Jean McMillan

I was too befuddled to look at his face!

Oh, please. I don't want to even think about his night.

He was nice looking, but not the type that I'm attracted to. But then, I've been married for 25 years, and my memory about that kind of thing is kinda hazy...

I don't post many questions here because I am (in my own mind) a band expert, but today I had an experience I can't quite figure out, so maybe y'all can help me with it. Also: an NSV is a non-scale victory - a weight loss benefit unrelated to the numbers on the scale. This morning I drove to a liquor store up in KY (this TN county and all the surrounding ones are dry, so KY is the nearest place to buy booze) to buy 100-proof vodka so my husband can make a cordial he calls “stumpblower” out of the pulp he extracted from last year’s blackberries. At the liquor store I had to ask one of the guys working there for help finding the 100-proof vodka. He was maybe in his late 30’s, pleasant and helpful. After I picked out the vodka (I chose the cheapest because my husband's past efforts at making stuff like cider and fruit cordial have not worked out well enough to justify something like Absolut), we walked up to the counter. I gave him cash and instead of just handing me the change, he pressed into my palm and kind of squeezed my hand. I’m not sure if that was an NSV because he was attracted to/flirting with me (in which case he must prefer older women, because I'm almost 60), or just weird. Years ago I read somewhere that touching a customer’s hand during a transaction like that is an effective way to make a personal connection to them, thereby building customer loyalty. I don’t know if I believe that. I don't think it's something a Yankee would do (but I haven't lived in the northeast for 14 years), but that’s the first time it’s happened to me here in the south. I very rarely touch customers at the JCPenney store where I work unless I’m doing a bra fit, and then I tell the customer in advance what I’m going to do so she doesn’t jump a mile when I touch her. I love to hug my old lady customers but even then I always ask for permission, like saying, “Is it OK if I give you a hug?” What would you think if something like that happened to you? Good, bad, indifferent? Thoughts? Opinions?

You're so right. That's why I said, "the re-education process is slow going." And even when surgeons and their staff get up to speed with patient education, it's entirely possible that patients who are so eager (as I was) to have WLS that they dismiss everything they hear and don't like will still end up wondering what went wrong. Information and anecdotal reports found on online forums like LBT have a lot of flaws that can be hard to sift through, but one of the best things Alex Brecher has brought to the WLS community is the open exchange of personal experience and the nitty gritty of what works for real life patients, and what doesn't.

And if we could lose weight, and keep it off, by consuming only liquids (like Protein shakes) for the rest of our lives, why have bariatric surgery in the first place?

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.

WLS coverage will depend on the terms of your particular policy. I have excellent insurance that covered both my band removal and my sleeve revision. My understanding is that insurance may cover band removal if it can be shown to be medically necessary - that is, causing complications. If your policy includes a single WLS per patient's lifetime clause, it's much harder to appeal insurance denial. A few years ago I served on an ask-the-expert panel at a WLS conference. I sat beside Walter Lindstrom, MD, a surgeon and sleeve patient who recently established a WLS patient advocacy company that can help with an appeal should you need it. Their service isn't free, but it probably costs a lot less than paying for a revision out of your own pocket. Here's a link to the company's website: http://wlsappeals.com/how-we-help/fight-your-wls-insurance-denial/

As far as I know, the most common reason for doing band removal and revision surgery in 2 separate surgeries is to allow the body to heal before subjecting it to more surgery. I don't want to rain on your parade, but it's impossible to predict what your upper GI tract is going to look like when your new surgeon goes in there to remove your band. If there's a lot of scar tissue or inflammation, it might not be safe to proceed with the sleeve at that time. I had my band removed in April 2012. I went in to the operating room expecting to wake up with a sleeve, and I woke up with nothing - no band, no sleeve. Here's a link to a recent thread about the band versus the sleeve, on which I posted my own story. If you have any questions after reading it, please let me know. If I don't know the answer, I may be able to point you in the right direction. Just one more thing - I applaud you for getting a 2nd opinion about this. Your health is too important to allow a doctor to pooh-pooh your concerns.

I'd want to call them on that, by saying something like, "Can you explain why you label me as obese? Now that I have a BMI of 25.5, am I not on the upper end of the normal weight range for my height?" I'd also tell the specialist (as calmly as possible) that it's very hurtful for a doctor to use the obese label for a WLS patient and that you'd like him/her to treat you with more consideration and respect.

Congrats on the start of your WLS journey! My band surgery was easy, and a lot less painful, than other surgeries I've had, ranging from oral surgery to a hysterectomy to a breast reduction. And yes, I would do it again, because those few days of discomfort were well worth it in terms of the long term benefits for my physical health, mental health, and lifestyle.

I understand that you still feel huge. I know that feeling well. The mental weight loss journey takes a lot longer than the physical one. Who is labeling you as obese?

No one here is qualified to diagnose what's going on with you, so I'm glad you've got a team of doctors helping you. I just hope one of them is experienced in treating eating disorder and/or WLS patients. Now I'm going to tell you a story to prove to you that I know about anorexics' inability to see any problems with their eating behavior. I had an inguinal hernia repair in my late 20's. I had lost a lot of weight in the months preceding that surgery. the weight loss started with genuine upheaval over my divorce. One day I saw my soon-to-be-ex-husband, who took a look at me and said, "What's happened to you, Jean? Aren't you eating?" I got a lot of gratification from that comment. Way too much. Having the power to make Joe worry about my weight went right to my head. My divorce upheaval continued, with a new twist: I realized that I could, for once in my life, lose weight. In the morning I ate a carefully measured and cut piece of coffeecake (hey, I make no claims that this was a good nutritional plan). For lunch I ate 4 slices of raw green pepper. For dinner I ate 4 potato chips (see above remark). That's what I ate, day after day, and I did a 45-minute exercise class twice a day. I became obsessed with weighing less than 100 lbs. So after the hernia repair surgery, I woke up in the recovery room in a great deal of pain. I asked a nurse for pain medication, and overheard her conferring with someone else (a nurse? a doctor?) about the appropriate dose for someone my size. I was 5'3" tall. The nurses' conversation went like this: Nurse A: "How much does she weigh?" Nurse B: "I don't see it in her chart. What, maybe 110 lbs?" Nurse A: "Naw, not that much. More like 107?" I lost track of the conversation then because my mind was overcome with panic because they thought I weighed only 107 lbs. I felt as if I weighed 1000 lbs. They didn't understand how horribly fat I was, and how urgently I needed to weigh less than 100 lbs. My physical pain didn't matter in the least at that point, not compared to the pain of being as huge as I was. Or...as I thought I was. After my surgery, my weight loss stopped. My mom came to take care of me (and feed me), and my family doctor insisted that I come to his office twice a week to be weighed. I felt as if I was being tortured. I felt they were all cruel and insensitive...but if I hadn't had them to police my eating, I might very well be dead by now.

A common feature of anorexia is that, like you, the patient has a distorted view of how much she ought to weigh. That's one of the things that makes it so hard to treat. I don't know how tall you are, but if your ticker is up to date and your BMI is now 25.5, losing another 25 pounds would put you in the underweight category, and that's dangerous territory.

I've heard tell of gallbladder problems from losing weight too quickly after bariatric surgery, but that's all. I believe that electrolyte imbalance can contribute to kidney disease, and electrolyte imbalance and malnourishment are complications from anorexia, so I hope you're in the hospital getting treatment for your kidneys as well as the anorexia. Or at least getting dialysis. That's scary stuff. Take care. Jean

I chose the band because (at that time) of the reasons other members have mentioned, plus it just felt right for me - sort of gut feeling. I can't recommend the sleeve, and no matter what surgical procedure you have, sooner or later you're going to have to make some permanent dietary and lifestyle changes. I wrote at length about my experiences with the band and the sleeve on this thread, plus other member's responses to that thread might interest you: http://www.lapbandtalk.com/topic/165182-restriction-riddles/#entry1946776 There are 2 important things to know about the band. 1. it probably won't start working optimally until you've had a few fills 2. it requires a lot of aftercare, so even if your insurance covers that, you need to factor in time and money (including time off work) spent going back and forth to see your surgeon for fills and unfills.

I love edamame, and they provide Fiber and protein along with the flavor, but are you asking if it's good to eat edamame as your only protein source? If so, personally I wouldn't do that, for 3 reasons: 1. food boredom always leads me astray 2. my body needs a variety of protein sources to meet my nutritional needs (for Vitamins & minerals) 3. dense animal, fish, or seafood provides better satiety than softer protein sources (like edamame, tofu, cheese, beans)

Hey, if I want salt on my popcorn, why should a unicorn make do with unsalted popcorn?!

Please don't agonize about facing your surgeon again. Most surgeons hate to see patients disappear and are happy to welcome them back. Your surgeon already knows you have a problem with food and eating. If I were you, I'd ask for a band refresher course along with that fill, including spending some time with a dietitian to figure out a detailed eating plan and talk about the foods or cravings or other things that you struggle with. As Cheryl said, it takes guts to own up to your band "failure". People who can't or won't admit to that have a much harder time of getting on track and staying there. You can do this! Jean

Good question. My original band surgeon told me that neither the stomach nor the band are fixed, unchanging objects like metal pipe with welded joins and closures. Dr. Paul O'Brien, an Australian surgeon who is one of the pioneers of clinical use of the band and author of The Lap-Band Solution, there can be a slight loss of fill over time (his example: 7.0ml can drop to 6.7ml in 6 months - a loss of about 4%), not due to leakage. In his book, Lap-Band for Life, Dr. Ariel Ortiz Lagadere reiterates that the band can lose up to 4% of its fill over the course of six months because some fluid can evaporate. Has anyone ever proved this fluid loss due to evaporation to be scientifically accurate? I doubt it. I mentioned the possibility of evaporation in Bandwagon and the book was vetted by a bariatric surgeon, Dr. Ross McMahon of Swedish Weight Loss Services in Seattle, WA. I hope that his failure to contradict the evaporation theory gives it a kind of backhanded credence, but it could be that he overlooked it.

Just for the record: Sleeve patients can dump also. Or at least I do. My surgeon says that's because my sleeve is too small to hold food long enough to start digesting it, so the food gets quickly dumped into my duodenum, causing a rapid and extreme blood sugar spike and miserable symptoms to go along with it.

Hurray, CG! You're a weight loss ROCK STAR!

The band can seem very fickle at times, giving you restriction riddles instead of restriction answers. How can we solve those riddles? RESTRICTION RIDDLES Restriction is the holy grail of bandsters, but even when you find it, it may not cooperate with you all day every day. Its fickle nature may allow you to eat one food on Tuesday but not on Wednesday. It may not show up until 2 weeks after a fill, or it may disappear 2 weeks after a fill. You end up puzzling over riddles like delayed restriction, disappearing restriction, and/or variable restriction. DELAYED RESTRICTION Although the fluid injected into the port during a fill travels immediately to the band, it can take several weeks for you to notice an increase in restriction. This may be because you spend a few days after a fill progressing from liquids to purees to soft to solid food, and then you're extra careful when eating: on the alert for more restriction. When we relax this vigilance, careless eating will eventually remind us (again) that we have a band with more fill in it. Delayed restriction is frustrating, I admit. You get a fill and want instant results. But all you can do is pay close attention to your body's signals as it adjusts to the tighter fit of the band. It is pointless to try to judge your restriction in the two to three days immediately after a fill, when you're on a liquid or pureed diet, because optimal restriction is experienced when you're eating solid foods. DISAPPEARING RESTRICTION At times during my weight loss surgery journey, I have asked myself, "Where the heck did my restriction go? Did thieves sneak in during the night and steal it?" In addition to thieves and elves, the following things can make your restriction seem to disappear overnight: 1. A few days to a week after a fill, the swelling and irritation caused by the fill calms down and the fit of your band feels looser. 2. In the first few weeks after a fill, you re-learn your band eating skills and unconsciously adjust to the new fill level so that you experience fewer negative symptoms. 3. As you lose weight after a fill, the visceral fat around your stomach shrinks, so the fit of your band doesn't feel as tight. 4. The position of your band against your stomach subtly changes due to normal body processes (see below). 5. Your band loses fluid due to evaporation, leakage, or inadvertent removal during a fill. Please note that in #1 and #3 above, I said that the fit of the band feels looser or tighter. The band itself does not loosen or tighten by itself. Only a fill, unfill, or manufacturing defect can do that. The band is not like a rubber band that stretches out over time and eventually snaps. WHY IS RESTRICTION SO VARIABLE? Sooner or later, every bandster discovers that the band is a fickle mistress. In the course of a week, it can feel too loose, too tight, or just right (kind of like Goldilocks and the Three Bears). The food that worked fine on Monday may get stuck on Tuesday. On Wednesday you can hardly eat at all, and on Thursday you could eat an entire wedding banquet all by yourself. Friday you're back to Square One. These variations are maddening but fairly normal. The stomach is living tissue that expands and contracts to aid digestion. It's affected by weight loss, the time of day (morning tightness is common), the time of month or fluid retention, medications, illness, dehydration and stress. The pressure of the band against the stomach can cause the stomach wall to thin out, so the band feels looser. And although the band and the stomach are sutured together, the position of the band can shift enough to affect your experience of restriction. Remember: the #1 factor affecting the amount of food you can eat is what type of food you eat. You will feel more restriction when you eat solid food (like animal protein), less when you eat soft food (even healthy stuff like yogurt and cottage cheese), and virtually none when you drink liquids (even healthy ones like protein drinks).

I don't think there's any such thing as a final fill. For one thing, as you lose weight, the fat surrounding your stomach (and other internal organs) shrinks, so your band feels looser and you need more fill. And also, your stomach is a living thing that expands and contracts to help digest food and move it into your intestines. And you're a living thing with a body that's affected by lots of different things that can affect restriction: hydration, medications, time of day, time of month, stress, illness, etc. etc. etc. So you never know when you might need Fluid added to or removed from your band. And that's OK, because one of the wonderful things about the band is adjustability. In the past, I've gone for months without a fill, then began to feel like I needed one. I asked my original surgeon about that and he said it's very common. It doesn't mean your band is or isn't working, just that life is about change. Living that way can require some extra effort, and extra attention paid to how your body feels, but in my view, that's a much better way to live than to live with the 92 lbs I used to lug around everywhere.

Keep in mind that physical hunger isn't just a function of your fill level. It's also related to your food choices. Solid food provides early and prolonged satiety, while liquid & soft foods (even "healthy" ones like protein shakes, cottage cheese, yogurt, SF pudding, etc.) or "slider" foods (such as thin, crispy foods - potato chips, thin crackers, popcorn) do not. Try to emphasize dense fish (halibut instead of flounder, for example), animal protein (like poultry, pork, beef), non-starchy veggies, and fruits.