (a boss once told me, "figures can lie, and liars can figure"), and can't comment on whether your port is pressing on a nerve (never heard of that), but I've encountered quite a few people whose port flipped. I understand why you're not feeling too swift about this turn of events, but a port revision is not the worst thing that could happen to a WLS patient. Hard as it may be to imagine, a year from now that revision will be a distant memory.

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.

I'm sure your surgeon would be relieved to hear that I approve of his advice! Following a liquid diet when you've been having eating problems and difficulty adjusting to a new fill is a good idea that I advocate often. It gives your upper GI tract a chance to calm down so that the next time you try solid food, you should be able to eat and enjoy it more easily. But I think we have to be cautious about that approach because it can delay facing up to the fact that we might need an unfill.

Yeah, calorie counting can become a "can't see the forest for the trees" thing!

You're not a failure. This whole thing is brand new to you, and you still have a lot to learn. If I were you, I'd contact your surgeon's on-call partner and schedule a small unfill. liquid and soft calories just do not provide the early and prolonged satiety that you need, and keeping your band too tight can cause complications like band slips. Also, try to be patient about the weight loss. I know that's hard, but losing 16 lbs the first month is very fast, and the plateau you've experienced then is quite likely due to your body's effort to readjust your metabolism. It may be thinking, "Oh, no! We're going to starve to death! Better slow this engine way down!" Because the body perceives calorie restriction as potential starvation, tt's possible to cause a plateau by eating too few calories. I've heard so many people say they started to lose again after they started adding more (healthy) foods to their daily intake. I love my summer fruits and veggies too, and complex carbs like that can also help weight loss because the Fiber content helps keep you satisfied while its doing all kinds of good stuff for your health. Hang in there!

