Jean McMillan

Ordinarily my answer to a question like this would be no, absolutely not. One of the reasons I was willing to follow (if not love) my dietitian's food plan was that the 90 excess pounds I was carrying around were ample proof that my own D.I.Y. diets in the past completely failed. The bariatric surgeon who vetted Bandwagon gave a talk at a WLS convention last year spoke at length on the subject of "Carbs are not your friends," and I'm not medically qualified to challenge him on that point, and I suspect neither are you. My dietitian's food plan did not forbid carbs, but it did restrict starches because (as she explained) starchy foods (potatoes, bread, white rice, flour, corn, etc.) wreak havoc with your blood sugar (even if you're not diabetic)...the kind of havoc that actually makes you hungrier and may also cause carb cravings. Then there's the problem with sugars, which can do the same thing and which lurk in foods you might not expect: milk and other dairy products (like yogurt), whey Protein powder, some fruits, and so on. But...my real reason for responding to your question is this. Why did you sign on with a bariatric surgery practice whose food plan you felt you couldn't live with?

I think line-dancer made the therapy suggestion with the best of intentions. I wish I had a dollar for every time I've recommended therapy to other WLS peeps. I'd be a richer person now, at least in terms of $$$. You don't have to be crazy to seek and benefit from therapy. In my opinion, recognizing that you might benefit from therapy is a sign of a healthy person. Now, about the thinking as a fat person phenomenon... I was obese for almost 30 years. During that time, my thoughts and feelings and beliefs about myself grew up all around my identity as a fat girl, so that even after losing 90 lbs, I could still see that fat girl in the mirror. Not all the time, but some of the time. The lesson here is that the mental and emotional WLS journey can take a lot longer than the physical one. And I'm OK with that, because at my advanced age (and being born a blonde), adjusting to changes overnight makes me very dizzy.

No, no, no. I'M the one who's vertically challenged. But I feel much taller now that I know CarolinaGirl. It's a real pleasure to finally meet someone shorter than I am, if only by 1/2".

Just because you CAN eat solids doesn't mean you SHOULD eat them. The point of the post-op diet progression (liquids-purees-soft-solid foods) is to allow your stomach to heal and your band to "seat" itself against your stomach. One of the most common causes of band slips is the failure to follow post-op and post-fill eating instructions.

I can't keep chocolate or chips (or other junk) in my house, because if it's here, I'll hear it calling to me.

As someone who has suffered major depression for over 40 years, I just want to give you a cyber-hug, tell you not to give up on yourself, and strongly advise you to talk to your PCP about getting an RX for an antidepressant (or changing the med and/or the dose if you're already on one).

It's good that you've been referred to a gastroenterologist, but I think your surgeon needs to work closely with that doctor. I had a bad esophageal dilation with dysmotility early this year that was diagnosed by my gastro doc, but he didn't know what to do about it until he talked with my surgeon and they agreed that taking all the saline out of my band was the best course of action.

If Lithium toxicity is a possibility, you really need to talk to the doctor who prescribes it for you. Maybe the dose needs to be adjusted, and if your dehydrated, you may need IV fluids.

I've tried papaya enzymes and pineapple juice and a hot beverage and prayer and probably more, and the only thing that ever helped was patience. Making yourself vomit is never a good idea. If the stuck episode is so bad that you can't drink Clear liquids, it's time to call your surgeon.

I think that depends on each restaurant's policies and practices. If I was denied service in a restaurant because I wanted to use my own cup, I'd be having a little chat with the manager or owner on my way out the door.

I completely understand how all the work you do taking care of your family can leave so little time for you, but when you have so many people relying on you, it's all the more important to set aside some time each day for yourself. You might even want to make an "appointment" for that and treat it as seriously as a doctor appointment. One of the small but helpful things I do is this. When I come home from work feeling frazzled and am greeted by a husband and 9 dogs who all want my attention, I greet them briefly and go into the bedroom to change out of my work clothes (very important step when you have 9 dogs). I take my time in there, change clothes, hang up the work clothes, do a little tidying while I think about the day, take some deep breaths, wash my face, putter around some more...well, you get the idea. By the time I emerge from the bedroom, I'm in a calmer frame of mind and better able to tackle preparing and eating a healthy meal and visiting with my family (human and canine). They're OK with this routine because they've learned the hard way that I'm extremely cranky if I don't get my me-time.

