Jean McMillan

Well, participating here on the LBT forums can help keep you motivated. You could also ask another member to be your accountability partner. That's someone to whom you tell your daily food and exercise plan, report how you did with the previous day's plan, and discuss any issues in your life that are affecting your eating and weight.

In my opinion, your band is too tight. You should not have to struggle that much to eat healthy foods, and a band that's too tight can lead to complications like a band slip, esophageal dilation, stomach dilation, or band erosion. Even a tiny unfill could make a big improvement in your quality of life without compromising your restriction. When was your last fill? It can take up to 2 weeks to adjust to a fill, but if you're still struggling after that, it's time for an unfill. The fact that you're having some trouble even getting Water down is troubling. Call your surgeon!

I can't help you with that because I'm in Tennessee. You might get more answers if you post your question in the Texas forum: http://www.lapbandtalk.com/forum/57-texas-local-lap-band-support/

Jim, you do need to pay attention and make good food choices...don't want to lose the muscle tissue that helps you move, gives you shape, and burns more calories than fat! Thanks for your good wishes for my surgery last week. It went off, but with a hitch. I woke up with 6 incisions, no band, and no sleeve, because my surgeon encountered a stricture at the juncture between my esophagus and stomach that wouldn't allow her to pass the "bougie" calibration tube through there, so she couldn't do the sleeve. So the next step will be to dilate the stricture a few times, then let everything heal for 3-4 months before we attempt any further surgery. God clearly wants me to master Patience!

I had a breast reduction before my band surgery. Aside from plain old age-related sagging (I'm 58), my girls look pretty good now, but I do have excess skin now that drapes over the old lateral incision line from the breast reduction. There's a photo of it here: http://jean-onthebandwagon.blogspot.com/2011/02/breast-reduction-surgery.html My plastic surgeon had predicted that I'd have that skin overhang if I lost weight, and he was right. He also said that it could be fixed or at least improved by additional surgery, but it doesn't bother me enough to warrant more surgery. The worst-looking part is in the area under my arms, and anyone who's staring at that part of me deserves a slap anyway. I've heard lots of bandsters complain that their breasts look like tennis balls in socks after weight loss, but I work in a department store as a bra fit specialist, and I also hear non-bariatric patients of various ages and sizes say the same thing. It's hard to predict how your skin is going to react to massive weight loss, and worrying about it won't change the outcome. You might be pleasantly surprised!

Thanks! It was a very unpleasant surprise to wake up with 6 incisions, no band, and no sleeve. It'll probably take a few months to come up with a new plan, and in the meantime, I'm flyin' blind! The good news is that being in better physical shape this time is making my recovery from surgery much easier than my original band surgery.

Yes, I've had the experience of not feeling physically hungry. I didn't experience it as an issue but rather as a benefit of my band. And yes, you need to plan healthy meals and Snacks and eat them according to a reasonable schedule. I also suggest that you weigh and measure your food. When you're not getting physical cues to eat, you have to rely on your own discipline. To understand why you no longer feel hungry and no longer experience satiety after eating, you really need to talk with your surgeon. It's my understanding that the presence of the band on the upper stomach stimulates the vagus nerves that are responsible for carrying hunger and satiety messages to and from your brain.

