Jean McMillan

To tell, or not to tell? That is the question on the lips of many WLS patients. Once again, there’s no one-size-fits-most answer to this question. The decision to tell (and how much to tell) or not to tell is unique to each patients’ unique personality and circumstances. IN & OUT OF THE WLS CLOSET I was happy about my decision to have WLS and thrilled when my insurance company finally approved it. I shared this happy news with many friends, acquaintances, family members, and coworkers. I don’t know but I assume that they discussed it amongst themselves to some extent, expressed opinions or concerns, and perhaps worried about my decision, but none of them gave me frankly negative feedback. They might have been thinking it, but they didn’t say it. I very much doubt I would have reversed my decision if someone had said, “That’s too risky/it’s a bad idea/I don’t want you to/you’re crazy/or whatever.” I’m going to assume that you, the reader of this article, are an adult over the age of 18, with the right to vote, the obligation to serve in the military, and (at some point, depending on your location) the right to purchase and use tobacco and liquor. Unless a judge has declared you mentally incompetent (and that’s harder to accomplish than you’d think), you are the one who’s responsible for your body – for its care and nourishment and any medical treatments or procedures that affect it. So if you’re in the early stages of considering WLS, whose input are you going to trust to inform your final decision? A bariatric surgeon, or your dad? Your primary care physician, or your sister? Your therapist, or your hairdresser? And hey, I’m not slamming hairdressers. Mine could do very well indeed as a therapist, but she has a cosmetology license, not a mental health practitioner license. Last summer I was startled to hear a 50-something bandster state that she had gotten her husband’s permission to have plastic surgery. His permission? Huh? Does that mean he’s the only adult in that relationship, or what? I’m not against asking permission, mind you. I ask my boss’s permission to undertake certain tasks or projects at work; I ask the State of Tennessee for permission (i.e., a driving license) to drive a car; if I still lived in a suburban development, I might ask the zoning board for permission to add a room to my house; I ask the government of China for permission (i.e., a visa) to travel in that country. I’m an extremely independent person in many ways, so I have to stop and think carefully about what I might ask my husband permission to do. We have our own separate checking accounts as well as a joint account, so I might ask him for “permission” to spend a chunk of that joint account on a big purchase like a computer or a car. Everything else gets negotiated. I have a lot of experience in negotiation because of my business career. I negotiated things with everyone from my coworkers to my suppliers. But people who do that kind of thing for a living aren’t the only ones who negotiate, and negotiators aren’t necessarily politicians or manipulators trying to advance some evil cause. My own career as a negotiator probably started when I was a child who realized that good behavior often yielded a treat. My negotiations with my mother went something like this: It’s 7:00 o’clock on Thursday morning. Mom is brushing the tangled cobweb of my hair in preparation for braiding it. I am sniveling because the untangling hurts. The negotiation begins. Mom says: “Jeannie, if you stop whining right this minute, you can have Cocoa Puffs for breakfast.” Jeannie sees an opportunity and negotiates this agreement by asking, “Can I have chocolate milk on my Cocoa Puffs?” Mom sighs and yanks at a hank of hair. Jeannie snivels a little bit more. Finally Mom says, “Yes, you can have chocolate milk on your Cocoa Puffs.” Jeannie instantly shuts up. Negotiation over. It’s a win-win situation. Everybody’s happy… for maybe 15 minutes. In 15 minutes, Jeannie’s hair is finally tamed into two narrow braids and it’s time to choose an outfit for school. This time Jeannie begins the negotiation. “Can I wear my pink dress to school?” Mom says: “That dress is brand new. We’re going to save it for church.” Jeannie says: “I promise not to get it dirty.” And so on and so forth. Well, that’s enough time spent traipsing along Memory Lane. My point (and, like Ellen Degeneres, I do have one) is that the “yes or no” WLS decision is yours. Everything else (how to make it work best; what your family can do to help you; how much to tell your nosy coworker) needs to be negotiated with (or modulated by) the people who will be involved in your WLS journey on a daily basis and possibly renegotiated as time goes on and your needs change. The negotiation may be simple (“Will you take the kids to McDonald’s for lunch if I pick up your dry cleaning?”) or complex (“Let’s talk about how we’ll handle Thanksgiving Dinner this year”) or downright messy (“I feel like you’re trying to sabotage my weight loss.”). That’s life, isn’t it? BE CAREFUL WHAT YOU ASK FOR Getting feedback from others is usually a mixed bag experience. It’s wonderful to get the positive stuff and uncomfortable to get the negative stuff. It’s also very frustrating when your announcement elicits no response at all. What if you tell your sister, “I’ve decided to have weight loss surgery,” and all she says is “Oh.” What’s that all about? She’s shared her thoughts about your hairstyle, your boss, your kid’s struggles with math, your parents’ new car, your high blood pressure and now she has nothing to say about something as momentous as weight loss surgery? If you’re like me, your mind