Jean McMillan

No, you will probably never feel "full" the way you did pre-op, and that's a wonderful thing. In the bad old days, I ate to the point of Thanksgiving dinner full at every single meal. I could out-eat my husband, who's 9" taller and does manual labor for a living. My early days as a bandster were a challenge because I had to give up that old definition of full and learn what my new definition would be. It also involved a lot of willpower because I knew that if I overate, I could cause my band to slip. So I weighed and measured my planned portions of food and stuck to that. I often felt that I could go on eating long after the small portion was gone, but I was too afraid of complications to do that, so I would tell myself I could have more food if i was still physically hungry (empty, growling tummy) in an hour. As I got more Fluid added to my band I discovered that the small portion of food was actually enough. I had to learn new "stop" signals to tell me when to stop eating - it might be a sigh, a cough, a burp, a hiccup, a runny nose, whatever. If I didn't notice or ignored those signals, I would end up in pain because eating too much caused a PB (productive burp), sliming (excess saliva), or getting food stuck. Eventually (maybe a year?) I didn't have to think much about all of that any more because I was in the habit of putting a small amount of food on a small plate, and would stop eating because suddenly I just didn't want any more. The band works by providing early and prolonged satiety. Satiety is the sense of having eaten enough food - no more, no less. To be satiated is not the same as being "full".

I'm having a hard time visualizing how the bowel could get nicked during band placement, since the bowel is down south and the stomach is up north. The surgeon would have to be massively inept to nick the bowel while placing the port, because the port is situated between the abdominal muscles and the subcutaneous fat beneath the skin. There would be no logical reason for the surgeon to make an opening into the abdominal cavity while placing the port. The organ that's most at risk for perforation during band surgery is the liver, not the bowel. Which is why most surgeons require patients to follow a pre-op liver shrink diet. As for the Crohn's disease, if your GI doc OK'd the band for you, I think you've got to stop obessessing about it. Bad things happen to good people all the time and every kind if surgery has some kind of risk.

Getting another fill at this point will not increase your weight loss. In fact, it may slow it because when you can't eat solid food, you're too likely to eat slider foods that provide little or no satiety. That in fact may be why you've "only" lost 2 lbs since your last fill.

That's an interesting question. For my first few years as a bandster, I felt like I was actually enjoying my food more because I wasn't shoveling it down - I was eating slowly, carefully, and really tasting it. But gradually I realized that a lot of food had lost its charm for me. It still tasted fine, but I wasn't bothered when I couldn't finish eating a meal. That actually turned out to be a blessing. When I started having problems and all the fluid was removed from my band, all that food suddenly started tasting marvelous again. I'm not sure if being a bandster so long had re-trained my brain's food pleasure center, or if the pressure of my band against my vagus nerves was interfering with the transmission of pleasure sensations, or what.

That's quite true, but I mentioned the other, harsher forum because if someone here is thinking of leaving town (so to speak), I want to wish them the best of luck in finding a friendlier neighborhood.

Well, we're in agreement about that, anyway. Unfortunately good communication skills are not required of LBT members.

I understand your point, but every word I've posted on this thread still stands, and I'm going to add a few more. If you think the response to this thread was harsh, you ain't seen nothin' yet. I can direct you to another online band forum frequented by people with the consideration and sensitivity of Attila the Hun. Also, when interpreting and reacting to posts on any online forum, keep in mind that these are people you may never meet in person. You can't hear their tone of voice or see their body language, so you have to decipher words that are, in a sense. out of context. My best friend, whose honesty I cherish, can say things to me that would make me smack another person for saying, because I know she loves me and wants the best for me. Finally, consider the possibility that "tough love" sometimes does us more good than coddling when we're headed down a bad road.

I'm probably not being very objective about the sleeve right now. I think it could be an option for someone who wants to revise because their band was so problematic, but if you're thinking of revising because of disappointing weight loss, I'm not sure you'd be all that much better off.