LET ME MAKE THIS PERFECTLY CLEAR… Or maybe not so perfectly. How about adequately? It should come as no surprise when I tell you that I love languages, especially English. My mother was an English teacher who once told me she'd rather I become a streetwalker than misuse the English language. I'm sure I'd have earned a whole other maternal lecture if I had become a streetwalker, but Mom's insistence on clear written and spoken communication was one of her greatest gifts to me, not just in my writing but also in my business career and social relationships. Despite all that, I've had many frustrating encounters with other English speakers who couldn't seem to grasp my meaning no matter how plainly I felt I had expressed it. That's because effective communication involves more than facility with words. This truth came home to be during a lengthy, complicated business negotiation with the owner of a Japanese manufacturing company from which my employer bought steel components. Mr. Hota brought his own translator, but I suspected that he understood a fair amount of English because he sometimes replied to me (in Japanese) before his translator had begun to translate what I'd said. Mr. Hota was calm, his face perfectly blank, he spoke no English, and I spoke no Japanese; we met in my company's conference room, not his; and yet somehow he was gaining the upper hand in a negotiation worth $3 million. When I told my boss, "I can't communicate with Mr. Hota," he said, "Yes, you can, but not necessarily with words." Communication can be difficult even amongst people who share a native tongue, be it English, Japanese, or Urdu, with results that range from comical to frustrating. When the other person is your doctor and 5 minutes of his/her time cost $200-$300, and your own most puzzling questions or symptoms are the topic of discussion, frustration can turn to fury. But what do you do with that fury? The doctor is an authority figure, an expert whose advice or care you urgently need. You could say, "That's it. I'm outta here!" and flounce out of the office. If the doctor were an automobile mechanic, it probably wouldn't be too difficult to find another mechanic to help you, but finding another doctor who's qualified, accepts your insurance plan, is taking new patients, and can give you an appointment sometime in the next decade….? That's not so easy. WHERE DO WE GO WRONG? Because of my interest in communication and my part-time retail job, I could tell you dozens of stories about communication problems. While I began this article complaining about people who can't seem to understand even the simplest sentence I utter, I could also complain about people who can't seem to make me understand the sentences that they utter. The fact that I'm hearing-impaired makes clear communication all the harder, but I can provide living, breathing witnesses to some of the funny and frustrating encounters I've had with customers at the department store where I work. I’ll do almost anything for a laugh, but when the communication is between you and your doctor and your health is at stake, the miscommunication story is not so funny, is it? So just whose fault is the failure to communicate? Yours, mine, your doctor’s, or Alexander Graham Bell’s? SHOW & TELL Back in the Stone Age when I was in elementary school, we had Show & Tell Days. Betsy (future veterinarian) showed us her hamster and described what he liked to eat. Joey (future geologist) showed a large piece of quartz he'd found and described what he'd learned about how it was formed. Jeannie (aspiring art teacher, future author) showed a potholder she'd made and gave a fascinating and heartfelt lecture on how to weave a potholder. Paul (aspiring magician, future attorney) showed us a card trick he'd learned. As grownups, when we go to the doctor "presenting" (as the docs would say) with a symptom, we play an adult version of Show & Tell. If we have a rash or a bruise, we can easily SHOW the doctor what's wrong. But often the problem is invisible, even to x-rays and blood tests, and sometimes a rash is only the tip of the medical iceberg. In that case, the TELL part of our presentation is extremely important. Our doctors are not mind-readers, their patients are each unique, and graduating from medical school does not automatically make a person perfect or infallible. As far as I know, there are no sensitivity training classes or even bedside manner courses in medical school. So we patients are trying to communicate and connect with a scientist, not a fortune teller. Communicating with doctors is a special interest of mine because of the extremely frustrating experiences I had while seeking a diagnosis and treatment for my chronic pain. It seemed to me then that my vaunted communication skills were completely ineffective when I was standing or sitting before a scientist in a white coat. I was slow to