Jean McMillan

"THOU SHALT NOT?" Somewhere in the dark mists of my distance past, the term “reverse psychology” entered my awareness, especially as applied to child-rearing. The idea was that if you told your child “Please slam the door when you leave the house,” the defiant devil in that child would shut the door quietly in opposition to your instruction. I don’t have human children and never observed reverse psychology work magic in my childhood home. No matter how firmly you told my brother not to brush his teeth, his teeth went unbrushed. Telling him to jump on the bed would trigger a marathon jumping session (causing the box spring to violently part company with the bed frame) instead of a peaceful bedtime story. And I was no angel – I rewarded my mom’s laissez-faire attitude towards teen dating by involving myself with the worst losers I could find. Despite all that, I know there’s a kernel of truth in the concept of reverse psychology. If you told me I must never, ever eat chocolate again, I’d get started on a chocolate binge before you even finished your sentence. And if you told me, “Thou shalt not even think about potato chips,” my every waking and dreaming moment would be filled with potato chips. Unfortunately, this principle doesn’t work in both directions, at least not for me. If you told me, “You must eat nothing but ice cream this week,” I’d be happy to comply. I’d grab my car keys and ice cream scoop and race to the frozen foods section of the nearest supermarket (after a quick stop at Baskin Robbins). Author and eating disorder expert Geneen Roth tells a story about a mother who worried about her daughter’s weight. Even when the mom locked sweets up in a cabinet, the daughter managed to smuggle sweets into the house and hide in her bedroom to gorge on them. When the mom took Roth’s advice to give the child free access to sweets, the girl tired of them and began to make healthier food choices within a few days. This was a clear case of what I call Forbidden Food Syndrome, in which forced abstinence increases the person’s desire for the “bad” food. I don’t doubt that Roth’s advice in that case was sound, but in my personal experience, food rules aren’t the only cause of secretive food hoarding and gorging. My mom’s food rules had more to do with good manners than with nutrition. I had to take at least one bite of each food on my plate, chew with my mouth shut, ask for permission to leave the table, and dirty no dishes after supper. Other than that, I could eat whatever I wanted, in any quantity. Even with that much freedom, I would hoard and binge on sweets, alone in my room, at every opportunity. I wasn’t eating out of defiance, but neither was I eating for “good” or healthy reasons. Even at age nine, I was eating for emotional reasons – comfort, numbing, entertainment, you name it. As an adult, I have a better handle on my emotional eating than I did at age nine. I’m well aware of the food-obsessed Jeannie who will run without hesitation right into rush-hour traffic if a brownie might be waiting for me on the other side of the road. I know intimately the defiant Jeannie who insists on eating a piece of garlic bread even though she knows that the third or fourth bite could easily get stuck in her esophagus or stoma and cause a lot of discomfort. I have to monitor myself every day in order to maintain the delicate balance between choosing not to eat a piece of birthday cake because eating it doesn’t serve my weight management goals and choosing to go ahead and eat the entire cake simply because I know it doesn’t serve my weight management goals. Sometimes I feel like a freak because I have to deal with issues like this. I watch “normal” people making carefree eating choices and enjoying complete eating freedom with no awful consequences (or at least, that’s the way it looks to me), and deep down inside, I hate those normal people. They’re not yoked to this heavy burden of disordered eating like I am. It’s just not fair. But I’m gradually relaxing about my eating issues enough to be able to listen better and to hear more messages from my normal friends and acquaintances, and to realize that they too struggle with things like Forbidden Food Syndrome from time to time. I have a disgustingly healthy co-worker who told me once that she can’t eat chocolate because it gives her bad migraine headaches. She avoids chocolate, but she confessed that she wants it all the more because she can’t