Jean McMillan

You can't understand how someone can gain their weight back? To answer that question, let me refer you back to your previous statement that obesity is a chronic condition. No weight loss surgery cures obesity. All it does is treat it. It sounds as if you're looking down your nose at people who've been controlling their food intake rather than letting the band do it for them. Controlling food intake is one hallmark of responsible adult behavior. Just because that's hard for obese people to do doesn't mean we ought to avoid it. But then again, maybe you're one of the people who "took the easy way out."

I agree that obesity is a chronic disease, but I think your statement that your surgery prohibits you from overeating is oversimplified and perhaps misleading. Expecting the band to limit how much you can eat is old school thinking. In the past few years, the bariatric medical community has realized that eating until your band has reached (or exceeded) its food capacity is a mistake that invites complications. The band's true mechanisms are to reduce hunger and appetite, and to create early and prolonged satiety. It may not do all of those things for everybody all of the time, but it should do some of those things for most people most of the time. Note: I didn't pull this view out of a magic hat. I got it from several bariatric surgeons and my rep at Allergan.

Do you save the “best” (or favorite) food on your plate for last? That might be sabotaging your weight loss. Here’s why. When I was growing up, my mom gave me confusing messages at meal times. We were not allowed to have dessert until we finished the meat and veggies on our plates. This rule taught me to save the best for last, and I applied it to everything – meals, homework, story books. I would play with my least-favorite doll all day in order to “earn” a nightly conversation with my favorite doll, Priscilla (who was forced to sit on my bed while I quizzed her math skills). One day, my mother eyed the mashed potatoes on my dinner plate and said in a warning voice, “Aren’t you going to eat that?” I said, “Yes, when I’m done with my peas. I’m saving the best for last.” She snorted and said, “Be careful with that. You never know when someone’s going to come along and take your plate away from you before you get to the potatoes. So quit dawdling and clean that plate.” Those were terrifying words to a kid like me, and they fostered my impulse to guard my plate, like a dog guarding a bone, while gobbling my food as quickly as possible. When I told a school friend about Mom’s warning, she said, “That’s nothing. You just have one brother. I have nine brothers and sisters. At my house, if you don’t move fast, you go hungry.” My mom’s hurry-up-and-clean-that-plate eating message might not have been a very caring or sensitive one to give a child, but over time, I’ve been able to see a few grains of truth in it. For a time in my 20’s, I would order just chocolate mousse in a restaurant and enjoy it while my companions slurped their way through bowls of clam chowder. Even now, I feel that I’m spending my calories more wisely when I skip right to a 400-calorie dessert rather than eat 800 calories of meat and veg in order to earn the dessert that I’m determined to eat even if I’m already so full I could puke. My other problem with Mom’s advice is that nowadays, it heightens my sense of deprivation. I’ve had more than enough of deprivation throughout several decades of unsuccessful dieting. Every diet guru had a list of Thou Shalt Not Eat foods. I often say that if you told me I could never eat ice cream again, I’d be on my way to Baskin Robbins faster than you can say “Jamocha Almond Fudge.” And what if I’m too full to eat the asparagus (a favorite veggy) after I eat my chicken and carrots? Even one bite of asparagus then might not stay down at all. I’m not suggesting that you forsake humdrum proteins and complex carbs so that you can gorge on fat and sugar at every meal. I certainly can’t recommend eating your trigger food, be it potato chips or ice cream, for every meal and snack each day. Like it or not, the #1 reason for eating is to fuel your body, no matter how the fuel tastes. I am suggesting that you forsake the “save the best for last” rule as you trudge through your daily life, not just at meals but in everything you do. If you save all your food, activity, or other treats for the weekend, or your vacation, or for 11:30 tonight after you put the last load of laundry in the dryer, five weekdays will feel like 15, and by the time you get to that day off, you may be too tired to enjoy or even remember what your reward was going to be. Your sense of deprivation by then could be a bottomless pit that will never, ever, get filled up with food.

Sure sounds to me like you have enough documented band problems to prove medical necessity.

I'm not sure if you were asking me or someone else how big I was before my band surgery, but I'll tell you anyway. I'm 5'2" and my highest recorded weight was 231 (it was probably more during the years that I refused to step on a scale). I was 212.5 lbs at the time of my band surgery and lost all my excess weight (90 lbs) in a year.

Try posting your question in this Washington State support group: http://www.lapbandtalk.com/forum/61-washington-local-lap-band-support/. Good luck!