realize that many of the docs I consulted viewed me with suspicion because of my communication style. They distrusted me because I had "inappropriate" knowledge: how to pronounce medical terms, the correct names for various parts of my body, and the names of medications commonly used to treat symptoms like mine. I tried different approaches, different communication styles, as I went from one doctor to the next, until finally I found one who was at least willing to hear me out before passing judgment, and whose subsequent treatment of my pain has been very effective in no small part because of the way we interact. WHEN YOU TALK TO YOUR DOC On the face of it, communication is a simple process. It consists of a message, the sender of the message (who encodes the message), and the receiver of the message (who decodes the message and gives feedback about it). All three of those components have to be functioning in order for communication to take place. This is why I once got spanked for asking my father for $5 while he was asleep, then helping myself to his wallet: he neither heard my message (he was snoring too loudly) nor gave me feedback about it (permission to take the $5). While communication is a two-way process, you can only control part of it, so when you talk to your doc, it’s your responsibility to phrase your message clearly (and politely). If you have trouble expressing yourself to your surgeon, consider bringing a more eloquent friend or family member with you to appointments. When you think of questions in between visits, write them down immediately, and bring your list to your next appointment (or telephone conversation). It is always OK to ask members of your bariatric team about anything at all about your weight loss surgery (questions, concerns, problems, symptoms, side effects, complications, frustrations, and even opinions), but don't expect answers to things like, "Are you a Republican or a Democrat?" If you're not sure if your question is related to weight loss surgery, go ahead and ask anyway. I always preface this kind of inquiry with, "I'm not sure who I should talk to about this, but maybe you can point me in the right direction." I know that not every medical thing in your mind is easy to say out loud, but while the issue burning in your mind might be embarrassing to you, you're not going to get very far with it if you hold it inside. Your doctor isn't going to laugh at you or tell your next door neighbor what you said. What's the worst he/she could say? "I don't know"? Don't dwell on whether he/she thinks you're an idiot for asking this question. You have no control over other people's thoughts, only your own, and you're not a mind-reader either. If you are truly the most challenging patient your doctor has ever had, you may actually be fulfilling a medical school dream of his/hers. If you need to make a critical comment, phrase it carefully and constructively. For example, instead of saying, "I'm sick of having to wait three hours to see you every time I come here," consider saying, "Could I avoid a three hour wait to see you if my next appointment is in the morning instead of the afternoon?" If that doesn't produce a satisfactory response, proceed to the next level with a stronger statement, like, "I'm extremely distressed about having to wait for three hours every time I come to see you." But don't burn your bridges with threats and accusations until you have another doctor lined up. Finding a new surgeon can be a time-consuming and expensive process (take it from one who knows that firsthand), so give your doc a chance to help you before you march out of the waiting room door and step alone into the big, bad bariatric world!

Who's the "everyone" trying to talk you out of weight loss surgery? Have any of them actually had weight loss surgery? Have any of them lost 255, 175, or even 100 lbs by any method? And if they lost that weight "on their own", without weight loss surgery, how long have they maintained their weight loss? I think it's wonderful that you've lost 175 lbs on your own, and losing another 80 lbs is a worthwhile goal, but if you've been stalled for a year, I'm not sure the on-your-own approach is going to take care of that last 80 lbs any time soon. On the other hand, you do need to be realistic about what adjustable gastric band surgery will do for you. It's not going to turn the weight loss switch back on for you. When properly adjusted, the band will provide you with early and prolonged satiety, but good food choices, portion control, dealing with emotional eating urges, and exercising will go on being your own responsibility. I won't try to persuade you to go ahead with surgery or give up the idea forever. I hope that losing 175 lbs has already given you many health benefits, and I would hate for you to consider yourself a failure if you don't lose the additional 80 lbs. Good luck!

Your band caused 2 herniated discs? Discs in your spine? Which of your doctors suggested that your band was the cause of that?

Are you a member of the clean plate club? Perhaps a lifetime member? Perhaps even its president? I belonged to the CPC (Clean Plate Club) for over 50 years, so I consider myself something of an expert on it (and I am, after all, The World’s Greatest Living Expert on Everything). I thought it was a lifetime membership, but my bariatric surgeon rescued me from the CPC Cult – oh, excuse me, Club - and deprogrammed me so that I’m able to function more or less like a normal person now. Here’s my story. I was inducted to the CPC as a child, when I was too young to realize that the promise of going to heaven if I always cleaned my plate was a bit more complicated than it sounded at the time. All I wanted to do at the time was to please the cult leaders: my mother and my grandmother. I have reason to believe that my grandmother, whom I called Dranny, was the original founder of the CPC. Orphaned as a small child, she was passed around the family like a piece of unwanted furniture, and she raised her own children during the Great Depression. Through the combination of those circumstances and her own peculiar (and wonderful) character, Dranny was a pack rat. She didn’t live in filth and disorder (just the opposite, actually), but she couldn’t bear to throw anything away, especially not food. If three green peas were leftover from a meal and she hadn’t been able to persuade someone to eat them, she would lovingly place them in a custard cup covered with a shower-cap style cover (this was in the days before Glad Wrap), and store them in the fridge, where they would remain until someone ate them (or my mother threw them out while Dranny was in another room). I’m a lot like my grandmother in various ways, and also something of a pack rat. So after eating my way through hundreds of childhood meals with Dranny and my mom (who was not a pack rat, but who was offended by the idea of wasting food that she’d worked so hard to procure and prepare), I emerged into adolescence with warring impulses – part of me still wanted to clean my plate, and part of me wanted to starve so that I could lose weight and be as skinny as the British supermodel, Twiggy. 101 WAYS TO CLEAN YOUR PLATE One of my problems with meal planning and storage is that it's hard for me to predict how much food I'll be able to eat at a future meal. Often I don't know that until I've eaten several bites. My basic strategy for dealing with this unpredictability is to keep my plate clean from the very start so that the food I leave behind doesn't overwhelm me or provoke an attack of guilt that could bring down Dranny's loving wrath upon me. A simple way to keep your plate clean is to prepare smaller batches of food so you won't be tempted by serving dishes overflowing with food or burdened with an excess of leftovers. I can't speak to recipes for baked goods (not my department), but most other recipes can be easily cut in half, thirds, or even quarters through the use of simple arithmetic. Sometimes I prepare the whole recipe, subdivide into 2 or 3 batches, serve one batch immediately and freeze the other 2 for future use. When we lived in the northeast, the elderly widow who lived next door was delighted when we shared excess food with her. Sharing food with family, friends, and coworkers can yield multiple benefits. When I'm craving a food or recipe whose leftovers would be a problem for me to store (or resist), I prepare a big batch of it for whatever social event is on the horizon and keep only one or two portions of it at home so that we get to enjoy it without having to worry about to do with all that food. I use cheap, recycled, throw-away packaging so that no one can insist that I take my corning ware, Pyrex or Tupperware container of leftovers home with me. You can also keep your plate clean by using the portioning technique I recommend for bandsters who are still learning their band eating skills, food portion sizes, and stop signals. Here's how it works for me. When planning my day's food (which I commit to my food log and my accountability partner every morning), I might decide that I'll eat 4 ounces (by weight) of chicken thigh and 1/2 cup of barley and veggy salad for dinner. Come dinner time, I grab my small plate (a salad plate) and put half of my planned meal on it: 2 ounces of chicken and ¼ cup of the salad. If I'm able to finish that, great. If I'm still physically hungry when I'm done with it, I go back to the kitchen and dish up the remaining 2 ounces of chicken and ¼ cup of salad. At the end of the meal, I'll probably have only 1 or 2 tablespoons worth of food to save or throw out instead of a plateful of food, therefore much less guilt to deal with. When I do have a plateful of food leftover, I usually scrape it into a small plastic container that I can quickly grab and stick in my lunch bag when I go to work the next day. Fortunately, we actually like leftovers at our house, and arguments occasionally break out over unauthorized consumption of leftover food ("Who ate the rest of the eggplant Parmesan?!?"). The same approach works with restaurant meals. We're happy to take leftovers home in what used to be called a doggy bag (as if I'd share my Maryland crab cakes with a dog!). My sister-in-law used to scrape leftover food into a bucket to add to her garden compost pile. I have no idea if that's a good practice. We'd have to have a 40' high electrified fence dug 20' into the ground and topped with razor wire in order to keep dogs, cats, deer, rats, raccoons, and other critters out of that kind of compost pile. I've also known people (including my mother) who fed leftover food to their 4-footed garbage disposals (dogs & cats), another practice that we avoid because why would you want to cultivate a fussy eater? Our pets have survived eating (stolen) candies (complete with foil wrappers), latex paint, and kip tails (fishing flies), and at our house, a fussy eater will end up starving because someone else is always willing to clean your plate for you, sometimes long before you've decided you're finished with it. BUT WHAT ABOUT THE STARVING CHILDREN? After over 6 years of post-WLS life, I'm now better able to detach myself from my emotional attachment to the food on my plate enough to throw out what's left. If it didn't taste right because my tummy was in an odd mood, if it caused me eating problems, if it wouldn't reheat or store well, I let it go. I haven't been struck by lightning for doing that, nor has God punished me with plagues, floods, or infestations (apart from the dog infestation, that is). Like many, I was raised to eat every meal while listening to a chorus singing the Children Are Starving in (fill in the blank) hymn. I agree that in world where so many children (and adults, and animals) go hungry, it is just plain wrong for an overfed middle-class person like me to waste or throw out food. But the fact is that me eating more food than my body needs (rather than throwing out) is not the solution to the problem of world hunger. The solution to world hunger, and to diminishing global food resources, is far, far more complicated than that. Working in your community (be it a village, a city, a country, or a planet) to solve that problem is a worthwhile effort, but you taking personal responsibility for causing the death of a starving, unknown child in India or Appalachia because you threw out a chicken wing and 5 green beans last night is (in my opinion) a misguided and foolish use of your energy. And you eating that extra bite of food just because you can't bear the thought of throwing it away is also foolish from a medical standpoint. If that extra bite causes you to PB, get stuck, or over-pack your pouch, it could lead to messy and expensive medical complications like esophageal or pouch dilation and/or band slips, especially if you eat that way on a regular basis. Finally, as long as overeating endangers your health through co-morbidities and through disrespecting your band, you may never be able to help deal with the hunger problem, whether on an individual, local, or global basis. So, first things first: make a top priority of eating sensibly for your own sake before you tackle the rest of the world.

