Jean McMillan

If your port site is red, swollen, and/or hot to touch, call your surgeon ASAP. Otherwise I wouldn't worry about it, but that's me. It's always OK to call your surgeon to ask about something like that.

I love the saying in your signature line!

Nobody, but nobody looks good wearing a hairdresser's cape!

Thanks! When you go to bed tonight, tell yourself: "If I dream about the scale, I'm going to throw it out the window."

Are mirrors and scales telling you lies? Don’t let them sabotage your weight loss and peace of mind. THE MIRROR LIES I don't know about you, but I have trick mirrors in my house. In fact, trick mirrors lurk everywhere, in public restrooms, department stores, hotel lobbies and on several walls of my health club. These mirrors never tell the truth. Like a funhouse mirror, they tell me I'm fat, thin, old, young, ugly or beautiful. Rarely do those messages match up with reality. If you have trick mirrors in your world, do not believe their lies! You know I'm kidding, right? The trick isn't in the mirror, it's in my brain. Because of decades of denial, self-hatred, weight fluctuation, aging, envy, societal messages (the fast food server asks me, "You want that super-sized?" while I study the skeletal body of an actress on a magazine cover), and random electrical impulses skipping crazily around my brain, I cannot accurately process data from my reflection in the mirror. This isn't unique to obese and formerly-obese people, but it's a special burden for us because as we work so hard to lose weight, we are even hungrier for positive feedback than we are hungry for food. For this reason, I suggest that you save your Before photos and one Fat Outfit (no matter how much you hate them), keep records of your body measurements (because sometimes you'll see progress there when none shows on the scale) and document your weight loss surgery journey with monthly photos. Last Monday I looked at myself in my bathroom mirror and thought, "Damn, girl! You look good!" On Tuesday, after a weigh-in that showed no increase or decrease, I looked in that same mirror and thought, "Damn, girl! You are porking up!" At moments like that, it is a great comfort to try on my fat clothes and feel them slide off my body because they're so big, or to set a Before photo alongside a Now photo and be reminded of how far I've come. THE SCALE TELLS THE TRUTH But not the whole truth. The scale weighs your clothes, shoes, fat, muscle, bone and water weight. This data will vary throughout the day as you eat, drink, exercise, urinate and defecate. You can buy fancy scales that will give you readings for total body weight, fat and water weight, and all those values will fluctuate every day. You can't let those fluctuations make you crazy. Recently I tracked my weight every day over the course of a week. It went like this: up, down, down, down, up, up, with a net gain or loss of zero. When I'm trying to maintain rather than lose weight, I'm happy about that. When I’m trying to lose weight, seeing my weight creep up and up as the day goes on does absolutely nothing positive for my weight loss effort. On the day when my early-morning weigh in showed a 3.6 pound increase, I could have let that information spoil my day, but instead I copied my British friend, Kate. I shrugged and said, "Silly cow." My body weight is just one piece of information about me. It does not tell the whole truth of my worth as a human being and a WLS patient. The scale doesn't remind me that I had lost 1.75" from my bust, waist, legs and arms when I measured myself that week. It doesn't remind me that I exceeded my weekly exercise goal by 75 minutes. It doesn't remind me that I met all of my nutritional goals, wrote 20 pages of my book manuscript, had a job interview, gave medication to my dogs, listened to my husband rant after a bad day at work, took one of my dogs to visit the nursing home residents, or any of the other things that are important to me. I realize that the scale is our primary tool for measuring our progress as we lose or maintain our weight, but you can't let it run your life. When an inanimate object starts to dictate your thoughts and feelings, it's time to lock it in the trunk of your car or have someone hide it from you. As Kate says, keep the scale where it belongs: beneath your feet, not in your head.

What if your surgeon could make a case for having to do a revision due to medical problems resulting from your band? Would that speed up the process? Just a thought...

It's infuriating when not everybody is singing from the same sheet of music, but getting angry about it isn't going to get you anywhere unless you decide to find another surgeon and start all over again. Even if your dietitian only gets half a vote in approving your surgery, you can't afford to lose even half a vote. And bottom line is that only a doctor (or in some states, a nurse practitioner) can prescribe medication for you.