I'm not a microbiologist, so I can't guess how many germs could survive a cycle in a commercial dishwashing machine. Why don't you bring your own cup when you go out to eat? I've never waitressed, but I deal with the public every day and a customer who wants to use her own cup would be pretty far down on my list of weird customer hijinx! If other diners give you a strange look, you could smile and say something like, "I'm just trying to protect you all from the highly infectious disease I have."

It's important to give some thought to what makes you feel "satisfied". There's physical satiety and then there's emotional, sensory, and mental satiety. I had overeaten, and eaten in response to cues that had nothing to do with physical hunger, for so long that it took me a while to understand that the band only helps with physical satiety. As you said, the band is around your stomach, not your mind. I agree with Missy that some counseling could help. Also, attending Overeaters Anonymous and/or food Addicts Anonymous meetings could help. Go to oa.org for more info.

I can't help you become a compliant patient - only you can do that. All I can say is that it sounds like you're sabotaging yourself for reasons you might want to explore with a counselor. Your surgeon can probably refer you to one who has experience with WLS patients and/or eating disorder patients. When you have a stuck episode, the worst thing you can do is to go on eating. When you do that, you can get into an endless cycle of stuck-eat-stuck-eat-etc. You won't lose weight that way and you can do yourself some real harm by means of a band slip or esophageal and/or stomach dilation. It will probably take a good deal of discipline for you, but I strongly suggest that when you have an eating problem like a stuck episode, you immediately stop eating and follow a liquid diet for at least 24 hours before carefully transitioning back to purees, then soft foods (that you can cut with the side of a fork), then solid foods. Also, don't be afraid to talk with your surgeon or a member of his/her medical staff about this. I can almost guarantee that you're not the first patient they've had with struggles like yours. They already know you have an eating problem, and presumably they're well qualified to help you deal with it.

The no-straw rule is a very common one for all WLS patients. We tend to gulp air when we eat and drink anyway, and a straw just makes it worse. It's along the same lines as the no-carbonated-beverages rule. In what way are you having trouble not using one? Sit-down restaurants usually give you a beverage in a glass; you don't have to use a straw at fast-food restaurants if you leave the lid off the cup; as far as I know, the International Order of Straw Devotees no longer does home visits to make sure you're using your straw as required by your lifetime membership; and if you can't drink a beverage from an open cup while in a motor vehicle (I sure can't), use one of those coffee cups with lids with an opening to drink through.

It's not just the length of the needle that's important. It's the type of needle. It has to be a non-coring needle (or Huber needle) or it will leave permanent holes in the port's membrane. And getting the Huber needle from a trustworthy supplier is yet another issue, because a few years ago the FDA recalled the Huber needles made by a certain manufacturer because they were not non-coring.

Even if the medical friend or family member is a bariatric professional trained to do fills (which are not as easy to do as they might look), I think that in most cases it's a bad idea to have a friend or relative administer medical care. A medical mishap could turn into a nightmare (personal, medical, legal, insurance) that could ruin a relationship and turn the patient into a mess that no bariatric surgeon would be willing to take on. Also, if I could get fills and unfills pretty much on demand from a friend or relative, my abdomen would be black and blue from so many needle sticks. I'd want an unfill at 11:42 am so I could eat fried chicken for lunch, a fill at 1:16 pm when I'm feeling regret about lunch, an unfill at 7:51 pm so I can eat birthday cake...well, you get the idea. The cases in which it's OK (to me) to do "family" medical care are things like parents giving diabetic kids shots of insulin, spouses giving morphine shots to partners dying of cancer at home, and adult children giving meds to elderly parents who can't or won't take care of themselves. If the cost of band fills is a big issue, I'd suggest a different WLS procedure.