You're looking fab and doing great! And your marriage sounds well-balanced. Hub likes the junk, and you've got the trunk!

Be careful what you ask for, Guy. You might just receive it! I'll bet there are lots of pretty clothes that other members would be happy to send you!

Whatever you decide about a revision, I don't think you should call yourself a failure. If you've lost "only" 44 lbs in 9 months, you've lost about 1.25 lbs/week, and the average with the band is 1-2/week. Also, if at all possible, I'd start looking for another surgeon. The one you have now sounds like a jerk. Good luck!

I for one am very thankful that we have WLS choices nowadays!

I can't answer your question about what you can do to push Tricare to cover a revision. Just want to say that I have a friend who converted from the band to RNY and had no problem getting Tricare to cover it. And she hadn't been having band problems, just had lost 100 of the 200 lbs she needed to lose with her band and then plateaued for a year.

I haven't done that diet, but know several people who tried it and found that it helped curtail some bad food habits they'd acquired, like too much sweet stuff. And since in theory it can cause quick weight loss, a pound or two lost (don't know if that's realistic in 5 days, though) might give you back some self-confidence that you can in fact succeed. I guess it depends on what's behind the 12 lbs you gained - poor food choices? not enough portion control? grazing? or what? If you can get some insight into the causes(s) of the gain, you can work on that as well as work on getting back on the bandwagon. Good luck!

When I was growing up, my mom gave me confusing messages at meal times. We were not allowed to have dessert until we finished the meat and veggies on our plates. This rule taught me to save the best for last, and I applied it to everything – meals, homework, story books. I would play with my least-favorite doll all day in order to “earn” a nightly conversation with my favorite doll, Priscilla (who was forced to sit on my bed while I quizzed her math skills). One day, my mother eyed the mashed potatoes on my dinner plate and said in a warning voice, “Aren’t you going to eat that?” I said, “Yes, when I’m done with my peas. I’m saving the best for last.” She snorted and said, “Be careful with that. You never know when someone’s going to come along and take your plate away from you before you get to the potatoes. So quit dawdling and clean that plate.” Those were terrifying words to a kid like me, and they fostered my impulse to guard my plate, like a dog guarding a bone, while gobbling my food as quickly as possible. When I told a school friend about Mom’s warning, she said, “That’s nothing. You just have one brother. I have nine brothers and sisters. At my house, if you don’t move fast, you go hungry.” My mom’s hurry-up-and-clean-that-plate eating message might not have been a very caring or sensitive one to give a child, but over time, I’ve been able to see a few grains of truth in it. For a time in my 20’s, I would order just chocolate mousse in a restaurant and enjoy it while my companions slurped their way through bowls of clam chowder. Even now, I feel that I’m spending my calories more wisely when I skip right to a 400-calorie dessert rather than eat 800 calories of meat and veg in order to earn the dessert that I’m determined to eat even if I’m already so full I could puke. My other problem with Mom’s advice is that nowadays, it heightens my sense of deprivation. I’ve had more than enough of deprivation throughout several decades of unsuccessful dieting. Every diet guru had a list of Thou Shalt Not Eat foods. I often say that if you told me I could never eat ice cream again, I’d be on my way to Baskin Robbins faster than you can say “Jamocha Almond Fudge.” And what if I’m too full to eat the asparagus (a favorite veggy) after I eat my chicken and carrots? Even one bite of asparagus then might not stay down at all. I’m not suggesting that you forsake humdrum proteins and complex carbs so that you can gorge on fat and sugar at every meal. I certainly can’t recommend eating your trigger food, be it potato chips or ice cream, for every meal and snack each day. Like it or not, the #1 reason for eating is to fuel your body, no matter how the fuel tastes. I am suggesting that you forsake the “save the best for last” rule as you trudge through your daily life, not just at meals but in everything you do. If you save all your food, activity, or other treats for the weekend, or your vacation, or for 11:30 tonight after you put the last load of laundry in the dryer, five weekdays will feel like 15, and by the time you get to that day off, you may be too tired to enjoy or even remember what your reward was going to be. Your sense of deprivation by then could be a bottomless pit that will never, ever, get filled up with food.