Restriction seems to be the Holy Grail of bandsters, a sacred thing that we hunt for with a level of passion and persistence that we may never have experienced before in our lives. In our minds, restriction is endowed with the magical power to make us lose weight. But exactly what is it? THE MEANING OF RESTRICTION We bariatric patients use the word "restriction" in every other sentence we speak, write, or think, but do we truly understand what it means? In my 50+ pre-op years, the word restriction basically meant "no can do" or "you can do it, but within externally-imposed limits." To use extreme examples, that means "Thou shalt not kill" (no can do) or "Drive no faster than 55 mph on this stretch of road" (55 mph being the imposed limit). Keeping those examples of restriction in mind, it's reasonable to say that a restrictive WLS procedure is one that allows you to eat, but in quantities no greater than ½ cup at a time (or whatever your surgeon's food amount limit is). That's clear enough, isn't it? It's clear, but it's not specific enough to ensure safe and effective use of the "restrictive" WLS tool called the adjustable gastric band. For one thing, it implies that the band comes equipped with a monitoring feature, like the radar guns used by police to measure the speed of passing cars. It doesn't make it clear that the only monitoring feature that will work safely with the AGB is a conscientious, hard-working patient's conscious mind. Surgeons and patients who aren't aware of this aspect of the band are headed for accidents such as stuck episodes, PB's, sliming, esophageal or stomach dilation, band slips, or weight loss failure. IS RESTRICTION JUST A MARKETING TERM? The adjustable gastric band was first approved for use in the USA in 2001. Over a decade later, we are just now beginning to understand the true function of the band. A decade of struggle and learning has gone by. Eleven long years! How could that happen? When the adjustable gastric band was first marketed in the USA, it was positioned as a restrictive WLS procedure. In the world of marketing, a product's "position" determines how its features and benefits are communicated to customers and how they compare to similar products in the market. When introducing a new automotive vehicle to the market, an automobile manufacturer must present it in a way consumers will understand: Is it a sedan or an SUV? Is it a sub-compact or a full-size vehicle? A car or a truck? Manufacturers of medical devices like the adjustable gastric band must also educate their customers (surgeons) and end-users (patients) when they market a new product. They ask themselves: Is this a completely new concept? How can we make customers understand it and want to buy it? What other products on the market can we compare it to? In the case of the AGB, Allergan compared it to other bariatric surgical procedures: RNY (gastric bypass, which combines restriction and some malabsorption), DS and BPD (duodenal switch and bilio-pancreatic diversion, which combine restriction and a lot of malabsorption) and VSG (vertical sleeve gastrectomy, considered a restrictive procedure). The AGB doesn't cause nutrient malabsorption, therefore it fell into the restrictive category. As a result of this perfectly ordinary business approach, thousands of surgeons and their patients were not fully informed about the mechanism through which AGB patients lose weight. It's quite possible that even Allergan didn't fully understand at the start just how the band works. If the makers of medical devices and pharmaceutical products waited until every last detail is known about a new device or a drug, some life-saving products might never reach the people who most desperately need them. So for the last decade, we all believed that the band is supposed to restrict the amount of food we can eat and cause weight loss through reduced caloric intake, but that's changing now. In the past few years, Allergan has refined the band's market position and has been teaching surgeons that it should not be used as a restrictive device. Allergan, Endo Ethicon, and the bariatric medical community are realizing that a patient who eats until she or he "feels" restriction is far too likely to experience complications. They are coming to the understanding that the band's chief weight loss mechanism is reduced caloric intake through the reduction of hunger and appetite, with early and prolonged satiety after a small amount of food is eaten. IF IT'S NOT RESTRICTIVE, WHAT IS IT? So if the AGB is not a restrictive WLS procedure, what the heck is it? How can we explain it without using the word restriction? A better term for the true function of the AGB might be something like "optimization" - the process of modifying a system to make aspects of it work more efficiently, use fewer resources, and/or produce the most beneficial results. In a bandster, the system is made up of several important components: the band, the saline fill, the bandster's food choices and exercise level, with a few parts that are so top-secret, nobody knows what they are. Optimization is a clumsy-sounding word, though, and it makes the