Do you expect weight loss surgery to pull 100 pounds out of a magician’s hat? Our expectations of surgery can have a greater influence on our success or failure than you might think. Recently an acquaintance told me about seeing an obese man on TV who claimed that bariatric surgery hadn’t worked for him. “How can it NOT work?!” Patsy exclaimed. There’s no simple answer to that question. In the past I’ve written about why weight loss surgery fails (read the article here: http://www.lapbandtalk.com/page/index.html/_/support/why-does-weight-loss-surgery-fail-r88). Today I’d like to revisit the topic and focus on how our expectations affect the perception of as well as the ultimate success or failure of WLS. BARIATRIC MYTHOLOGY Some powerful myths influence our beliefs about and expectations of WLS. An especially insidious one that affects both bariatric patients and the general public is that WLS is essentially magic, requiring little or no effort on the patient’s part to achieve the desired weight loss. Hence the infamous and heinous phrase: “Weight loss surgery is taking the easy way out.” This magic myth has a corollary one that purports that the weight lost as a result of bariatric surgery is weight lost forever, again without any effort on the part of the patient. Sorry, but that’s not true either. While the whole point of bariatric surgery is to make weight loss easier, it does not eliminate the need for hard work by the patient. No bariatric surgery can cure obesity, which is a chronic, recurring disease. That doesn’t mean that succeeding with WLS means you’re sentenced to a lifetime of hard labor, dragging heavy chains and digging ditches, but it does mean that in the long term a successful patient is one who takes responsibility for his or her eating behavior, weight management, and general health. Reading the paragraph above may serve to shatter some illusions that you held dear, but when would you rather face the truth: early in your journey, or later? Although I was once a bandster like you, I lost my beloved band and recently converted to vertical sleeve gastrectomy. I have to tell you that despite all my advance research and preparation, the reality of living with a sleeved stomach is giving me a bad case of buyer’s remorse, but there’s no going back now. Seventy-five percent of my stomach is gone forever, but living with what’s left and finding a way to eat and to manage my weight now is an ongoing challenge. And I’ve heard countless stories from all kinds of bariatric patients about the challenges they face after surgery. Anyone who promises you a completely sunny picture of the future is either mistaken or trying to avoid bursting your bubble. BAND MYTHS There are a number of myths related to the adjustable gastric band. One of them is that slower weight loss with the band will prevent sagging or excess skin, and that just ain’t so. A more dangerous myth, peculiar to bandsters, is that fills cause weight loss and unfills cause weight gain. While fluid adjustments are an important part of how the AGB works,the fluid is NOT what causes weight loss. In fact, there is absolutely nothing in any part of the band system (the band, the tubing, and the port) that causes weight loss. The band does not directly affect the way nutrients from food are ingested or metabolized. It releases no weight loss instructions into the patient’s bloodstream, nervous system, or endocrine system. It doesn’t directly affect the patient’s eating behavior or exercise habits. It doesn’t compel the patient to make good food choices, limit portion sizes, eat slowly, or resist the urge to graze or binge because of boredom, stress, cravings, etc. Weight loss results from eating fewer calories than you burn, and the band helps with that by reducing your appetite and causing early and prolonged satiety. Those features are related to the pressure of the band against the stomach and the consumption of solid food whose mechanical digestion triggers the vagus nerves in the upper stomach to send satiety signals to the brain. If the patient ignores those signals, the calories taken in may exceed the calories burned, slowing or preventing weight loss. And since weight is affected by many other factors entirely unrelated to the band (like medications, hormone imbalance, etc. etc.), all we can do is to concentrate on the ones that are within our control and understand that it’s a fallacy to attribute weight loss to the band or to fills. One harmful consequence of the fills=weight loss myth is that the patient seeks more and more fills in the quest for “perfect restriction” (also a myth) or the legendary (but also mythical) “sweet spot.” This patient tends to tolerate side effects and eating problems that can cause serious damage to them and their band because they’re so focused on finding that perfect but elusive fill level and believes (erroneously) that the more fluid in their band, the better. When you suggest to this person that they may actually need less, not more fluid in their band (so that they can eat healthy, solid food instead of not-so-healthy slider foods), they react with panic, so aren’t able to make a good decision and may not even be willing to tell their surgeon about the eating problems they experience. Please don’t read this article thinking that my purpose is to discourage you. I’m the eternal optimist who believes in self-fulfilling prophecies. If you’re determined to lose weight and work hard at it, you can indeed use your band to reach your weight goal. The key phrase in that sentence is “work hard at”. There’s just no getting around that, so if your expectation is that you’ll lose weight effortlessly, you’re probably going to be disappointed in your band, yourself, or both. Your band can assist your weight loss efforts by providing early and prolonged satiety, but it’s not going to make good food choices, control portion sizes, make you exercise, be vigilant with aftercare, win you cash and prizes, or turn you into America’s next top model. On the other hand, believing that you will succeed and working hard to learn and change what you need to in order to lose weight will greatly increase your chances of becoming a bariatric superstar. And when stardom comes from hard work, it is much, much sweeter and longer lasting than stardom that falls at random out of the sky!