Bandster Hell is the period after your surgery and before you've had enough fills to give you optimal restriction. You may be very hungry and feel like you don't even have a band because you can eat anything, in any amount. Surviving that period requires a lot of patience, and most weight loss then is from dieting.

I'm with you on that. And another nasty thing about it is the way it seems to burn as it goes down my esophagus.

I would think so. What does your surgeon say? But... it's hard to predict these things. My recovery from having my flipped port repositioned was harder on me than my original band surgery. My recovery from having my band removed was a piece of cake (but without frosting). My recovery from my sleeve surgery is going fine but it's been harder on me overall - I get tired so easily and don't have much energy. In my general experience of recovering from surgeries (including an abdominal hysterectomy and a breast reduction), the longer I'm anesthetized for the procedure, the longer my recovery. And since any kind of revision requires the surgeon to deal with scar tissue, I think that probably adds to the time you spend in the operating room.

I know your question wasn't addressed to me, but I thought I'd chime in too and mention that the old 4 cc band (no longer in use in the USA) is favored by some Mexican surgeons because Allergan sells it there at a deep discount.

I'll try to make a long story short. I've had "silent" reflux (reflux with no symptoms other than an occasional dry cough)since the mid 1980's. I didn't believe the doc who told me I had reflux, so I didn't treat it (the lesson there is don't self-diagnose). Over the years the acid caused thickening (stenosis) of the walls of my esophagus. I ended up with a severe esophageal dilation because my esophagus wasn't able to move food down into my stomach. Unfilling my band fixed the dilation, but my surgeon felt that a gastric band was incompatible with my faulty esophagus. I agreed to remove my band if we could revise me to the sleeve, but after removing my band, my surgeon discovered a stricture at the base of my esophagus so she couldn't fit the "bougie" sleeve calibration instrument in there. Later I had the stricture dilated and the 2nd attempt at sleeve revision went fine on 8/16/12.

Gas and diarrhea are intestinal problems that are rarely associated with a band slip or pouch dilation. Symptoms of a band slip: vomiting/PB'ing, heartburn, reflux, foaming, chest pain, left shoulder pain, dysphagia (difficulty swallowing). Symptoms of pouch or esophageal dilation: being able (often suddenly) to eat far more than previously; heartburn; regurgitation of food you ate a few days ago.

There's a band-to-sleeve revision forum at VerticalSleeveTalk.com.

I know lots of people who had to wait a few months between band removal and revision surgery, usually because their stomaches needed that time to heal. I tried to do band removal and sleeve revision in one operation this spring and my surgeon wasn't able to do the sleeve because she found an esophageal stricture we didn't know I had, so I ended up waiting about 3 more months for my sleeve surgery. My surgeon says that any kind of revision surgery is riskier and more difficult than a first surgery. And unless the patient is himself a bariatric surgeon, I doubt he's qualified to decide whether a one-step or two-step revision is safe. Nothing wrong with telling your surgeon that a one-step revision is your preference, but if your surgeon says no, I think you should take his/her advice. If you don't trust your surgeon to make the right decision for you, why are you letting him/her operate on you?

Are you saying that Tricare won't cover revision surgery until you reach your 2-year anniversary? I have a friend who revised from the band to RNY, not because of problems with the band but because after losing 100 lbs with the band, her weight loss stopped and she still needed to lose 100 lbs. Tricare covered her revision, which was done about 4 years after her band surgery. She wanted to revise to the sleeve, but Tricare wouldn't cover it.

I didn't get a primer fill during my band surgery. I had a barium swallow the next morning. My surgeon said it was to check that my band was in the correct position and draining freely.

As far as I'm concerned, it's not a new or emerging trend. It's been going on for at least the 4 years I've been paying attention to patient anecdotes. You might be able to find some abstracts of research about the benefits of primer fills by searching at http://www.ncbi.nlm.nih.gov/pubmed/. There also may be information about primer fill research done in the UK, Europe, Australia and New Zealand, where the band has been in use a lot longer than here in the USA. You could also ask your own bariatric surgeon about it (assuming you have one). Ethicon Endo's practice tools for surgeons ony give ranges for initial fills (for example, 3-4 cc for a 9 cc Realize band) and don't specify whether the initial fill should be performed at the time of band placement or in the post-op period, but they stress the importance of evaluating the patient's eating behaviors and other criteria before determining when and how much saline should be added. To me, that implies a preference for post-op versus operative fills, so surgeons who add saline during Realize band placement surgery may be doing so under their own initiative. North American surgeons I spoke to about the Lap-Band while I was researching Bandwagon told me that Allergan doesn't dictate rigid protocols regarding things like how to select an appropriate size band for a particular patient or at what rate/timing to add saline, but you could call 1-800-LAP-BAND and see if you can coax some comments about it out of Allergan.