gets busy filling in all the empty spaces with scenarios and speculation. My own little mind is always full of running commentary (most of it – well, some of it – never uttered aloud). When I’m exercising, I’m planning what to wear to work that day. When I’m driving to work, I’m considering the best way to write the first or fifth or fifteenth sentence of my next article. When I’m driving home at the end of that day, I’m replaying a conversation I had with a coworker and fiddling with what I could have said better. So when I encounter my complete opposite (someone who has nothing to say on a matter that’s important to me), I cast my fishing net into my teeming mental pond, scoop up a dozen squirming fish, and off I go into Wonderland. “Wonderland” as in the land where I wonder, and wander, on an endless circular track. Around and around Jean goes, and where she stops, nobody knows, least of all Jean. The official term for that is “projection”. You project your own internal drama onto someone else’s blank white movie screen without having the first clue about what’s really going on behind that blank screen. You’ve known your sister all her life, ever since she supplanted you as the baby of the family. That’s what, 35 long years? After 35 years together, you might think you could predict her reaction to almost anything, but it’s also quite possible that you cannot correctly read her mind. Your suspicions about her reaction to your weight loss surgery announcement may be accurate, but you’ll never know that unless you specifically ask her. That’s more or less what happened to me when I first began discussing weight loss surgery with my husband. We had been married for 20 years, so he had two long decades of experience with his wife launching herself into risky situations (be it a new job, an overseas trip, adopting a pet, redecorating a house, taking fen-phen). He had been amazingly patient through all of that, not just because he loves and supports me but also because he knows that hell hath no fury like Jean with an obstacle in her path. So when I said, “Today I made an appointment to go to a bariatric surgery seminar,” and he said nothing in response, a dozen things ran through my mind. He thinks I should be able to lose weight by dieting. He doesn’t want me to lose weight because he likes fat girls. He thinks this is another of Jean’s wild goose chases and if he leaves it alone, she’ll get over it and move on to some other project…and so on and so forth. What was actually going on in his head was probably more like, “I wonder if there’s more rice in that saucepan, but if Jean forgot to buy soy sauce again, I won’t have another helping because I can’t eat rice without soy sauce. If Jean has weight loss surgery, will we ever get to eat rice with soy sauce again? Will we be living on warm water and melba toast? Did I remember to fill the cat’s water dish before I came in the house? We really need to get the cat fixed but I don’t want another argument about whose turn it is to take a critter to the vet. Oh no, Georgie’s puking in the living room again. If I ignore it, can I get Jean to clean it up? I’m going to write SOY SAUCE on the grocery list in big letters so Jean won’t forget to buy it. Maybe if I ignore the weight loss surgery thing, it’ll disappear, like Georgie’s puke”…and so on and so forth. I’m not trying to make my husband’s thought processes sound asinine (for a taste of truly asinine thinking, you really need to listen to a few minutes of my own stream of consciousness). I’m just making the point that our minds are full of stuff that may be worthwhile or interesting to us but doesn’t necessarily have to be shared in detail with everyone around us, and that nobody but the Amazing Kreskin can hear someone else’s thoughts. When my husband finished his dinner (without a second helping of rice) that night without making any response to my bariatric ambitions, I asked him, “So what do you think of the idea of me having weight loss surgery?” And he said, “I’m not crazy about it, but if you really believe it will help you, I’ll do my best to support you.” And what did I say to that? All I said was, “Thank you.” I could have said a lot of other things. I could have said, “Why aren’t you crazy about the idea?” I could have quizzed his knowledge about weight loss and weight loss surgery. I could have asked him if he would still love me and desire me when I was thin. I could have gone on and on for hours, while adding to my own anxiety and creating a host of brand new anxieties in his poor head. But instead I said, “Thank you,” because his promise of support was all I needed to hear at that time, and we had a lifetime of conversations ahead of us. And I said “Thank you” because when I’m in the planning stages of something big that will require a group effort, I try not to invite discussion that will derail the whole project even before its engine starts. You may have a different style, and you may think I was postponing a discussion that should be tackled immediately, but my approach is: one step at a time. I don’t try to build Rome in one day. I pick up one brick, walk it over to where I want the wall, put it down, and go back for another brick. Eventually the wall (or Rome) gets built. IN & OUT OF THE BAND CLOSET My feelings about sharing my WLS journey with other people have changed as time has gone on. For three months before and about 18 months after my band surgery, bariatrics was the #1 subject in my mind at least 75% of the time. I had to exert effort to not talk about it constantly. If I hadn’t discovered online WLS forums, where I could talk about it constantly with other people who talked about it constantly, I think my head may have exploded. I didn’t talk about WLS with every single person in my everyday circle of friends and acquaintances (for example, I decided not to tell my church friends about it, mostly out of laziness), but most of the people who knew me as obese also knew about my surgery. When I had lost my excess weight, the focus of my life began to shift to other things. Yes, bariatric surgery was still important to me, and so fascinating that I wrote a 500+ page book about it, but as my interests and activities grew and changed, I acquired a whole new set of friends, acquaintances, and coworkers who had never known Fat Jean. It didn’t occur to me to tell them I’d had WLS any more that it occurred to me to tell them I’d had a hysterectomy or hemorrhoids. If the subject of weight loss or dieting or exercise came up, I was willing to talk about those topics, but not necessarily in the context of weight loss surgery. I guess you could say I was in the band closet then, though I won’t admit to hiding in there. I still wanted to talk about bariatric topics, but not with the general public. I made two new friends during that time who know about my band surgery. One of them had heard about it from her mother (a former coworker of mine) and the other heard about it from me. Otherwise I was kind of enjoying being perceived as a “normal” woman by people who couldn’t even imagine me as a fat woman. But one day my feelings changed. I opened the door of my band closet and peered out. It was time to get out of there. Here’s what happened. During an exercise class at my fitness studio, another (naturally slender) student began making fun of fat people, and a few more people there chimed in. They just couldn’t imagine how someone could “let themselves go” like that. It sounded to me like these well-meaning people were saying that obesity is a choice – that the fat people had made a conscious decision to overeat, under-exercise, and gain an unhealthy amount of weight. It sounded to me like these well-meaning people were saying that fat people don’t have the willpower or intelligence to maintain a healthy weight. And suddenly I heard myself say out loud, “Those people aren’t proud of their fat. Don’t be making fun of them.” After a minute or two of mumbled objections, those well-meaning people fell silent, and soon the conversation took a new direction. Months later, when I was about to publish Bandwagon Cookery, my friend, instructor and personal trainer, Caroline, suggested holding a book-signing event at the fitness studio. At first I was wary of the idea. It would require me to step out of the band closet and expose my bariatric secret to a community of people who had never known Fat Jean. It would require me to step out of my comfort zone and into the limelight. I’m not afraid of public speaking – I actually enjoy it in most circumstances – and I’ve told my WLS journey story plenty of times, but mostly to bariatric patients and professionals. At Caroline’s loving insistence, we hosted the book signing, which was well-attended by women for whom weight management was an interest but for whom obesity was not an issue. One of them had a sister who was banded, but the rest of the guests were blank slates when it came to bariatrics. I want to share with you what I told this audience after announcing that I had weight loss surgery, something that I felt they needed to hear before I could tell my nitty-gritty obesity story: “I need to talk about the elephants in the room. The elephants are the beliefs that many people have, that obesity is a moral failing and that weight loss surgery is taking the easy way out. Obesity is not a choice, nor is it evidence of inadequate willpower. It’s a chronic and incurable disease caused by a combination of genetics, environment, and behavior. Weight loss surgery is the only effective long term treatment for obesity available in the United States today. And weight loss surgery is by no means the easy way out. Weight loss is hard work with or without the help of surgery. Has my weight loss been easier because I had bariatric surgery? Of course it has. That’s one of the reasons I chose surgery – because without it, my previous weight loss attempts had been so difficult and so ineffective. “I’m glad to have my Lap-Band, but it’s just a little piece of plastic, a tool that reduces my appetite. When I stick my hand in a bag of potato chips, my band doesn’t yank it out again. When my alarm goes off in the morning and I want to roll over and go back to sleep, my band isn’t what gets me out of bed, into workout clothes, and into this fitness studio. When I’m thinking that I need a 2nd helping of mashed potatoes, my band doesn’t shout, “Don’t do it, Jean!” When I’m sad and thinking that buying and eating a gallon of ice cream would make me feel so much better, my band doesn’t hide my car keys on me. “I am the one who makes decisions about what I eat and how I exercise. I am the one who’s responsible for making good food choices and changing my eating and exercise behavior. So I get the credit for my weight loss, and I’m the one who has committed to maintaining that weight loss for the rest of my life.” Looking back, I’m not sure how much of an impact that speech had on any of my listeners, but it had an impact on me. Hearing myself say those words affirmed my important and life-changing decision to have bariatric surgery. Whatever you do as you go forward on your weight loss journey, be proud of what you’re doing. It’s a courageous thing. If no one else congratulates you for the undertaking, you should still pat yourself on the back for it.

Aha! I knew that title would get your attention! Are you thinking that Jean, a very vocal, longtime band fan, has finally lost her mind (on which she never did have a very firm grip)? No, I haven’t lost my mind. I still think the band is grand and I still wish I still had mine, but because I want everybody to succeed at weight loss, I feel duty-bound to tell you some reasons not to have adjustable gastric band surgery. So here goes, in no particular order. Don’t have band surgery if… You’re phobic about needles. Right now, a needle is the only way to get fluid into the band. The fill needle is not a big, scary one, and you don’t have to look at it at all if you prefer, but it’s still a needle. You believe that band surgery cures obesity. Obesity is an incurable, chronic disease with the very real potential for recurrence. Weight regain can happen to anyone. You think that once you get to your goal weight, your weight loss journey stops. Nope. It’s only just begun. Next you’ll have to maintain that weight loss for the rest of your life, and that takes vigilance and hard work. You’re a self-pay planning on having surgery in Mexico or elsewhere out of country. What are you going to do if you have a problem or complication or just need another fill or unfill? Travel back to the Mexican clinic? Try to get help locally? Finding a US-based bariatric clinic that will accept patients who had surgery overseas is not easy, and once you do find one, you’re probably going to have to pay a non-refundable program fee, from $200 to $2000. You can’t afford the time and expense for frequent follow up visits for fills, unfills, and other medical care. Even if your insurance covers those visits, you’ll have to take time off work, arrange for child care or pet care, fill your car’s gas tank, and shell out a co-pay. You're a self-pay and don't have money or plans for dealing with fills, unfills, and possible complications. See above. You hope to lose weight without getting any fills. Sorry, but it probably won’t work that way. See above. You expect to lose a pound+ a day. Average weight loss with the band is 1-2 pounds/week. That average includes people who lost weight faster as well as people who lost no weight at all. Rapid initial weight loss is usually related to fluid retention, not fat loss. You believe that slow weight loss with the band will prevent sagging skin. According to several plastic surgeons I’ve asked about this, your age and genetics have the most influence on how your skin will respond to massive weight loss. The rate of weight loss has little or anything to do with it. You expect to experience restriction and lose weight steadily from the moment you wake up after surgery. Most band patients need several fills to achieve optimal restriction, plus more fills and unfills (or adjustments) to maintain that restriction, and virtually no one loses weight at a steady rate. My weight loss was extremely uneven – down 1#, down .5#, up .75#, down 1.75#, down 0/up 0, down .25#, and so on. You believe in the sweet spot or perfect restriction. Restriction is constantly changing, just like our bodies, because of dozens of quite ordinary factors (food choices, eating and drinking habits, weight loss, time of day or month, illness, medications, stress, etc.). If you think you’ll lose weight only at the mythical sweet spot, you’re going to spend energy on frustration that could be better applied to changing your eating behavior. You’re not willing to follow pre- and post-op liquid and puree diets. No, liquid and puree diets are not fun, but they’re short-term. When I was banded, I had 36 years ahead of me, assuming that I live as long as my mother did. That’s 12,672 days. My pre- and post-op liquid diets used up a whopping 17 days. Do the math. Even if you add in post-fill liquids and purees, those liquid and puree days represent a teeny, tiny fraction of my life. You believe you’ll never be hungry again. Maybe, maybe not. The fact that you feel hungry 5 hours after a meal doesn’t mean your band isn’t working. It just means that your body needs fuel. And part of your ongoing work as a bandster is going to be figuring out whether you’re feeling physical hunger or “head” hunger. You think the band is going to do all the work for you. The band has no magic ingredient that triggers weight loss once it’s wrapped around your stomach. All it does is affect your hunger and appetite. The band is not going to make good food choices, practice portion control or banish the demons who make you eat when you’re stressed or bored. Nor is it going to exercise for you. Success with the band is the result of a joint effort between you, your band, your surgeon and dietitian. Have a don't-have-band-surgery reason to add to this list? Post it in the comment section!

Is it true that weight loss with the band is basically the same as weight loss with a diet? And if it is, why have surgery at all? From time to time, a bandster will comment (sometimes in the context of a complaint, sometimes just in surprise or confusion) that weight loss with the band is basically the same as weight loss with a diet. They’re disappointed by this. They expected WLS to make weight loss easier than it is with dieting, and while that's true, it's only part of weight loss success. They may hold the mistaken belief that the band itself is what causes weight loss, but that’s not true either. The band is just a piece of plastic. Although it’s inside the patient’s body, it 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. After reading that long list of what the band doesn’t do, you may be thinking that it’s a mighty expensive and not very helpful weight loss tool. Why go through the risk, trouble and expense of WLS when you could achieve the same results with plain old dieting? HALF EMPTY OR HALF FULL? Here’s some news that may shock you: I lost 100% of my excess weight by dieting after my band surgery. My dietitian gave me a food plan to follow, and I followed it. It never occurred to me to do otherwise or to complain about that because my bariatric team had made it clear that I, not my band, was going to have to make some significant lifestyle changes in order to succeed. It wasn’t until after the excess weight was gone, after a big unfill to treat an irritated esophagus and stoma (after swallowing a large, corrosive antibiotic capsule), that I realized how much my band had been helping me by reducing my appetite and giving me early (if not always prolonged) satiety. I had been taking my band for granted – out of sight, out of mind. I suppose it’s possible that I had been experiencing a placebo effect; that my band worked for me simply because I believed it would. If so, it was a remarkable and long-lived placebo effect. It wasn’t until my band was being refilled after a complete unfill (to treat a band slip) when I was 3 years post-op that I experienced a stunning, “Oh, so this is what it’s all about!” aha moment. My experience of restriction then was quite different than it had been the first time around, because I understood more about my band’s effects and how to optimize those effects, and because my body had changed so drastically since my surgery. Whether your 8-ounce water glass is half empty or half full, it still contains 4 ounces. Getting the most out of those 4 ounces is largely a matter of attitude adjustment. You can accept that you have 4 ounces, then make the best of it, or you can give up all together and spend your life in wistful regret. You can find another way to fill your WLS glass – complain to your surgeon, or the band manufacturer, revise to a different WLS procedure – or give up altogether and spend your life in angry regret. Taking the “half full” viewpoint may be easier for me than for others because I’m an opportunist who actually enjoys making a silk purse out of a sow’s ear. Webster defines “opportunist” as one who uses the art, policy, or practice of taking advantage of opportunities or circumstances, often with little regard for principles or consequences. Since I do have immense regard for principles and consequences, perhaps I’m not a classic opportunist. But I see nothing wrong with taking advantage of opportunities and circumstances when my own careful plans aren’t working or have led me into unknown territory. Resourcefulness has been a handy life skill for me. BUT I WANT IT TO BE RIGHT THE FIRST TIME I do know what it’s like to be disappointed with a purchase, though, be it a band, a blouse, or a bicycle. I want the item I purchase to be suitable, if not perfect, for its intended use. During a shift at my retail “day job” the other day, I helped a customer whose garment size wasn’t in stock. She didn’t want to order that garment – she wanted it now, so much so that she considered buying the wrong size and having it altered to fit her. Before I could volunteer an opinion, this woman uttered the very words I was thinking: “I hate to pay good money for something new and have to alter it. I just want to buy it and wear it.” If I were a better (or pushier) salesperson, she might have bought that garment, but I’m not and she didn’t. If your adjustable gastric band hasn’t (yet) lived up to your expectations, you do have my sympathy. It’s not easy – if even possible – to return a disappointing medical implant, and it’s maddening to have to “alter” it (by dieting, for example) to make it work for you. I could tell you (unhelpfully) that your expectations were not realistic, but it’s also possible that your surgeon educated you well, you’re a “compliant” patient, and yet your band just isn’t up to snuff. According to Doctors Jerome Groopman and Pamela Hartzband, authors of Your Medical Mind, “Medicine is an uncertain science.” No one, not even your doctor, can say with certainty what impact a condition “will have on an individual’s life or how someone will experience the side effects from a particular treatment. Each of us is unique in the interplay of genetic makeup and environment. The path to maintaining or regaining health is not the same for everyone.” Doctors Groopman and Hartzband go on to describe what they call the ‘focusing illusion’. “In trying to forecast the future, all of us tend to focus on a particular aspect of our lives that would be negatively affected by a proposed treatment. This then becomes the overriding element in decision making. The focusing illusion neglects our extraordinary capacity to adapt, to enjoy life with less than ‘perfect’ health. Imagining life with a colostomy, after a mastectomy, or following prostate surgery can all be skewed by the focusing illusion. We cannot see how the remaining parts of our lives expand to fill the gaps created by the illness and its treatment.” Despite carefully-devised formulas and scoring systems (intended to direct resources and money to those most likely to survive) for calculating a patient’s chances of surviving a treatment or illness, doctors are lousy at predicting outcomes. A study in England found that one out of 20 ICU patients who doctors predicted would die actually lived, and most of those who survived had a good quality of life. I don’t think that’s a sign of medical incompetence. I think it’s a sign of the unquenchable human spirit and its enduring will to survive and even thrive against all odds. One of my life goals is to survive and thrive, no matter what. That’s an ambition you can’t get from a medical device or bottle of medicine. It comes from within you, and if you think you don’t have it, or not enough of it, I suggest that you look again. You might be pleasantly surprised.

A weight loss plateau or stall is a temporary cessation of weight loss that can happen at any point in your weight loss surgery journey and can last days, weeks, or months. Plateaus happen to almost everybody sooner or later (no matter what means they're using to lose weight), no matter how hard they work at weight loss. Why do plateaus happen even when we’re doing all the right things? The human body wants to preserve itself. It fights weight loss by adapting the metabolism to accommodate decreased calorie intake and/or increased calorie output. The body's new plan of attack is multi-pronged: increase calorie intake by making you hungrier (so you eat more), use less energy to accomplish physical activity (so you burn fewer calories) and hold on to stored fat (so it can use it for energy). I think plateaus often happen because we're in a rut. So even if you believe you're doing all the right things in terms of diet, exercise, and mental or emotional effort - try changing them. If nothing else, it will prevent boredom and help you feel that you're taking positive action instead of being a victim of fate. Here are some things you can try to shake up your routine. Change the intensity, duration, frequency and type of exercise you're doing, so your body doesn't become too efficient at burning calories when you work out. Don't neglect strength training - muscle burns far more calories than fat does. Don't over-train - take one day off exercise a week. Plan all your meals (the "how much" as well as the "what"). Weigh and measure your food before you put it on your plate. Log your food intake - you might be surprised to see what and how much you're really eating. Try calorie shifting: vary your calories - eat 1200 one day, 900 the next, and so on, to keep your body guessing. Eat 3 small meals and 3 healthy snacks a day instead of 3 meals a day. Increase your water intake. Decrease your sodium intake. Don't weigh yourself every day - switch to once a week. Don't skip breakfast. By the way, if you weigh yourself every day and think that no weight loss for three days running is a plateau, you're going to have a long journey ahead of you. Get off that scale, now! I have one more suggestion that you probably won't want to hear: CULTIVATE PATIENCE. No, it's not one of my virtues, either. Give it a try anyway.