Be aware that former bandsters who convert to the sleeve may be delighted with their sleeve mainly because their band was so troublesome, not because the sleeve isn't troublesome. I lost my band in April and had sleeve surgery in August. The good news is that I've lost 12 lbs since then. The bad news is that my physical hunger (which supposedly disappears because of reduced grehlin production) is fierce. I can eat only a few bites of solid food at a time and get ravenously hungry an hour later. It's a pain when I'm at home, but a real problem when I'm at work and am not allowed to eat or drink except when I'm on my 15-minute break, during which time it's almost impossible to eat a sustaining amount of food. The other bad news is that I experience dumping if I overeat, eat too fast, or eat anything with more than 5 or so grams of sugar in it. You'd be astonished at how much sugar some "healthy" foods contain, like skim milk with 12.4 grams per 8 oz serving. I had been told that VSG patients don't dump because the pyloric valve is preserved (unlike RNY), but my surgeon says it can happen because my tiny new stomach can't store or churn food for very long, so it dumps the food into my intestines fast enough to make me hot, sweaty, dizzy, and very nauseated. I hope that none of that will happen to you, but beware of the rosy picture some ex-bandsters paint about the sleeve. Results not typical, you know....

I had to go through a lot of the pre-op stuff again in honor of losing my band and gaining my sleeve. I have a friend who's having to go through ALL the pre-op stuff again in preparation for converting to RNY. If those are the rules of the game, those are the rules you've got to play by. It's frustrating but by no means lethal.

I find it hard to believe that drinking a hot liquid could convey enough heat through the stomach walls and into the band enough to change the rigidity of the band. I wonder if what your surgeon meant is that a hot liquid can lubricate and relax the stomach (and esophagus) to make it possible for stuck food to pass through the stoma and into the lower stomach. The hot liquid tip reminds me of yet another tip, to prevent stuck episodes and other eating problems that I've heard from a number of bandsters: that drinking a hot beverage before you begin to eat can lubricate and "soften" the esophagus and stomach. Might be worth trying.

Who told you that? Your surgeon? First I ever heard of it.

Amen to what Missy said.

Not necessarily. While there some trial and error involved in adjusting to a fill, careful eating can prevent a lot of problems.

Strategies for stuck episodes: 1. Prevention - take tiny bites, chew very well, eat slowly, don't drink while eating, be extra cautious with foods you haven't yet eaten since your fill 2. During the episode - the only thing that ever worked for me was patience. 3. After the episode - DO NOT GO BACK TO EATING YOUR MEAL, and follow a liquid diet for 24 hours to let your esophagus and stomach calm down.