bandster sound like a machine instead of a human being. For the time being, we don't have a better term than restriction, so we'll go on using it until something better presents itself. HOW CAN I FIND IT IF I DON'T KNOW WHAT IT LOOKS LIKE? How will you recognize restriction? If you were hunting for the Holy Grail, you could equip yourself with a picture of a chalice to guide you, but there's no picture of restriction. Don't kid yourself into thinking that a fill under fluoroscopy (x-ray) is going to yield a picture of your very own restriction. That x-ray image is just a snapshot of part of a living, breathing, changing human body, and while it might illustrate a theoretically good fit on the band on the stomach, it cannot illustrate what's happening in your nervous system. It can't track the production of hormones that triggers hunger or satiety messages between your brain and your body. To recognize, utilize, and safeguard your restriction, you're going to have to start paying attention to dozens of things that you took for granted or didn't even know existed before. I don't go on and on about eating slowly just because it helps prevent unpleasant side effects, but because it's mighty hard to pay attention to your body's signals when you're gobbling your meal. I didn't realize this until perhaps 6 months post-op. Until then, I was eating carefully only to prevent stuck episodes, PB's, and sliming. Very gradually, over the next 6-12 months, I learned to listen to my body, not just when I was eating but between meals. It wasn't until after my 15th fill, at almost 3 years post-op, that I had mastered mindful eating enough to actually enjoy my experience of restriction. Three years is a long time, but don't let that scare you. I lost 100% of my excess weight with far less "restriction" than I had at 3 years post-op. And when you remember that I spent over 50 years eating carelessly and excessively, changing my eating in only 3 years is pretty good! So, what signs of restriction you should be looking for? 1. Early satiety after eating a small portion of food. You lose interest in eating, feel that another bite would just be too much, and/or feel a sudden distaste for the food. 2. Prolonged satiety after eating a small portion of food. You are not physically hungry, and have no appetite (desire to eat) for several hours after you eat. How many hours? It's going to vary by person, and will be affected by many factors, such as food choices (solid versus liquid, for example). For me, 3-4 hours is a very long time to experience satiety and I'm delighted by that. Another person might not care to eat again for 5-6 hours after a meal. 3. Reduced appetite. You're just not as interested in food as you used to be. You think about it less and you might even forget to eat. The food may not even taste as wonderful as you remember it. 4. Reduced physical hunger. You're just not as hungry, and not hungry as often, as before. All that sounds marvelous, doesn't it? A dream come true! It is indeed, but it's also very complicated because the human body and human behavior are very complicated. We're constantly changing, in changing circumstances. While our unconscious brain and body are trying to communicate hunger and satiety, our conscious brains and our lifetime habits are also at work. So even though you weren't especially hungry for that chicken dinner at 6 pm, it's quite possible that a phone call from a troublesome family member will trigger some comfort eating at 6:15 pm, or that boredom will send you looking for snacks at 8:00 pm, or that craving will send you looking for chocolate at 9:00 pm. OBEY THE STOP SIGNALS! Stop signals aren't there just to make you late for work. They're there for your protection. Some of the worst car accidents in my town happen at a major intersection on a busy road where some drivers seem to be ignoring the stop signals. As those drivers are sped away from the scene in the back of an ambulance, I wonder how badly they're hurt or whether they'll survive. I think it's good that our town has installed cameras at that intersection. Stop signals are equally important to bandsters. How? In addition to the 4 signs of restriction explained above, you will also get hints to stop eating that I call "stop signals". As newly-filled or newbie bandsters, we expect our bands to give us good, loud, clear stop signals with clanging bells and flashing lights, but eventually learn (if we work on it) to recognize the quiet stop signals such as mild queasiness, fullness or pressure in the back of the throat, difficulty swallowing, burping (or the urge to burp), sneezing, sighing, hiccups, watering eyes, runny nose, and so on. If we heed those signals, we stop eating before something more drastic and uncomfortable happens. You may not experience any soft stop signals, but don't stop looking for them just because you aren't noticing any; they could sneak past you at any time. And if you experience no hard stop signals (like stuck episodes, PB's, sliming), don't go looking for trouble! The absence of hard stops does not mean that your band isn't working. It means you’re doing a good job!