have it, and when she tells herself it’s OK to eat one small piece, she finds that she can’t stop – she eats three, five, seven pieces even though she knows she’ll pay for it sooner or later. She doesn’t pay with obesity, she pays with pain. She doesn’t know the pain of obesity as I do, but she and I struggled with the same basic problem. Little does she know how valuable her chocolate story is to me. It reminds me that I’m really not a freak – I just have a more intense and widespread eating problem than hers. It’s a matter of degrees. She’s five degrees off-center while I’m 45 degrees off. Neither of us is perfect. We both have to work at making good choices – not just in our eating behavior, but in every piece of behavior that could have good or bad consequences for us or for our family and friends. To my mind, this is just part of human existence, part of the responsibility that adult humans bear for maintaining a civilized and (we hope) peaceful co-existence with each other and ourselves. All this may be too philosophical for you, but I’m telling you about it because thinking about my eating problems this way has helped to put them in perspective, and putting them in perspective makes them a lot more manageable. Perspective is the art of seeing things in correct relationship to each other. As I wrote in Bandwagon, without perspective, my computer’s monitor looks ten times bigger than my neighbor’s barn across the road. In fact, my computer monitor is tiny compared to that barn. Without perspective, my weight management challenges seem enormous. I lost all that weight in just one year, but my maintenance job goes on forever. But consider the alternative. I could go back to obesity. I could have a stroke and become a human vegetable, reliant on others for everything from speech to toileting. I could lose my limbs to diabetes, reliant then on others for everything from tooth-brushing to transportation. I could suffer cardiac arrest and die at age 60. Or I can work at maintaining my weight and my health, with a huge payoff of mobility, independence, and longevity. So…back to Forbidden Food Syndrome. Although I’ve said that reverse psychology doesn’t always work with me, I must also say that one of the reasons I chose the band was that living with it would allow me to choose from a wide variety of foods I like. My nutritionist told me I might have problems eating certain foods, like celery or pasta, and I was willing to take the chance because life without celery or pasta still looked pretty good to me. But when my surgeon, speaking at the bariatric surgery informational seminar I attended, said that gastric bypass patients need to avoid all foods that are high in sugar, fat, or simple carbs because of the possibility of dumping, I mentally walked into a barbed wire fence and backed right off. At the time, I had one gastric bypass friend who didn’t dump, but the bypass patient who spoke at the seminar reported that he does dump, and when he described a typical day’s eating, I thought, “That’s not for me.” That guy was justifiably proud of his weight loss and didn’t mind a limited list of food choices, but I knew that limited food choices would send me running straight for the junk food if only out of sheer boredom. The night of that seminar, I hadn’t eaten a chocolate chip cookie for several months, but just the idea of giving up cookies forever made me want to stop at a bakery on the way home. I chose the adjustable gastric band, and the breadth and flexibility of my “OK Foods” list is one of the things that makes my post-op life enjoyable. I do overeat from time to time, but not because of Forbidden Food Syndrome. Taking foods off the Forbidden list has robbed them of some of their power over me. As a pre-op, I would attend a co-worker’s birthday party and eat two pieces of cake (Forbidden) because I’d been avoiding cake and missing it so much. As a post-op, I recently walked through the break room at work and saw a birthday cake on the table. I briefly wondered what flavor it was (impossible to tell from the decorative frosting, whose neon colors can’t be found in nature) and told myself I could try a little piece of it later, on my official break. Lo and behold, come break time I was quite hungry and not in the mood for cake. I wanted my chicken salad, and when I was done with that, I had no room for cake, so I went back to work without another thought about birthday cake. Now, that’s freedom!