I don't know how the plication aspect affects fills. Will be interested to hear what your experience is. 1. but how much do they put in the first time? Depends on your surgeon's protocol & your band size, plus more (see question #3) 2. is there a set (amount)? Not that I've ever heard of. 3. what do they base it on? Your weight loss, your symptoms/side effects (if any), what and how much you're able to eat, and how long your meals keep you satisfied (in terms of physical hunger). 4. do you feel sick to your stomach afterwards? If you mean do you feel nauseated, no, I never did. Other than my reaction to the general anesthesia, nothing related to my band ever made me feel nauseated. Eating mistakes occasionally made me PB, but that's not the same as vomiting and I experienced no nausea. 5. can you request very small amounts instead of 1 or 2 cc's? Sure. Your surgeon may have other ideas about appropriate fill level amounts. If you're not comfortable with a fill amount he wants to use, tell him. Presumably he'll be willing/able to explain why he feels that amount is appropriate.

My favorites: 1. Combine 3 scoops Click Vanilla Latte protein powder, 1 cup unsweetened almond milk, 1 cup cold water. Blend and serve over ice. 2. Combine 1 cup cold brewed coffee, 1 cup fat free milk, 2 tbl sugar-free caramel or vanilla syrup. Serve over ice.

I agree with the others. That night choking business is serious because if you aspirate stomach contents (food, bile, etc) into your lungs, you're going to be in big trouble. Even a tiny unfill can relieve the symptoms without compromising your restriction.

Yes, a complete unfill and 6-week rest period cured my band slip. Whether surgery is needed to correct a band slip will depend on how bad the slip is and how it slipped (up or down). If your only symptoms were reflux and eating problems, the unfill may do the trick for you. When the lower portion of the stomach moves up above the band (called a prolapse), often caused by vomiting, the blood supply to the stomach can be compromised. That causes severe pain and possible death of the prolapsed portion.

I know a number of people who've had their bands removed due to complications (me included) and all of them regained weight. Why do you want your band removed? I mean, is there a medical reason to remove it? Or are you just afraid that leaving it in there will cause you problems in the future?

Welcome, and congrats on the start of your weight loss surgery journey! You'll find lots of info here just by cruising the forums and asking questions as they come to you.

Are you on a liquid diet? If so, liquid in = liquid out.

Ask your surgeon for a prescription for anti-nausea meds.