If you’ve been married as long as I have (we just celebrated our 25th wedding anniversary), you’ll probably know what I mean when I say that at times, my relationship with my husband is a love-hate thing. The hate is provoked by stupid little things, like: why must an adult male in good health and in possession of all his faculties spit toothpaste on the bathroom mirror every single day of his life? Ten minutes after wanting to throttle him for that, I catch a glimpse of him cuddling a tiny kitten and my heart melts. He has truly been there for me through thick and thin (more thick than thin) and I can’t imagine life without him, but the next time I walk into the bathroom and see the Colgate version of a Jackson Pollock painting on the mirror, my husband’s life will hang by a thread, at least for a few moments. I also have a love-hate relationship with my band at times. I resent it because it prevents me from eating mindlessly. I love it for the very same reason, but when I’m tired or hurried or distracted, the effort to eat carefully seems enormous. Why can’t my band just do its job and leave me the heck alone? I’m by no means a lazy person but there are days when living with an adjustable gastric band is a lot of work. It’s certainly not a spectator sport – to win this game, you have to jump right in and get busy, and it’s not over when the cheers fade away…it starts all over again the next day, and the next day, for the rest of your life. Like me and the stupid bathroom mirror. Happily Ever After? I think that many people have bariatric surgery believing or hoping that it will solve everything, that they’ll never have to struggle with their food or eating again. Most of the time, that’s not the happy ending to their story. Their story has a different ending that could be happier if they adjust their thinking to it. Is the burden of good eating choices too heavy? If surgery helps you lose all the excess weight, shouldn’t it help you maintain that weight loss without another thought for the rest of your life? Dream on. I’ve seen a lot of bandsters (including the short blonde one in that bathroom mirror) crash into the Forever Wall, kind of like hitting the “seven-year itch” in a marriage. We prepare for band surgery with all the hope and care of a bride and groom planning a wedding – what we’ll wear, what we’ll eat, what music we’ll dance to. We enjoy a romantic honeymoon with the band, things go great for a while, and then things get harder and harder. At that point, you can fall in love with another bariatric procedure, believing that a revision to gastric bypass or whatever will hand you the key to happily-ever-after. Or you can stick with the partner you’ve already got, survive some tough times, and come out of it all the stronger. My friend Tami send me these wise comments: “Your comparison of WLS to marriage made me chuckle. One time my daughter asked me whether I’d ever divorce her dad (sometimes he can be such an ass!). I said, “Absolutely not. He’s family. You sometimes can’t stand your brother, but you can’t divorce him.” Now, if there was a serious “complication” in my marriage, like abuse, I’d have to reconsider my options. And that’s exactly how I feel about my band. It’s part of me, and as long as it doesn’t abuse me with serious complications, we’ll stick together. And just like my husband, I have to respect my band, take care of it, and learn from mistakes.” To Have & To Hold – til it’s no fun any more? I’ve survived some complications with my band that I suppose you could classify as on the low side of serious: a band slip, and a flipped port. Since the actions my surgeon and I took in response to these complications were swift (in the case of the slip) and sensible (in the case of the port flip), neither one of them ever endangered me – not in terms of my health, and not in terms of my quality of life. In fact, they seemed quite minor to me compared to other problems that my fellow humans face every day – a terminal cancer diagnosis; a fatal automobile accident; a crippling disease; the loss of a partner; parent or child – that except for the occasional moment of frustration or angry, “Why me, God?”, I just kept trudging onward. Perhaps another person with a different world-view and/or different expectations would consider a band slip grounds for divorce. I can’t criticize people who choose divorce, whether it involves their spouse or their band. Only I can decide what’s acceptable and tolerable for me, and others must decide that for themselves. But if you walk down the church aisle three minutes before your wedding begins thinking, “If I don’t like marriage, I can always get a divorce,” perhaps you don’t belong in the church in that fancy get-up in front of all your family and friends after all. At this (fairly advanced) stage of my life, I’m convinced that God or the universe throws nails on the road before me as a way to get my attention, make me stop and get my bearings, make me enjoy the scenery and make me appreciate how far I’ve traveled so far. So I do my best to learn what I can from each challenging situation with the gastric band that’s complaining or my husband who’s vigorously brushing his teeth or the dog who’s chewing on a chair leg. For all I know, my greatest goal in life is to be a champion cleaner of bathroom mirrors!

Deciding who to tell about your WLS is a tricky business. Do you tell your friends, family, neighbors, hairdresser or dentist? What about all those coworkers? What (if anything) should you tell them? Coworkers occupy a unique position in our lives. They’re closer than acquaintances, but not as close as families and friends even though we generally spend more time with them than just about anyone else in our lives. Keeping your own private business private at your workplace can be a challenge under the best of circumstances, and it can be dangerous territory for someone having weight loss surgery. Any kind of medical procedure, from a root canal to open heart surgery, is so fascinating that it’s almost instantly transmitted via the office grapevine no matter how solemnly your good friend and coworker swears to keep it a secret. On Monday morning, I tell Amy about my upcoming band surgery in the hushed tones of utmost confidence, and she promises to tell no one. On Monday afternoon, Bud waves at me while passing through the hallway and says, “Good luck with your surgery!” How did that happen? Did Amy betray my confidence? No, not exactly. She called her husband Tim at lunchtime and told him because his mother is considering bariatric surgery, and Tim’s office mate overheard the conversation and called his cousin Dale to ask if it’s true that Jean’s having weight loss surgery…and so on and so forth. Pre-op, who (if anyone) are you going to tell you’re having bariatric surgery? You’ll have to explain your absence (not necessarily in gory detail) to your immediate supervisor and/or a human resources person, and (depending on your employer’s policies) provide a letter from your doctor excusing your absence. You are not obliged to divulge the details of your surgery to anyone; a letter from your surgeon (preferably not on stationery imprinted with “The Hometown Center for Surgical Weight Loss”), stating that you are under his/her care and will need XX days off work to undergo surgery and recovery, should be enough. Be aware, though, that the employer who provides your health insurance probably has access to more of your confidential medical information than you might like. In these days of the Information Age, it’s quite possible that Michelle Obama and the Prime Minister of Japan could discover the details of your weight loss surgery (assuming they even cared). I have no idea how to control that and suggest that you focus your privacy efforts at the local level. If you tell your employer’s human resources manager that you’re having bariatric surgery and later discover (or surmise) that she told the payroll clerk, the receptionist, and her sister Maybelline about it, it would be appropriate to let her know (in private) that she violated the confidentiality of your medical information, but it might not be worthwhile to start a war over it, especially because workplace wars tend to draw curious crowds and foster the growth of the office grapevine. As my wise friend Miss Pat says, “You gotta pick your battles.” Let’s look at a few possible pre- and post-op workplace scenarios. 1. You don’t tell your coworkers about the nature of your surgery, and/or the one coworker you tell keeps her lips zipped. Your cover story is that you’re having your gall bladder removed. Remember please that you have only one gall bladder, and if eventually the real one has to go, you’re going to have to come up with another story. Every other person in your workplace bends your ear with their own gall bladder stories and finally they all get bored with it and move on to the next burning issue, like the fact that Jack got written up for putting a photo of Beyoncé’s backside on his cubicle wall. You come back to work, life goes on, and everything’s fine until you decline an invitation to go out for pizza, or you sit down in the lunch room with a lunch so tiny compared to your pre-op meals that five observers jump to the conclusion that you’re on a diet again, and want to know all the details. Deal with the situation in a way that suits your style and doesn’t back you into an awkward corner. My response to the diet inquisitors would be something like, “I’m just trying to eat less and exercise more,” and then change the subject by saying, “Did you hear that (fill in the blank with the latest office gossip thread)?” or “Hey, when are they supposed to finish painting the lines in the parking lot?” or (as I recently told a coworker who exclaimed, “I don’t know why you even bother!” when she saw my tiny lunch), “Things must be mighty slow if my lunch is the most interesting thing you’ve seen all day.” 2. You’re like I was, so delighted to be having weight loss surgery that you tell everybody and their brother and their dentist and their mail carrier. Instant experts crawl out of the woodwork. Walking into the lunchroom gets to be like turning on the light in that ratty first apartment you had, where the bright light revealed an army of cockroaches swarming over the room. Before your surgery, the cockroaches (excuse me, coworkers) tell you every fractured and horrifying bariatric fairy tale they ever heard, tell you that they know you can lose the weight without doing something drastic like surgery, or proclaim that they would never do such a thing to themselves. If you are extremely patient (not my strong point), you can conduct your own personal bariatric surgery ministry by correcting the cockroaches’ misconceptions (I’m not sure that cockroaches even have ears, however). Or you can perform another version of the strategy outlined above and repeat the same phrase every single time they try to “educate” you. Say, “Thanks for your concern,” and change the subject. 3. After your surgery, you are no longer the center of attention. Life goes on, with occasional excitement when Jack once again gets written up, this time for repeating an off-color joke within the hearing of Mary Smith, the Senior Vice President of S.E.I. (Something Extremely Important). You gradually lose weight, pound after pound. You begin to buy new clothes, you change your hairstyle, you become more outgoing, and eventually several things happen: a) You wonder why no one has noticed your weight loss. Can’t they see the difference now that you’re 40 pounds lighter? What kind of friends are they, anyway? Remember, they’re work friends. Very likely they’re jealous friends, or self-centered friends (and so am I – I care a lot more about my weight than yours), or distracted friends (they’re thinking about their daughter’s need for expensive orthodonture, for example). You wish people would stop saying, “So how much weight have you lost so far?” You can answer honestly and deal with the feedback, or you can follow my example and say something lighthearted like, “20 tons!” or “Not enough!” or “My doctor’s thrilled with my weight loss.” c) The next time someone says, “I hope you’re done losing weight. You’re beginning to look sickly,” you want to smack them upside the head. Instead you can say cheerfully, “I’m sorry to hear you say that, because I’ve never felt better in my entire life.” d) Someone says, “You’ve lost 40 pounds? Really? I just don’t see it.” You run into the restroom and cry for 20 minutes. When you’re done mopping up mascara trails, march right back out there and give that jerk his or her comeuppance with a belated comeback like, “You have an IQ of 40? Really? I just don’t see it.” e) A former eating pal says, “You’re so stuck up now. You never some with us for lunch at Pizza-Rama.” You can respond by saying, “I’m sorry you feel that way, but I’m trying to avoid pizza right now. How about we have lunch at Veggy Heaven today?” If that “pal” frowns at the very idea of eating veggies and the only way they enjoy being with you involves food, you may have to write her/him off. Don’t worry, you’ll find another friend sooner or later, one who can appreciate you for who you are, not what you eat!