Thanks, Alison! Your praise made my day!

Don't worry, I'll always be a bandster at heart!

Morning tightness is extremely common. I'm not an advocate of liquid calories, even healthy ones, but my breakfast is usually a Protein shake. Several nutritionists have told me it's important to consume some protein within an hour of waking (without it, your metabolism slows for the rest of the day and you're more likely to overeat later in the day). Drinking a Protein Shake is an easy and (to me) delicious way to accomplish that.

For heaven's sake! You're on a liquid diet and you're not supposed to drink juiced veggies? I don't want anyone to accuse me of suggesting they ignore the advice of medical professionals, but surely in this case, what she doesn't know won't hurt her? Or you?

And remember, you can't necessarily believe everything you see on the internet as God's truth. Maybe the You Tube braggers were torturing the truth. Or maybe they started out twice as heavy as you did, so naturally lost weight more quickly (at first, anyway). Comparing yourself to others is usually fruitless unless you can somehow use it for inspiration.

Oh, oh! I just had a great idea! Why don't you call your surgeon's office and tell them that your PCP is extremely concerned that you will lose too much weight during this strict pre-op liquid diet and that you undergoing surgery when you're underweight would be dangerous? Well, maybe not a great idea. A good idea. An idea worth considering? :-)

No, no surgery date yet. We have to make sure all the i's are dotted and t's are crossed, you know. I had to get cardiac clearance because of my age (I'm 58, and I'm proud to say I aced the treadmill stress test) and blood tests for TSH and H. Pylori (the 1st was normal and the 2nd was absent). My internist's office was supposed to fax it to my surgeon's office yesterday afternoon. I left a message for the patient advocate this morning and haven't had a reply yet. I'm going with the sleeve instead of another band because my surgeon thinks another band would be asking for trouble (not her exact words, but that's what it boils down to). I love my band and hate, hate, hate to see it go, but I'm just trying to make the best of the circumstances. God clearly wants me to learn some more lessons...

I truly believe some of these surgeons just want to torture you LOL! I think there's a grain or 2 of truth in that. I've been wondering if the surgeons are even aware of all of the rules their clinics impose on patients. My current surgeon's patient advocate (advocate isn't the exact word I'd use to describe her) told me that I have to follow all their pre-op procedures for my revision surgery despite the fact that I've already done all of this before. She said, "Listen, Jean, I know you wrote a book about it and everything, but this is the way we do things." Ah, yes, my very favorite reason for doing things: "we've always done it this way"! But, trying to give them the benefit of the doubt, I'm telling myself that since my original surgery was done by a different surgeon in another state (who also got his medical license yanked), my current surgeon's office has to assume that everything I learned the first time around is worthless, despite my evident success. I went to a mandatory nutrition class yesterday (which involved a 240 mile round trip, with gas at $4.09/gallon) and heard the dietitian say some things that just did not click with my understanding of things, but you'd be proud, I didn't make any smart-aleck or know-it-all remarks. Out loud, anyway.

It does seem strange that a nice, soft scrambled egg could cause problems, but that's happened to me. Also, your esophagus may have been inflamed from yesterday's episode with the egg and bread. As for losing "only" 30 lbs since your surgery...by my reckoning, that means you've lost an average of 1.5 lbs/week. Typical weight loss with the band is 1-2 lbs/week, so you're right on track!

Insurance approval will depend on the terms of your particular policy. Call the insurance company and ask for the weight loss surgery coverage terms for your own policy. Most surgeons have an insurance coordinator who helps patients determine what requirements each patient has to meet in order for their policy to cover pre-op tests & evaluation, the surgery, and fills or aftercare visits. For input about Dr. Enoch and his/her staff, you might get more responses if you post your question here: http://www.lapbandtalk.com/forum/47-north-carolina-local-lap-band-support/

Some signs of a band that's too tight: > eating problems - getting stuck, regurgitating food (PB's), sliming > heartburn > night cough > reflux > sore throat (from the reflux) > chest pain (also need to screen for cardiac problems) > fullness or pain in the back of the throat > difficulty swallowing liquids If you're having eating problems and feel that your eating skills are good (take tiny bites, chew very well, eat slowly, etc.), you might need an unfill. In my experience, even a tiny unfill can make all the difference in your quality of life without compromising your restriction. If you suspect that your band is too tight, call your surgeon. The longer you ignore a problem, the harder it is to fix.

I don't have any more helpful suggestions, I just want to say, "For crying out loud!" I hate it when medical offices bungle important patient communications like that. I would be indignant too, but save expressing my thoughts about it until I calmed down. At this point it'd be counterproductive to alienate that surgeon & clinic. Good luck!