Plication is a procedure in which the surgeon puts sutures in your stomach to make it "pleat" (that's the plication part) and reduce its holding capacity. Sometimes it's done as a procedure by itself, sometimes in combination with band placement. I think I'm not understanding you though when you complain about losing 13 lbs. You were banded 2 weeks ago and feel that you should have lost more than 13 lbs by now? That would work out to 6.5 lbs a week, which is a heck of a lot faster than the band average loss of 1-2 lbs/week. Or were you banded prior to 2 weeks ago?

This is something I find myself saying over and over again, but I truly mean it every time: I hope that reading Bandwagon helps you as much as writing it helped me.

Channing, Why don't you try posting this on LBT's sister site, RNYTalk.com? There's a link to it on the bottom of the page (towards the right hand side). Jean

Depends on whether you're on Clear Liquids or "full" liquids. I wasn't allowed skim milk when I was on clear liquids, but I was allowed Unjury's chicken Soup flavor, which is very good mixed with warm (not boiling) Water (the powder tends to clump up if the water's too hot). I've never mixed unjury chocolate flavors with water, just skim milk or unsweetened almond milk. Unjury also has a strawberry flavor that I didn't like mixed with water or milk.

I'm the author of 2 books about living and suceeding with the band: Bandwagon, Strategies for Success with the Adjustable Gastric Band - it's what I call the giant encyclopedia of band advice Bandwagon Cookery - a cookbook with 180+ recipes (with nutritional stats and instructions for adapting recipes to each post-op diet phase) plus tips for band-friendly cooking methods, meal planning, etc. You can order the books by clicking on one of my ads here on LBT or by going to http://jean-onthebandwagon.blogspot.com and choosing one of the purchase options (credit card, PayPal) found on the left hand side of the page. Jean

Bandwagon and Bandwagon Cookery are not available in e-book format. I've looked into that, but I'm told that converting them would be difficult and costly because the books have so many charts, illustrations, diagrams and photos.

Naturally I want to recommend my own books, Bandwagon (strategies for success with the band)and Bandwagon Cookery (a cookbook with food prep strategies, meal planning tips, and 180+ recipes including nutritional stats and ways to adapt each recipe to the various stages of the post-op diet) but I can also recommend: WLS BOOKS: Laparascopic Adjustable Gastric Banding, Jessie Ahroni - the author is a band patient and NP so she knows both the patient's point of view and the medical point of view. Just the chapter on how to know if you need an attitude adjustment or a band adjustment is worth the price of the book. Weight Loss Surgery with the Adjustable Gastric Band, Robert Sewell, MD & Linda Rohrbough - by far the most comprehensive book I've read about the band (aside from my own, of course). Rohrbough is a band patient and journalist, Sewell is a surgeon, so the material is detailed, clear, and easy to read. It also includes information about the other WLS procedures which I found much easier to understand than anything else I had read. COOKBOOKS Recipes for Life After Weight Loss Surgery, Margaret Furtado & Lynette Schultz Eating Well After Weight Loss Surgery, Pat Levine & Michele Bontempo-Saray

It depends on the details of your pre-op diet. Surgeons' pre-op diet requirements vary greatly. Some insist on only liquids (Protein shakes). My current surgeon allows only Protein shakes and Protein Bars, where as my original surgeon's pre-op diet was 1200 calories a day of real food with absolutely no processed food (to reduce sodium intake). Without knowing the exact pre-op diet you're on, and how long you've been doing it, and when your surgery will be, it's hard for me to make suggestions. The purpose of the pre-op diet is to shrink your liver and improve its texture (making it less slippery) so that your surgeon can maneuver your liver out of the way (because the upper lobe lies on top of your stomach) without damaging it. My original surgeon told me that if he didn't like the looks of my liver after he got his scope inside me, he'd bail out of my surgery altogether. The idea of waking up with no band scared me into 100% compliance with my pre-op diet.