Jean McMillan

What happens at your pre-op appointment depends on your surgeon's protocol. As I recall, my pre-op appointment I spent some time with my surgeon (last-minute questions), his nurse (going over what was going to happen at the hospital before and after surgery, and my post-op instructions), and the dietitian (going over the pre-op and post-op eating plans). I also had to sign release papers.

So a revision request never got submitted to your insurance? You might want to ask about that again, because my revision was approved when my BMI was only 26.6. Apparently my insurance company decided that since my band removal was due to medical problems, and they'd already made an investment in my bariatric health back in 2007, they were willing to OK the sleeve. It'll depend on the insurance policy, but it doesn't hurt to ask.

I had my band completely emptied in February removed in April because of esophageal problems apparently caused by reflux. I had hoped to revise tot he sleeve but my surgeon wasn't able to do it because of a stricture we didn't know I had. I've re-gained 24 lbs since my unfill. I know a few other people who had their band removed for various reasons, and unfortunately they've all regained some weight. I regained weight so quickly at first that I was shocked, because I wasn't pigging out, just eating bigger quantities of healthy foods. My gastro-enterologist said that was my body's response to what it had perceived as long-term starvation/deprivation. Now that I can eat easily, my body seems to be holding on to every freaking calorie I eat. I still plan to revise to the sleeve. If I were you, I'd want some sort of revision, but not until your doctors have a better explanation (and treatment)for those pre-cancerous cells in your stomach. Good luck!

Since you'll have justed started eating a normal diet, my #1 advice is don't take chances. Don't order foods that you haven't yet eaten as a post-op. When in doubt, order Soup. If you'll be traveling by air, airline food is only an issue on long flights, on which you may be able to order a special diet meal (vegetarian, etc.). Bring non-perishable Snacks with you (Protein bars; granola bars; jerky; single-serving applesauce, fruit, or dry cereal; packets of protein powder). Most full-service restaurants serve things like oatmeal, yogurt, soup, smoothies, juice and milk, and hotel shops often have a refrigerated case stocked witgh juiced, iced tea, milk (ignore the soda), though their packaged snacks (chips, crackers, cookies) are best ignored. Restaurant eating tips: order an appetizer or a half-size entree; avoid buffets; order a child's meal (if there's a healthy-looking choice on the menu); order an extra vegetable instead of potatoes, rice, Pasta or other starch; order salad dressing, sauce, or condiments on the side so you can control the portion size; put a napkin or bread plate over your beverage glass so the server won't fill it; avoid alcohol; always locate the restroom before you start to eat, just in case you have to leave the table in a hurry. Who was it that asked if you have any special food needs? Is it someone you've met before, or are likely to meet in the future? Does this person reasonably have control over all the foods you'll be offered during the trip? Will you be seeing anyone you've previously met, or will it be strangers who know nothing about you? You don't owe anybody, stranger or not, any explanation about anything unrelated to the business at hand. In social situations, there are dozens of things you can talk about that have nothing to do with your eating. You can not tell anyone you'll be traveling with or visiting that you've had bariatric surgery and just wing it, or you can tell them you're recovering from (unspecified) surgery and give them some guidelines (see above). I have an acquaintance who told her coworkers she was recovering from surgery to repair a hiatal hernia (which was part of the truth), and another (whose coworkers were mostly men) who explained she'd had surgery for "female trouble" (almost guaranteed to turn them off). You could also say you're recovering from oral surgery. The problem with telling those little white lies is that there's always a chance you'll run into someone who also had that kind of surgery and would love to talk about it in detail. My own approach is to not explain anything and not do anything to call attention to the way I eat. If coworkers get nosy about it, I change the subject or give myself an exit line (like, "Oh, there's Bob. I've got to ask him something before I forget, so excuse me.")

I've done a fair amount of business and other travel since being banded and might be able to give you some suggestions, but I need to know what post-op diet phase will you be in then? Purees? Soft foods? Solid foods?

Jessie Ahroni's book, Laparascopic Adjustable Gastric Banding, has an excellent section entitled, "How Can I Tell If I'm Perfectly Adjusted?" While I'm not sure there's such a thing as "perfect" adjustment (for me, "almost perfect" works very well), Jessie gives helpful lists of questions to ask yourself to determine if you need an eating adjustment, a behavior adjustment, an acitivity adjustment, an attitude adjustment, or a band adjustment. There are dozens of things that can affect your weight and though not all of them are within our control, quite a few of them are. I like re-reading Jessie's questions because she reminds me of things I'd overlooked or forgotten.