One of the reasons for the pre-op liver shrink diet is to improve the texture of the liver (not just the size) so that it's less slippery for your surgeon to handle, making the procedure safer for you. But I completely understand how tiresome it is to go through all of that stuff all over again. I'm facing something similar myself. I keep telling myself it's only 2 weeks, not 2 or 20 years!

Ah, stability! I long for it too. I grew up in a very unstable family situation, and in adulthood have faced the truth over and over again that being a control freak is very, very difficult. Unfortunately, living and succeeding with an adjustable gastric band requires a lot of fine-tuning of fill adjustments and eating skills. And so do a lot of other things in life. The #1 benefit of living with a fickle band has been that it's forced me to pay much closer attention to my body and all its signals about hunger and satiety. I think most people (obese or not) could benefit from awareness like that. My body used to be my enemy. Now it's my friend. Or frenemy, depending on the day...

I'm glad that article clicked for you. Marriage to anyone (or anything) is a big question mark no matter how much in love you are at the start. As time goes on, you discover things you never expected or dreamed of. Some of them are hard to take, and some of them are wonderful!

If you’ve been married as long as I have (we just celebrated our 25th wedding anniversary), you’ll probably know what I mean when I say that at times, my relationship with my husband is a love-hate thing. The hate is provoked by stupid little things, like: why must an adult male in good health and in possession of all his faculties spit toothpaste on the bathroom mirror every single day of his life? Ten minutes after wanting to throttle him for that, I catch a glimpse of him cuddling a tiny kitten and my heart melts. He has truly been there for me through thick and thin (more thick than thin) and I can’t imagine life without him, but the next time I walk into the bathroom and see the Colgate version of a Jackson Pollock painting on the mirror, my husband’s life will hang by a thread, at least for a few moments. I also have a love-hate relationship with my band at times. I resent it because it prevents me from eating mindlessly. I love it for the very same reason, but when I’m tired or hurried or distracted, the effort to eat carefully seems enormous. Why can’t my band just do its job and leave me the heck alone? I’m by no means a lazy person but there are days when living with an adjustable gastric band is a lot of work. It’s certainly not a spectator sport – to win this game, you have to jump right in and get busy, and it’s not over when the cheers fade away…it starts all over again the next day, and the next day, for the rest of your life. Like me and the stupid bathroom mirror. Happily Ever After? I think that many people have bariatric surgery believing or hoping that it will solve everything, that they’ll never have to struggle with their food or eating again. Most of the time, that’s not the happy ending to their story. Their story has a different ending that could be happier if they adjust their thinking to it. Is the burden of good eating choices too heavy? If surgery helps you lose all the excess weight, shouldn’t it help you maintain that weight loss without another thought for the rest of your life? Dream on. I’ve seen a lot of bandsters (including the short blonde one in that bathroom mirror) crash into the Forever Wall, kind of like hitting the “seven-year itch” in a marriage. We prepare for band surgery with all the hope and care of a bride and groom planning a wedding – what we’ll wear, what we’ll eat, what music we’ll dance to. We enjoy a romantic honeymoon with the band, things go great for a while, and then things get harder and harder. At that point, you can fall in love with another bariatric procedure, believing that a revision to gastric bypass or whatever will hand you the key to happily-ever-after. Or you can stick with the partner you’ve already got, survive some tough times, and come out of it all the stronger. My friend Tami send me these wise comments: “Your comparison of WLS to marriage made me chuckle. One time my daughter asked me whether I’d ever divorce her dad (sometimes he can be such an ass!). I said, “Absolutely not. He’s family. You sometimes can’t stand your brother, but you can’t divorce him.” Now, if there was a serious “complication” in my marriage, like abuse, I’d have to reconsider my options. And that’s exactly how I feel about my band. It’s part of me, and as long as it doesn’t abuse me with serious complications, we’ll stick together. And just like my husband, I have to respect my band, take care of it, and learn from mistakes.” To Have & To Hold – til it’s no fun any more? I’ve survived some complications with my band that I suppose you could classify as on the low side of serious: a band slip, and a flipped port. