Jean McMillan

Burning at the back of the throat can be a sign of reflux, and reflux can be a sign that your band is a bit too tight. A small unfill can relieve that. Also, when I had esophageal dilation, one of the symptoms I had (that I didn't know was related to dilation at the time) was burning, pressure, and general discomfort at the back of my throat. It turned out that my esophagus had stopped moving food into my stomach, so the food sat in my esophagus for far too long - it was literally just at the back of my throat. It's definitely something you should tell your surgeon about. In the meantime, you can try taking omeprazole (available over the counter) and make sure you're using good band eating skills - take tiny bites, chew very well, eat slowly, etc.

Heartburn is often a sign that your band is a bit too tight. A small unfill could relieve it without compromising your restriction. I would definitely tell your surgeon about it. In the meantime you could try taking omeprazole (an acid reducing medication available over the counter).

It's probably safer to say, "No more today" than "No more!" I often say that if you told me I could never, ever eat ice cream again, I'd be on my way to Dairy Queen faster than you can say "saturated fat."

If tortilla chips and hot sauce are your demon, you need to keep those bad boys out of your house, your car, your workplace... Ice cream used to be my demon. I would eat half a gallon at one sitting every single night. Ice cream happens to be entirely compatible with the band. The band can do nothing to stop that demon. Only I can. So I no longer buy ice cream and I do my best not to even walk down the freezer aisle at the grocery store.

My surgeon told me that the band was safe to leave inside the body (with or without fill) for a lifetime. It's made of biocompatible ingredients, like artificial joints and other medical devices. Yes, complications are possible, but that's true of every WLS procedure. Since the band was approved for use in the USA in 2001 (12 years ago), you're probably not going to find anyone here who can tell you what banded life is like after 15-20 years. You might be able to get feedback about that from bandsters located in Australia, Europe, and the UK. Maybe ask about it in one of the forums listed here: http://www.lapbandta...support-groups/ A bariatric surgeon is really the best person to tell you about the long-term safety and implications of band surgery, but depending on low long they've been in practice, they may not have anyone in their current practice who has been banded as long as 12 years. It's entirely possible that those patients lost their weight and moved on to new and wonderful things. Removing a band is possible if medically necessary but is not something you'd do (I hope) just because you felt you were done with it, because it's not as easy as band placement because of scar tissue from the original surgery. I loved my band, but If I were a self-pay patient like you, I probably wouldn't choose the band because I'd be afraid that I couldn't afford to pay for enough adjustments (adding and removing saline) to help me lose weight and to deal with any side effects or complications. I can't recommend the sleeve because I'm not getting along with mine very well, and I have no personal experience of other WLS procedures. You can get feedback on those procedures at LBT's affiliate sites (shown at the bottom of the forum page).

Look at it this way. Being reminded of how you felt before you were banded can give you a useful reminder of how far you've come since your surgery. I try not to dwell on stuff like that, but I don't want to become complacent either. And I don't ever want to take for granted something that turned my life around.

Guess what? Today is almost over, so your bad eating day will soon be history. And the best part is you can start fresh tomorrow.

Nate, People often ask me what I wish I had known before I had band surgery. My answer is invariably that I wish I had known how long it could take me and my band to achieve optimal restriction. My dietitian assured me that I wouldn't be hungry after surgery because of internal swelling, but I was starving hungry the day after surgery and felt that I could eat anything in any amount. Fortunately for me, I was too scared of complications to vary from my post-op diet progression. Should my dietitian or surgeon have told me anything different? Probably not, because individual patients react so differently to the band over the course of time. It might have been helpful if they had used more words like "might" and "probably". So where I got most of my encouragement and guidance in the first few months was from the in-person support group meetings where I was able to talk with other patients who had gone through bandster hell and come out the other side feeling great. I hope you're able to find that kind of support here on LBT. Right now, I just want to tell you one more thing: Don't give up on your band or yourself. This is just a little bump in the long road to weight loss.

Do you mean higher on the stomach? Because the band would be useless if placed anywhere on the esophagus.

You weren't asking me, but I'll answer anyway...Variable restriction is extremely common, and can be one of the most frustrating things about the band. It's not necessarily due to a complication like a band slip or esophageal or stomach dilation. Your stomach is living tissue that expands and contracts to help you digest food and is affected by a variety of ordinary things like the time of day, time of month, stress, hydration, medications, illness (for me, seasonal allergies always played havoc with my band). But...if the variations in your restriction are so extreme that it interferes with your daily living, I would suggest that you bring it up to your surgeon again.

Well, one good thing about an unfill (or the least bad thing) is that it makes you appreciate how much your band was doing for you before the unfill.

Try not to be too discouraged by negative posts. People tend to post more often when they're struggling than when they're doing fine. It's just the nature of a support site like this. I was banded on 9/19/07 (with the old 4mm Lap-Band) and lost 100% of my excess weight (90 lbs) in one year. I had some ups and downs, many of them due to user error, but I loved my band. I loved the adjustability of it, the early and prolonged satiety it gave me, and also its appetite reduction feature. I had a band slip at 21 months post-op that was resolved with a complete unfill and 6-week rest period. We don't know why it slipped because I hadn't been having any problems, so it could've been related to poor surgical technique by my original surgeon or plain old dumb luck. Then when I started getting gradual fills again, my port flipped (maybe due to a failed suture) and my new surgeon had so much trouble accessing it that we decided on surgery to reposition it. Unfortunately my work schedule delayed that surgery for several months and I regained about 20 lbs, but as soon as I got enough fill back in there. I was able to lose the 20 lbs. I lived happily with my band until December 2011, when I started having reflux. It got worse despite taking omeprazole, so I had another complete unfill, an upper GI study that showed esophageal dilation, and an EGD that showed esophageal damage from decades of "silent" reflux (long pre-dating my band). Since my band was probably aggravating it, my surgeon and gastro doc decided that we needed to remove my band. My band was removed in April 2012 and I had VSG surgery in August 2012. Since then I've lost the 30 lbs I had regained because of losing my band, but I'm having more problems adjusting to life with my sleeve than I ever did adjusting to my band. Weight regain is a possibility for every obese person, no matter what (if any) WLS procedure they have, because obesity is a chronic, incurable disease affected not just by our conscious eating behavior but other factors not within our individual control (like hormonal, neurological, inflammatory and other problems). Weight management is a lifetime project, but I promise you, all that work is soooo worth it! Jean

I think it's way too early to give up on your band. And take my word for it: I had to revise from the band to the sleeve, and life with the sleeve is far more difficult than I ever expected it to be. And unlike the band, you can't adjust the sleeve. Once that big chunk of stomach is removed, it's gone forever, like it or not.

I'm even more techno challenged than you are. The e-book is formatted (not very neatly) for Amazon Kindle products and I don't know if that's compatible with an iPad. You might find more info about it on Amazon. There's a Kindle help forum (see below) where Kindle users might be able to help you. Or ask about it wherever you got your iPad? http://www.amazon.com/gp/help/customer/forums/kindleqna/ref=hp_ss_comp_kindle_forum_C

Missy and CG gave you good advice about calling your surgeon for post-fill protocol instructions. It's possible that eating a meal of solid food added to your discomfort, but I don't see how holding your 20-lb child could affect your band or stomach. If by saying your stomach hurts you mean that your abdomen hurts, it's probably just irritation from the needle and that will go away soon enough. If picking up or holding your daughter causes you pain or discomfort right now, you might want to ask a family member to help out for a few days.

Yes, there is a risk in not following your post-op diet. That's a common cause of band slips. Here's a link to an article on why it's not a good idea to cheat on your post-op diet: http://www.lapbandtalk.com/topic/163124-help-guys-band-or-sleeve-im-scheduled-for-band-feb1/

It sounds like you've got a case of Soft Calorie Syndrome. A small unfill could help you eat the solid food that provides the early and prolonged satiety that the band is supposed to give you. Part of your problem could be not that your band isn't working but that you're very sensitive to it and can't tolerate the same amount of fill as others can. If I were you, I'd want to try a different fill protocol before giving up on the band altogether. I'm not qualified to say whether your surgeon is acting in your best interest, but performing another surgery on you can be seen as a way for him to increase his income. Please don't let yourself believe that weight loss with the sleeve is easier than weight loss with the band. It's not. Success with every WLS procedure requires good nutrition, exercise, and other lifestyle changes, and no WLS fixes the eating demons in your head. I loved my band and am having a hard time getting along with my sleeve. You can read about my experience in this thread: http://www.lapbandtalk.com/topic/163124-help-guys-band-or-sleeve-im-scheduled-for-band-feb1/

Your surgeon and/or nutritionist are the best people to advise you about your diet progression at this point. Until you get clarification from them, I would follow whatever your post-fill protocol is, such as 24 hours of liquids, 24 hours of purees, 24 hours of soft foods (foods you can cut with the side of a fork), then carefully transition back to solid foods.

Hilary, Sounds like your bariatric surgeon & staff haven't been doing their job, which unfortunately happens quite often. I wrote a book about how the band works and how to get the most out of it, but I can't figure out how ti distill everything you need to know into something that would fit in a forum post. So right now I'll just mention 3 things. 1. If you are having eating problems (stuck episodes, regurgitation, etc.) a few times a week, your band may be too tight and/or you may need to work on your eating skills (take tiny bites, chew very well, eat slowly, don't drink while you eat, etc.) and on making yourself stop eating when you've had about 1 cup of food. You may want to go on eating at that point, but if you do, you'll risk another eating problem, and those things tend to snowball, and you'll end up with an esophagus and stomach that are so irritated that eventually you could have problems even drinking liquids. 2. The consistency of the food you eat counts for a lot. While it may be easy to eat 2 cups of something like oatmeal, yogurt, mashed potatoes, or thin crunchy stuff like chips and crackers, you'll get the most and the most long-lasting satiety (the sense of having eaten enough food) by eating mostly solid food like animal Protein, non-starchy veggies, and fruits. When eating food like that, you may find that only 1 cup feels like enough. 3. After eating like every meal was Thanksgiving dinner for several decades, it took me a long time to learn how to recognize satiety and how to make myself stop eating. It's important to pay very close attention to how you feel as you eat now. If you wait until you get a Thanksgiving-stuffed feeling, you've overeaten. Everybody's different, but some "soft" stop eating signals include: hiccups, burping (or the urge to burp), sneezing, a fullness at the back of the throat, an urge to clear your throat, pressure (but not pain) in the chest, and right shoulder pain. You may not notice those signals every time you eat, but over time you'll be able to notice and heed them better. Jean

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!

You might want to consider finding another surgeon to do your aftercare. Sounds like you didn't get off to a good start with the original one.

Dude, Please keep your pecker to yourself. Or talk about it in the men's forum.

Not to worry. I know for a scientically proven fact (courtesy of Reader's Digest) that laughter is the best medicine.

When I decided to have bariatric surgery (back in the olden days), I went into it open-minded. A friend was having great success with RNY (gastric bypass), but when my surgeon explained the 3 procedures he did then (Lap-Band, RNY, and VSG), I just had a gut feeling that the band was right for me. It didn't involve altering my anatomy (other than clamping a removable silicone band around my stomach) and the adjustability of it appealed to me. At the time, I also bought into the idea that the band is the least invasive surgery, an idea whose time has passed because all surgery is invasive. So I had band surgery on 9/19/07, a red-letter day in my life. I loved my band. I lost 100% of my excess weight (90 lbs) in a year. I put my heart and soul into my band and my online community of bandsters, wrote 2 books for bandsters, started work on a 3rd book, met a lot of my online friends in person, published an e-newsletter for bandsters, attended WLS conferences, sat on ask-the-expert panels, spoke at support group meetings...and life was wonderful, until December 2011, when I began having symptoms of esophageal damage from 20+ years of "silent" reflux. My gastro doc and my surgeon agreed that my band could be aggravating my condition and had to come out, so in April 2012 my band was removed and in August 2012 I revised to the sleeve. I have had more medical problems in the 5 months since then than I'd had 15 years, all of them related to my sleeve. If you can hold back your tears of pity for me for a few more minutes, you can read about my life with the sleeve in my response to this recent thread: http://www.lapbandtalk.com/topic/163124-help-guys-band-or-sleeve-im-scheduled-for-band-feb1/ And if you have any questions after reading that, let me know. If I can't answer your questions, I can probably point you in the right direction. The take-home message here is that there is no such thing as a perfect, effective, risk-free weight loss surgery, but bariatric surgery of any type is still the most effective treatment for obesity available at this time. One day, medical science may come up with a cure, and even some kind of innoculation against obesity. In the meantime, obesity is a chronic disease without a cure, and no matter what kind of WLS we choose, we'll have to fight the obesity devil for the rest of our lives.

That's the first time I heard of the sleeve reducing sweet cravings. Or any cravings. When my band was adjusted properly, I had very few cravings, very few intrustive food thoughts, and even the flavor of food wasn't thrilling any more. But in the time between my band removal and my sleeve revision, all that changed. Lots of cravings, lots of food thoughts, and every bite of food tasted fabulous again. I have now been sleeved for 5 months, and none of that has changed. Everything tastes wonderful, I think about food a lot, I crave certain things (including sweets, which I can't eat because they make me dump), and every meal or snack requires Iron will to survive it without overeating. And unlike my band, there's no way to adjust this sleeve of mine. It is what it is. 75% of my stomach is gone forever, so there's no going back now.