How do you feel about kids under age 18 having WLS? I hate to see kids growing up obese, suffering bullying and health problems and social problems, but I'm not sure I was mature enough as a kid to make all the lifestyle changes that WLS requires. What do you think?

I had to do Lovenox shots for 3 weeks (I think). I'd never given myself an injection before but it wasn't at all difficult. The needle is tiny and the Lovenox came in pre-measured disposable syringes. I was told to inject it into my thighs (they didn't want any injections near my healing incisions) and believe me, there was plenty of flab there. The Lovenox stung going in, and the needle left bruises (I bruise easily anyway), but it turned out to be no big deal. It did, however, make me glad I don't have to do several insulin injections a day for the rest of my life.

Sooner or later you'll find yourself in a situation where you have little or no control over the food served. That doesn't mean you have to abandon all your band eating skills or go hungry. The key is to have plans, even for unpredictable situations. Social eating poses all kinds of challenges to the bariatric post-op. How to resist the dessert cart? How to refuse an extra helping of potatoes that Mom mashed especially for you (with just a little gravy)? How to chat with nine people and still concentrate on taking tiny bites? One recommendation applies to all social eating situations: do not experiment with new foods. You don't know how well they'll go down and you don't want to disgrace yourself in public. This has been a challenge for me because I love to try new foods, especially when I travel, but taking food risks in public is just not worth the potential pain and embarrassment. How easily you can pull off social eating will depend in part on whether your hosts or fellow guests know about your weight loss surgery (a topic worthy of an article of its own, so stay tuned). Sometimes I think my new eating habits are harder on my friends than they are on me. For example, a few months ago I went out to lunch with a group of women, including a friend (we'll call her Kathy) who knew me when I was fat and knows I had weight loss surgery. This was not the first time I had dined with Kathy since my surgery, so I was a bit surprised to realize that she was studying me as I ate. "Is there a problem?" I said. "I'm sorry, I shouldn't stare," she answered, "But I just can't get over the way you eat now." "Isn't it great?" I said with hearty enthusiasm. "Um, yeah, I guess so." There was an awkward pause. Then she rallied and said, "So how many dogs did you say you have now?" I have survived many post-op social eating occasions with acquaintances who don't know about my weight loss surgery (and I'd rather keep it that way). Most of them keep their opinions about my eating (if they even notice it) to themselves. Sometimes they ask, "Don't you like the food?" (I answer honestly, yes or no), or "Are you diabetic?" (yes), or "Are you allergic to nuts? (no). Sometimes I have to use Kathy's change-the-subject method of getting out of an awkward moment (asking the hostess for the recipe, or a portion of dessert to take home, works well as both a compliment and a distraction). Advance planning is crucial for successful social eating. Try to find out what will be served and decide what you'll eat. Eat something before you leave home, because the old advice to save your calories for the party is risky business for a post-op. Imagine how irresistible the buffet table is going to look if you haven't eaten for 10 hours. You're not just risking extra calories at that point - you're risking a stuck episode, a productive burp (regurgitation), or sliming - because you're too hungry to eat carefully. If at all possible, bring some food that you can eat and share with the other guests (tell the host or hostess you're going to do this or it might get whisked away and stashed in the refrigerator). If you know alcohol is going to be served, bring a pitcher of a non-alcoholic beverage you like and announce that you thought everybody might like to try your special punch or fruit tea or whatever it is. Stand-up can be easier than sit-down affairs because everyone is busy balancing a plate, cutlery, beverage and conversation and it's easier to sneak off and ditch the food without being seen. At sit-down meals, I'll grab my plate and a neighbor's (making sure it's empty first, of course) and head for the kitchen saying, "Do let me help clear the table" or "Can I get you anything while I'm up?" (that's hard to pull off in a restaurant, though). Speaking of stand-up affairs, finger food is a terrible idea for bandsters. Human teeth are just not designed to take a small enough bite of anything solid enough to be held in the fingers, so proceed with caution. Whether you're standing up or sitting down, cutting up your food into tiny pieces and occasionally moving it around your plate with your fork are good ways to camouflage your spare post-op eating style. And one last piece of advice: please do not give your uneaten food to your host's dog (or cat, or potted plant), no matter how hungry the dog claims he is. You have no way of knowing if the food is even safe for the dog. My dogs are four-legged garbage cans, and they have even worse judgment about food than I do!