You go, girl! I'm really impressed that you've been working out at home, because I'm so terrible at that - I use my fitness studio membership as my exercise "conscience".

No, I didn't have an irrational fear of something happening to me, maybe because I'd survived so many other surgeries by the time I was banded. But I can tell you that you are absolutely not the only person that's ever felt that way, and everything seems harder when you're on a liquid diet. It's hard to deal with irrational fear. You can sit it down and try reasoning with it, but it generally doesn't listen to reason and doesn't follow any rules of logic. Maybe you could just give it slap upside the head. And then take a deep breath. It's going to be OK!

I haven't had an umbilical hernia (I do have a hiatal hernia, but that's another story), and I'm not a doctor, but I can't see why that would delay your band surgery, and your surgeon might even be able to repair the hernia while you're anesthetized for band placement. Good luck!

He may not be getting updates from your PCP unless you specifically tell your PCP to update him and sign a waiver to allow them to share your medical info. That must have been a mighty painful fill to prevent you from getting another one in 3 long years, and it's hardly surprising that your weight loss has been disappointing because the band doesn't usually work very well without fills. I wouldn't give up on it too quickly, though. You can ask for a shot of lidocaine to numb your abdomen to make another fill more comfortable.

I don't know how far you'd get with that. None of the papers I signed for my band surgery said anything about guaranteed results or guaranteed no complications. Have you talked with your surgeon about it?

Every dietitian and doctor I've asked about this has said that yes, starvation mode in WLS patients exists in that extreme calorie deprivation will eventually cause your body to do everything within its means to conserve calories and store fat for current and future use, but not in the sense that we're actually going to starve to death. That could contribute to weight loss plateaus, but it's not necessarily going to permanently stop weight loss.

Consider your butt kicked, but to be perfectly honest, a 1756 calorie day is not the end of the world, especially considering that you burned 961 of those calories in exercise and yard work. When I think back on how I ate pre-op, I easily consumed 1756 calories in a single meal!

I can't remember how often I was supposed to change the packing. At least once a day, for sure, using both the sterile gauze and the gel.

Wow. All I know about closing that hole is that it'll take a lot of patience. I had 2 holes that refused to close after my breast reduction and had to keep packing them with the gel and sterile gauze for several months. They did eventually close, though. Good luck!

Welcome, Trixie. I live in NW TN and am also a patient of Dr. Weaver's. She is wonderful! She didn't do my original band surgery, but I wish she had. My PCP was not on board either but I called his nurse to request a referral letter, and she wrote it, printed it out, and somehow got him to sign it. If that hadn't worked, I would've asked my gynecologist, who was/is very supportive about WLS. I wish I could give you a recommendation for a WLS-friendly PCP, but there must be thousands of PCP's to choose from, and if they aren't part of your insurance policy's provider network, you may not get very far with them. I feel compelled to tell you something about the St. Francis bariatric surgery program. They don't do a great job of support for bandsters because most of their patients walk in asking for the bypass. Some of the information about the band given out at the St. Francis support group meetings and nutrition classes is inaccurate or misleading. Don't get me wrong - I think very highly of St. Francis - but if you hear something there about the band that worries or puzzles you, feel free to ask me for another (non medical professional) opinion.

The sleeve surgery involves putting a staple line along the stomach to create a small, banana-shaped (or sleeve) stomach, after which the surgeon cuts away and removes the rest of the stomach. In plication, the surgeon reduces the size of the stomach by making a pleat in it and securing it with staples. So no part of the stomach is permanently removed. I know 3 people who've had the band with plication. One has lost an enormous amount of weight (but she has a lot to lose - started at almost 500 lbs), one I've kind of lost track of, and the other just had her surgery last month. I'll ask her to drop in on this thread and give you her comments about it. The band with plication has very good results so far, but it's too new to have accumulated any stats about long-term weight loss and possible complications.

Yes, I'm afraid I have. I had a complete unfill in February and since then have gained 25 lbs. I haven't been pigging out, but I'm physically hungry most of the time and eating bigger portions.