My surgeon didn't do that because he was concerned that saline in my band combined with surgical swelling would create problems for me. But I've been hearing about surgeons giving "primer" fills for about 4 years now. It makes sense because if you put (for example) a 10cc band in 3 different patients, each with a unique stomach anatomy, the fit of that band may need to be tweaked a bit for each patient using saline. The general purpose answer to your question is that some surgeons are more aggressive about fills than others. It's a matter of their philosophy and their own experience with patience outcomes in their patient population.

My nutritionist told me the same thing, but I was very hungry starting the day after my surgery. Some people lose their appetite for a while from the combination of anesthesia, meds, and swelling, but not all of us. I wasn't given any restrictions on how much liquid I could have. In theory it's possible for anyone to drink too much liquid, which can throw your body out of whack, but I've never actually encountered anyone that happened to. My instructions were to drink 1 oz every 15 minutes, which comes to 72 ounces if you're awake 18 hours a day, and to call my surgeon if I couldn't drink at least 64 ounces a day. If your urine is pale yellow or clear, you're adequately hydrated. If it's medium to dark yellow, you need to drink more liquid.

In almost 5 years of banded living, I drank copiously up until about 5 minutes before starting a meal. Since I got to my weight goal a year after my surgery, I don't think that hurt my weight loss. However, I didn't drink while eating or for 30-60 minutes afterwards (depending on the circumstances).

The official reason for the no drinking while eating rule is that filling your stomach pouch with liquid changes solid food into a sludge that doesn't provide the early and prolonged satiety that the band is supposed to give you. In Australia, where the band has been in use a lot longer than in the USA, current thinking that drinking (that's sipping, not chugging) and eating during a meal are OK. Dietitian Helen Bauzon wrote an interesting article about it: http://www.lapbandtalk.com/page/index.html/_/healthy-living/food-nutrition/yes-you-can-drink-and-eat-at-the-same-meal-time-r63 My own experience was that when I drank while eating, there was nowhere for the liquid to drain, so it came right back up and out my mouth, like a baby spitting up. The resulting fountain (or at times, drool) was not at all socially desirable.

Oooooh! Half a cup of potato salad! Honey, you don't need to kick yourself for that. How much potato salad would you have eaten in one sitting as a pre-op?

My prediction is that your attendance at recovery meetings and your work as a peer counselor will help you tremendously as you move forward. Buena suerte!

I know one person who had band surgery the week after her initial consult with her surgeon, but that was in 2007, she had fantastic insurance, and the surgeon was a general surgeon, not a bariatric surgeon, so he had no hoops for her to jump through. My own band surgery was 4 months after the educational seminar required by my surgeon, and I had lots of hoops to jump through. But again, that was in 2007. Since then, the popularity of bariatric surgery has exploded, putting a huge burden on bariatric clinics who have to hire more surgeons and support staff to respond to the increased demand. Staffing up a bariatric clinic isn't as easy as (for example) hiring Christmas help at JCPenney. You need a highly-qualified staff, and even when they're all in place and ready to go, they can't process patients like widgets on a production line, because each one of us is so unique and our medical problems are usually complex. I know it's frustrating for you, but rushing through the qualification and education stuff before surgery would be a really bad idea. It's possible that your surgeon's office is taking its own sweet time, but it's far more likely that they're struggling to give each patient the attention they deserve. If you absolutely cannot bear another week of waiting, you can try contacting a second bariatric clinic to initiate the qualification process with them. Depending on your geographic location and your insurance requirements, that may or may not speed things up for you. In the meantime, hang in there, and try to distract yourself by learning as much as you can about the surgery itself and what your life will be like afterwards.