Frustrated by a weight loss plateau? You need a combination of patience and a plan to push through it. It happens to everyone sooner or later. Your bandwagon stalls. You’ve been going great guns, fired up with enthusiasm, working that tool, doing all the right things, and losing weight. Then one day the weight loss stops. One day, two days, twenty days go by…you’re still stuck, and you’re wondering what happened. And because you’ve spent so many years failing at dieting, and being told that obesity is always the fault of the patient, you start to wonder what you are doing wrong. You even think, “Is my band broken?” Chances are, you’re not doing anything wrong, and neither is your band. What’s happening is that your body is adjusting itself to the many changes that have happened during your weight loss. The human body doesn’t know what you’re going to do next, be it climb a mountain or relax on the couch, so it has to continually adjust and readjust your metabolism to make the best use of the calories you take in. It looks at the history of what you’ve been eating and how much you’ve been burning off through physical activity and comes up with a forecast of what you’ll need to stay alive for the next week or so. THIS MONTH’S WEIGHT LOSS FORECAST IS… At work I’ve had to prepare sales forecasts for various jobs through the years. How many widgets will we sell in the month of April? How many defective widgets will be returned by unhappy customers who want a refund? Will all this income and outgo generate enough cash (in our case, energy) to cover the payroll and the equipment maintenance and the CEO’s country club membership? I once had a boss who joked that we might as well toss a deck of cards down a flight of stairs to come up with a prediction of which new product (represented, say, by the joker card) was going to be the best-seller. That suggestion didn’t go over big with the finance guys. Like us, they were trying to follow the rules, keep everything identified, counted and categorized. And like the bean-counters, we count our calories, carbs, fats, proteins, liquids, solids, income, outgo, with faith that this accounting system will help us win the weight game. Meanwhile, our bodies have a different agenda: survival. When we decrease our food intake and increase our physical activity, the body watches to see what will happen next. As our purposeful “starvation” continues, the body struggles to accommodate the changes we’re making. It makes some withdrawals of funds from our fat cells and fiddles with our metabolism to prevent an energy (calorie) shortage. Gradually it becomes acclimated to the new routine so that it’s making the best possible use of the few calories we’re consuming. It’s keeping us alive, but it’s also putting the brakes on weight loss. Eventually we find ourselves stalled on what seems like an endless weight loss plateau. And unless we change our routine and keep our bodies working hard to burn up the excess fat, we’re going to grow to hate the scenery on that plateau. AND ON THE FLIP SIDE I’ve suffered through countless weight loss plateaus but by varying my exercise, my total caloric intake, my liquid intake, my sleep, and so on, did manage to finally arrive at my goal weight. For the past few years, I’ve felt mighty smug that I finally got promoted to the Senior VP of Weight Management here at Chez Jean. Maintaining my goal weight +/- 5 pounds seemed effortless. But it didn’t last. Turns out it was time for me to learn another lesson about my body’s fuel economy. When I had all the fill removed from my band to deal with some bad reflux, my eating didn’t go berserk. I didn’t pig out at Burger King, didn’t drown my sorrows in a nightly gallon of ice cream. I was definitely eating more because I was so much hungrier than before – perhaps 500 extra calories a day, which would amount to a weight gain of one pound a week. Imagine my dismay when I gained seven pounds in 2 weeks – the equivalent of an extra 1750 calories a day! There was a time when I could have overeaten that much without any effort at all, but as a WLS post-op, I’d have to work hard at eating that much extra food. I was flabbergasted. And frightened. Obesity was a mountain on my horizon again – far in the distance across my weight maintenance plateau - when I thought I’d left it far behind. So at the end of a visit with my gastro-enterologist during that scary time, I asked him if my sudden and substantial weight gain was the equivalent of my body shouting, “Yahoo! We’re not starving anymore! Let’s get ready for the next starvation period by hanging on to every single calorie she takes in! Let’s store those calories in those fat cells that have been hanging around here with nothing to do! C’mon, troops, get to work!” I’m pretty sure that’s not the way Dr. Nuako would have explained it, but he smiled, nodded, and said, “Oh, yes.” I felt like I was facing the flip side of a weight loss plateau: I might be in a weight gain plateau. All I could do is keep on keeping on with exercise and healthy eating, enjoying some of the foods, like raw fruits and veggies, that had been harder for me to eat with a well-adjusted band. PUZZLING OUT THE WEIGHT LOSS PLATEAU So the good news was that my wonky metabolism following that complete unfill wasn’t my fault, but the bad news was that my metabolism wasn’t in a cooperative mood. I was going to have to start playing much closer attention to the details of weight loss and maintenance again. What a pain! But hey! I’d already had a lot of practice at that. I had the tools – a little rusty maybe, but still in usable condition. I ended up regaining 30 pounds between that unfill and my revision to VSG, but I have a suspicion that without those weight tools, it could have been 60 pounds. And that’s one of the reasons that even today, bandless for 14 months now, I don’t regret my band surgery. The band helped me lose 90 pounds and learn a host of useful (if uncomfortable) things about myself, my behavior, my body, my lifestyle. What about you? How can you get your weight loss going again and avoid regain? So many factors can affect your weight that sorting out the reason(s) for your weight loss plateau can make you dizzy even if you’re not a natural blonde like me. To help you assess what’s going on and what might need to be changed, I created a Weight Loss Plateau Checklist. To access the checklist in Google Docs, click here: https://docs.google....emtSYjJLRnVGTFE The checklist includes a long list of questions about you and your behavior, with answers and suggestions for each question. I can’t claim that it will give you the key to escaping that plateau, but it should give you some food for thought and perhaps some ideas to try. Use that to come up with a plan to deal with the plateau, and work that plan for at least a month to give your body a chance to get with the new program.

I just want to share a wonderful article written by Australian writer Kasey Edwards, entitled "When Your Mother Says She's Fat." It's about the dangerous messages we get about body weight, not just from our parents but from our society. Edwards is dead-on, and her story is very touching. Here's a link to the article: http://www.rolereboot.org/life/details/2013-06-when-your-mother-says-shes-fat

That's exactly how I feel!

Oh, I forgot to mention something important but entirely off-topic. Your dog is adorable!