I haven't had that on the pre-op liquid diet, but on the post-op diet, yes. For me it's crampy diarrhea from consuming only liquids. Depending on what liquids you've been drinking, it could be related to lactose intolerance or an overload of artificial sweeteners. Hope you feel better soon.

Yes, an EGD or upper endoscopy involves putting a scope down your throat and into your stomach, while you're sedated, so not something you'd want to do while pregnant. You shouldn't have an upper GI while pregnant either. A common symptom of band erosion is an infection at the port site (from bacteria traveling along the tubing). The port site would be red, swollen, and hot to touch. Minor erosions are often "silent" (no symptoms). Other signs of erosion include fever, back pain, difficulty eating, complete loss of restriction. You really need to discuss this with your surgeon, and maybe have a complete unfill to reduce the amount of stress on your stomach and esophagus.

Yes, it could, but you might also need an EGD.

Your doctor should have told you what to do about taking time off work. For every EGD I've had, I was told not to drive, operate machinery, make important decisions, or sign any legal documents for 24 hours after the procedure, because of the sedation given. You'll need to bring an adult with you. The procedure itself is quick - maybe 5-10 minutes - but the prep (checking you in, putting in an IV, waiting for the doctor) and the recovery (waiting for you to wake up enough to get up, get dressed, and walk out. What to expect: check in, be put in a curtained cubicle, change into a johnny, lie on a gurney, have an IV put in, talk to the anesthetist, and wait for the procedure to start. Be wheeled into the procedure room, say hi to the doctor, be rolled over on your side (usually the left side), and lights out when they start the sedation. Wake up in your cubicle, talk to the nurses and doctor, get your discharge instructions, get dressed, go home. You might have a sore throat from the scope. Doing an EGD is a way for the doctor to get the lay of the land (so to speak) in your upper GI tract. He/she might find a hiatal hernia that needs to be repaired during your band placement. They'll look for any other structural abnormalities in your esophagus and stomach, and for signs of disease, like ulcers, that might need to be treated before your surgery. I've never heard of anyone being disqualified from band surgery because of the findings of an EGD, so you need to ask your doctor about that. Edited to add: Also, don't drink or eat anything after midnight the night before unless your doctor says it's OK to take a medication (like blood pressure meds) with a tiny sip of Water.

Seems like everybody hits a weight loss plateau sooner or later. Soooo frustrating. I don't know enough about spinal stenosis to know what exercise is appropriate for you, but surely the doctor (orthopedic?) who monitors your spinal problem could recommend something? A physical therapist that I've worked with in the past has mentioned that Water exercise can be very helpful and my mom participated in a chair exercise program for a while. Also, I just wrote an article called Breaking a Weight Loss Plateau. You can read it here: http://www.lapbandtalk.com/page/index.html/_/plateaus-and-regain/breaking-a-weight-loss-plateau-r67

EAting solid protein is what satiety is all about!

So, what is your question? Are you asking if your band's increased tightness is related to eating under 1000 calories a day? If so, I doubt it. There are lots of things that can cause variations in your experience of restriction. Time of day, time of month, hydration, seasonal allergies, illness, medications, Fluid retention, stress, etc. etc. If the only consequence of this increased tightness is that you get full faster, that's great, but if you find you're unable to meet your nutritional goals each day and/or are unable to drink liquids, give your surgeon a call.

Could be esophageal spasms, but since chest pain can also be a cardiac symptom, call your surgeon and go to the ER.

Been there, done that, and didn't even get a tee-shirt. Like you, I found that my experience of restriction was different after a complete unfill, and a lot of people find the last 20 or so pounds hard to lose. IMO, the most important thing to address is not your weight gain but the reflux. I recently learned how severely reflux can damage the esophagus and wouldn't want you to lose your band because of tolerating reflux for an extended period of time. Have you tried taking omeprazole for it? Do you avoid eating a few hours before bedtime? As for the weight loss puzzle - I just wrote an article about breaking a weight loss plateau. Check it out here: http://www.lapbandtalk.com/page/index.html/_/plateaus-and-regain/breaking-a-weight-loss-plateau-r67

I know that delayed restriction and slow weight loss are frustrating, but I don't think it's fair to say that they mean your surgery was a waste of time. You're young (compared to me!) and have a long lifetime ahead of you (God willing). If you could lose your excess weight and keep it off for the rest of your life without surgery, then maybe surgery would be wasted time & effort, but if you could do that, wouldn't you have already done it by now? The band is a tool for lifetime weight management.