Your band is on the very top of your stomach. You shouldn't be able to feel it from outside at all because it's in the vicinity of your lower chest, between your breasts and behind your breastbone. So, exactly where is that top incision? Incisions from any kind of surgery create scar tissue and I suspect that's what you're feeling.

I'm a thirsty person too. I was told to drink one ounce per hour for the first 3 days post-op. At 5 days post-op it should be OK to drink freely, but not guzzle. As time goes on, you may discover that any liquid you drink too fast and too much will come right back up. Scratch the one ounce per hour. I meant one ounce every 15 minutes!

Oh, I forgot to answer your question about whether drinking 6-7 pints of water or herbal tea a day. That's about twice as much as my surgeon recommends. Staying well hydrated as you heal and for the rest of your life is essential for your health, but I'm curious about why you're drinking so much. Is that a typical amount for you? Are you extra thirsty? Are you taking any new medications? Are you diabetic? Those and many other factors can make you thirsty, and if that's not typical intake for you, you really need to talk to your primary care physician about it. In theory it's possible to drink too much liquid, upsetting your electrolyte balance and wreaking havoc throughout your body, but that's not very common. I just don't want you to be ignoring a symptom of something that could be wrong with your health.

What's done is done. Time to stop kicking yourself and move on. Some lessons we learn the hard way. If your post-op eating so far has damaged your esophagus or stomach, you have no way of knowing that right now. So take better care of yourself going forward. And I would seriously start looking for a better, more thorough bariatric clinic to do your aftercare. It sounds like the one you've got now has done an inadequate job of educating you. It's GOOD that you don't feel the obstruction any more, so stop freaking out about it (remember what I said about not looking for trouble?). What's happening in there is that the swollen tissues in your esophagus and stomach are calming down, and as that happens, the "fit" or feel of your band will change. In fact, your band may always seem to behave in unexpected ways. I could write a book about that. Hey, wait! I DID write a book about that!

Feeling a "slight obstruction" when you eat is in fact a problem. You should never, ever feel that again, and the way you do that is to let your stomach heal, your band to seat itself in place against your stomach, and eat very, very carefully for the rest of your life. As for wondering why you don't have reflux or vomiting, those too are danger signs. DON'T GO LOOKING FOR TROUBLE!

I was starving hungry before I even left the hospital. Some people lose their appetite or hunger because of surgical trauma and swelling, but that's not true for everyone. Also, your band probably won't do anything to reduce your appetite and hunger until you've had a few fills.

I feel your pain, but I can top your 3 lbs gained in 3 weeks. I have gained that much OVERNIGHT. During my weight loss phase, I never lost weight at a steady rate. I lost some, lost some more, gained some, lost some, and so on. Food isn't the only thing that affects body weight; not all of that is within your control. Try not to let your scale mess with your head. You're the boss: put that scale in its place. Like, locked in the trunk of your car.