I'm not clear on the sequence of events in your story. Had you regained the 50 lbs before your unfill, back when you were eating slider and junk foods,or after? When was your unfill? Has your eating changed since then? In what ways? If you have plenty of restriction when you eat now and rarely feel physically hungry, what is the problem? Are you snacking/grazing even when you don't feel physically hungry?

Welcome, Steph. How have you been cooking your veggies? Have you tried cutting them into small pieces before cooking them, and/or mixing them with a small amount of low-fat salad dressing, yogurt, mayo, sour cream?

There's a band vets forum at another support site, and to join that group you need to be at least one year post-op. So based on that...Welcome to the world of band veterans!

READY TO BE WEDDED TO YOUR BAND? On a humid May morning 37 years ago, after a four year courtship, I married my first husband. We exchanged our wedding vows in front of a Catholic priest, a Presbyterian minister, and 40 guests consisting of family and friends. We walked out of the church and into our married life with “until death do us part” in our young minds. Six years later, we divorced. Eventually each of us married again, this time to the right partner, and we’re all still happily married today. As the saying goes, practice makes perfect. It’s practice that will make your “marriage” to your adjustable gastric band perfect, or as perfect as any human endeavor can be. It’s important to know that when you wake up in the recovery room after your surgery, you won’t be magically endowed with all the knowledge, experience, and habits you’ll need to succeed with your band. Even if you did tons of research, faithfully attended every pre-op educational class, and listened closely to and made detailed notes of everything your bariatric team told you, some things – important things – you’ll have to learn through the everyday experience of living and eating with your band. When you leave the hospital or surgery center after your surgery, you probably won’t be headed for your honeymoon quite yet. That will come later, when you’ve had enough fills to achieve optimal restriction and you begin to feel that your band is really working. The excess weight will start coming off and you’ll walk around in a dreamy pink haze, delighted with your new life partner. You might even give your band a silly private pet name, the way my husband calls me “Love Bug” (which always makes me think of my first car, a chubby little Volkswagen Beetle). Then one day, the reality of banded life will wake you up. You’ll think, “Who is this creature I’ve married?” And like Jenny, a former coworker of mine, you’ll realize that while the engagement, wedding and honeymoon were exciting and fun, the day-after-day business of marriage isn’t exciting or fun 24 hours a day. It’s hard work. It’s boring. It’s frustrating. It’s humdrum. Jenny divorced her new husband after only three months of marriage not because she didn’t love him, but because she didn’t love being married to him. For many of us, being a wife isn’t nearly as fun as being a bride. One day you’re a smiling princess dressed up in flowers and lace; the next day you’re a haus frau frowning at the skid marks in your prince’s underwear. I suspect that Jenny just wasn’t old enough or mature enough to be a wife. Neither was I when I married the first time. One of the reasons most bariatric surgeons and insurance companies require a patient to have a pre-op psychological consult is to evaluate the patient’s understanding of what they’ll have to do to succeed after surgery. Are they ready for a lifetime commitment? Do they have reasonable expectations? Can they follow instructions? Are they capable of learning the new behaviors they’ll need for a productive, peaceful partnership with their band? HABIT FORMING New bandsters need dozens of new habits – something like 60-70% of my book Bandwagon is devoted to explaining those habits, so I’m not going to try to cram them all into a single article. I’ll pick one at random. Hmmm…how about EAT SLOWLY? How are you going to turn that behavior into a habit that will serve you well for the rest of your life? So Dr. McMillan tells you, “Eat slowly,” and you nod your assent while thinking, “Get real! I’m too busy to do anything slowly. I have 3 kids and 2 dogs, I work 2 jobs, I take care of my elderly Aunt Bertha, I coach my daughter’s softball team, I have a house to run and a spouse who’s always on the road…” Well, you get the idea. Dr. McMillan has just told you to do something that’s very simple and yet impossibly difficult, you think Dr. McMillan needs to wake up and smell the coffee, and a door in your mind slams shut. Actually, Dr. McMillan is already awake, has had a cup of coffee, has tended to all 10 of her dogs and all 3 of her cats, is about to leave for the fitness studio, and when she returns she will deal with a home renovation project while running her home-based publishing business off the kitchen table; tomorrow the fun will start all over again, including a 5-1/2 hour shift at her retail job and a trip to the supermarket. She’ll get someone to come look at the leaking French doors, do the laundry, pick another batch off ticks off the new dog, and cook several meals. Dr. McMillan’s friend Nina calls her the “Tennessee Tsunami”, and despite all that, Dr. M. still manages to eat slowly every time she sits down to a meal. As a pre-op, it took her maybe 5 minutes to hoover her way through a meal that would feed a farmhand, and now it takes her 5 minutes to chew her way through the first bite. But that EAT SLOWLY habit (or any other habit) didn’t become a habit for me overnight. It takes many, many repetitions to turn a new behavior into a habit (a British study found that it takes anywhere from 18 to 254 days of daily repetition to make a new behavior “automatic”). I know it’s a big challenge, especially when you’re also trying to learn a few dozen other new behaviors and turn all of them into habits while somehow conquering the dozens of bad habits you already had, but I assure you, it’s worth the effort. MIND OVER MATTER? Sometimes the biggest stumbling block in changing my behavior isn’t the behavior itself – it’s me and my stubborn, willful mind. I rarely have a valid reason to refuse a new, healthier behavior, whether it’s a small thing like putting my fork down while I chew each bite, or a bigger thing like always wearing seat belts in the car. My brain stomps its feet and cries, “I don’t WANT to do it!” I have to ease into the new behavior gradually, so that I don’t become overwhelmed and end up crying, “See, I TOLD you it wouldn’t work!” So although part of me knows that this is a huge, lifetime deal, I dole out the changes in small pieces, one day at a time, one hour at a time, one minute at a time. If I live as long as my mom did, I have another 32 years of eating ahead of me. I eat 6 times a day, 7 days a week, so if my arithmetic is correct (no guarantees there), I have another 69,888 meals to chew my way through. That is a truly mind-boggling number, so I’m tackling this task one meal at a time, and I suggest you do the same. I also suggest that you tackle one behavior at a time. Even simple things can become too complicated when you try to do them all at once. Last year, I bought a new cell phone. I hate the telephone and always have; as far as I’m concerned, cell phones are the work of the devil. I chose a phone with far more capabilities than my old one. It seemed like a dandy little gadget when the sales associate was demonstrating it, but when I’d had it a week, I had to return it because (as I told the puzzled 20 year-old who processed the return), I simply could not deal with a device that required me to hop on one foot while patting my head, rubbing my tummy, and singing the “Star Spangled Banner” in order to send an e-mail. So sitting down to each post-op meal trying to remember whether you’re supposed to hop, pat, rub, or sing is a set-up for failure. Better to pick out one new behavior as this week’s challenge. Next week, add another new behavior to your repertoire. The week after that, another one. During that time you’ll be repeating all the new behaviors as you slowly add new ones, and gradually the behaviors that were new become old…in other words, they become habit, and you won’t have to think about them much if at all. When I was a little girl, my mom had to remind me to brush my teeth every day, but eventually the tooth-brushing became an automatic part of my routine. If I were in a car accident (God forbid) and suffered a spine or brain injury that erased all my old habits (good and bad), I’d have to start it all over again. I’d probably festoon my house with reminder notes: BRUSH TEETH on the bathroom mirror; EAT SLOWLY on my placemat; FEED DOGS (well, maybe not – the dogs come complete with their own extremely reliable and audible meal reminder system). That’s a lot of work, I know, but the pay-off is enormous!

An accountability partner is someone with whom you share your daily food & exercise plan, how well you've been following the plan, and any events or situations in your life that are affecting your weight loss or management.

It took me a year to reach my weight goal (90 lbs lost). I lost weight most quickly in the first 6 months, more slowly after that. I've never been able to correlate my weight loss rate with my fill level, though, and I lost weight fairly evenly throughout my body as the months went by. My middle is my trouble spot too. It still is...but not nearly as bad! I eat a very wide variety of foods I like - meat, poultry, fish, shellfish, vegetables, fruits, grains, dairy, etc. I need plenty of variety, because when I get bored with food I'm too likely to turn to sweets and salty snacks.

Unbeknownst to me (since I hadn't had a fill or any eating or other band problems for over a year), my old 4cc band was too tight. That put so much pressure on my esophagus that it dilated and lost its ability to transport food into my stomach. Now I'm afraid that even a bigger, newer band could create the same problem, so I'm revising to the sleeve. Not thrilled about it, but making the best of the circumstances. I'm extremely lucky that I have another surgical option for weight management and even more that my insurance is willing to pay for it. I'll always be a bandster at heart, though!

thanks!

The "zones" come from Allergan's patient education materials. Click the link below to see their current Lap-Band Green Zone diagram. You'll need to place your cursor over each section of the diagram to see a list of the signs that you're in that particular zone. http://www.lapband.com/en/live_healthy_lapband/about_adjustments/#greenzone Generally speaking, if you can eat more than one cup of food at a time, you may need a fill. It depends on what kinds of foods you're eating. For example, I can eat a lot more soft food like yogurt than I can of solid food like chicken. In 4-1/2 years, I've had 17 fills and 7 unfills. Three of the unfills were to treat problems, the rest were a matter of "fine tuning". I'm glad you've found a surgeon in Seattle. I think have a local doctor, nutritionist, and other support will help you a great deal.

Raushanah, I think there's hope for you yet, if only because you recognize that you can't do it alone. One of the things you can do is to find an accountability partner. I'm going to send you a PM about that. Another thing you can do is to participate here on LBT - ask questions, answer questions, etc. Even if you don't have a lot of "in person" support, you can find lots of "virtual" support here.

Thanks, Manda, but some of us - me, anyway - should thank you. LBT participation is one of the things that keeps me on track!

Makes sense to me...

Tammy, I kind of wish he'd given you a bigger band, but hope the surgery and hernia repair will be a long term fix. Sometimes small hiatal hernias are missed altogether, and sometimes they worsen or develop as a result of weight loss. A few years ago I asked my surgeon if my untreated hernia could have contributed to my band slip and all she would say was "possibly."

Thanks, Karen. My advice may be crap, but I'm always good for a laugh!

And I'll bet your surgeon said you had the most beautiful liver he'd ever seen in a patient!

Sometimes a small hiatal hernia is missed altogether, and sometimes hernias develop or worsen after weight loss. My original surgeon knew I had a hiatal hernia and was supposed to fix it when he placed my band, but he didn't. I'll never know why. Hehas since lost his medical license and as far as I know, he might be carrying bedpans in Tijuana by now.

She was in her late 40's, so there's hope for you yet!