Welcome, Gregg, and congrats on being banded. Everybody's pain tolerance varies. I've been told that bandsters who had a hiatal hernia repaired during their surgery experience a bit more pain because of the work done on the diaphragm. That work on the diaphragm, plus the gas used to inflate the abdominal cavity during surgery, can cause quite a bit of pain in addition to any discomfort from incisions. Some of that pain can be "referred" to the left shoulder due to quirks in the nerves in the upper GI tract. I found that moving around a lot (which also helps prevent blood clots) was the ony thing that helped the gas, but some people have found that Gas-X helps with that. I did OK sleeping in my own bed, propped up with LOTS of pillows, but if you're more comfortable sleeping in a recliner, you won't be alone. Lots of folks sleep that way when recovering from surgery. When you're sleeping in your own bed, what body position do you favor? I'm a side-sleeper so I clutched a big bed pillow to my tummy and leaned on it a bit to find a comfortable position. If you're a tummy sleeper, you may be out of luck for the moment. If you sleep on your back, you should be OK except when trying to get in and out of bed. My technique for that is: GETTING INTO BED: 1. sit on the edge of the bed at the approximate point where your butt would be if you were asleep in it, turned slightly so that you're looking at the foot of the bed. 2. using your arms to brace yourself, fall as gently as possible onto your back, then wiggle as necessary, holding a pillow against your abdomen if need be, until you're more or less in your desired sleeping position. GETTING OUT OF BED: 1. Holding a pillow against your abdomen, roll onto your side so that you're facing the edge of the bed. 2. Bend your legs so they're right at the edge of the mattress. 3. Use your body weight to lean forward so you "roll" off the bed onto your slightly-bent legs, and slowly stand up when your feet hit the floor. I think I need to make a video of that method because words don't seem to do it justice! Finally, about the pain medication. Narcotics are wonderful, but the limitations are that it's constipating and it's depressing. It depresses your respiration and your nervous system. For me, that results in low energy and a depressed mood. So at some point pretty soon you'll want to start cutting back on the pain meds. Your doctor's the best one to tell you how to do that. What I did was start spacing the doses out further apart, then took half the dose each time, then took a dose only once a day, then none at all. You shouldn't be driving a vehicle while on pain meds so that might be an additional incentive for you to taper off them. Hope you feel better soon!

Helen, You may be able to avoid (or at least minimize) future brou-ha-has about your articles by including a disclaimer before or after the article text. Here in the litigious USA, even highly qualified medical experts find it necessary to use the language shown below when publishing material aimed at end-users, patients, or consumers: The information contained herein is intended solely for the general information of the reader. It is not to be used for treatment purposes, but rather for discussion with the reader’s own physician. The information presented is not intended to diagnose health problems or to take the place of professional medical care. It is neither intended to dictate what constitutes reasonable, appropriate or best care for any given health issue, nor is it intended to be used as a substitute for the independent judgment of a physician for any given health issue.

Helen's beliefs about drinking while eating are shared by Terry Simpson, MD, an American gastric band expert. http://azlapband.com/blog/what-we-know-from-successful-band-patients/ If you read through his article, you'll find this statement: Drinking and eating Successful patients eat and drink at the same time. We use to think this wasn’t a good idea, and some patients from those days don’t eat and drink at the same time- and tell us it makes a difference.

Helen didn't post it as a separate thread. The LBT system does that automatically.

I haven't heard of taking calcium to prevent hair loss. Calcium supplements are important for bone health (especially for women), but it's Biotin that's most commonly recommended for hair loss.

I also wish I had known how long it would take to feel some restriction. My (unbanded) nutritionist had told me I wouldn't be hungry after surgery, but I was very hungry, and it took several fills for me to start feeling like my band was really working.

By all means, read Helen's excellent PDF, but the short version is that the presence of the band against the upper stomach, and the action of the stomach as it contracts and expands to break down solid food and move it south, triggers the vagus nerves in the upper stomach to send satiety signals to your brain.

Helen, Thanks for sharing that PDF. While I still have concerns about drinking while eating, I had to laugh when I saw your funnel diagram because it's so similar to the diagram I created for the chapter in Bandwagon on how the band works. Surely this proves that agreement and disagreement can co-exist without obliterating a common truth!

I'm so glad you liked it!