I don't mean to rain on your parade, but the most common co-morbidities recognized by insurance companies are hypertension, hypercholesteremia, type 2 diabetes and sleep apnea. If the surgeon who did your back surgeries can fully document that your obesity caused your back problems, then that would probably count as a co-morbidity, but depending on your insurance policy, it could be a harder sell. So after saying those discouraging words, I also want to welcome you to LBT and congratulate you on starting your weight loss surgery journey. Jean

From the point of view of someone who was banded for almost 5 years and wrote 2 books about the band which were vetted and blessed by a bariatric surgeon and a bariatric dietition... The general purpose answer to your question is: EVERY BANDSTER IS AT RISK FOR A BAND SLIP AT ANY TIME AFTER THEIR SURGERY. Overeating can cause a band slip, and so can vomiting, coughing, a failed suture, and poor surgical technique. We need to concentrate on the factors we have some control over, so we need to keep an eye on portion control and get prompt treatment for vomiting or coughing.

Um, let me hazard a guess. She was trying to be - wait for it! - helpful. Nothing Maddysgram said was presented as medical advice (which to my knowledge no one on thie forum is qualified to give). "Stick to your doctors orders" is hard for me to misunderstand, anyway.

It sounds like your esophagus and stomach pouch are inflamed after the vomiting-eating-vomiting thing. Call your surgeon and follow a liquid diet until you get to the bottom of this.

Sorry to say this, but since the hospital ruled out heart issues, yes, your band could have slipped. Call your surgeon for an appt ASAP. When caught early, a band slip can often be resolved with a complete unfill and rest period, after which you can gradully start adding Fluid back to the band. Depending on what type of slip it is (up onto the esophagus or further down onto the stomach), you may need surgery to reposition it. Usually an upper GI study will be enough to verify that the band has slipped. If the problem is being caused by band erosion (when the band migrates into the inside of the stomach), however, you may need an EGD to diagnose that. Good luck!

I'm glad you're doing well, and gray hair on men is so distinguished, but I hope you're not looking forward to a fill so tight that food doesn't pass through easily. That kind of a fill is a too tight fill, and being too tight does not increase weight loss. As a matter of fact, it can cause a plateau because you start eating high-calorie, low-satiety soft foods.

Good for you!

I got a stomach bug and retched once, puked once, took a dose of phenergan (anti-nausea med) and puked no more. Neither PB's or vomiting are good for bandsters (not good for anyone, but most especially bandsters). I don't think one or two episodes of vomiting would be as bad as several days of it. Definitely worthwhile to keep an anti-nausea med on hand, just in case. While we on the subject of illness, hard and/or continuous coughing can also be a problem for bandsters (can cause a band slip), so it's also a good idea to keep some cough medicine on hand. But here's hoping you won't need the meds at all!

Your post is so interesting to me, especially because it's your only post since you joined LBT in September 2010. If you've belonged to LBT that long and never once posted even a single question until now, you must be really, really desperate, and that's hard for me to ignore. But before I start sharing my thoughts and ideas with you, I need to know something. Just tell me this. Have you given up on yourself and your band? I don't care which way you answer, but if your answer is "Yes, I've given up," I want to hear you say it. And if yes is your answer, I'll be on my merry way, because giving up is not in my personal vocabulary, so my kind of advice probably wouldn't suit you. If on the other hand you haven't given up, I'd like to hear you say that, loud and proud. If that's your answer, I'm your girl. I will bombard you with questions, answers, ideas, and possibilities. In fact, I'll be all over you like white on rice. I will pester the living daylights out of you, until you may wish you never heard my name. We will find a way to move you forward on your WLS journey, even if it's a bumpy ride and the scenery's lousy. I won't leave your side for one freaking second, until you finally turn to me and say, "OK, I got it now!" So, what'll it be? Just say the word. It's very basic though perhaps not easy. Choose one: yes or no. Yes, I give up, or no, I don't give up. Jean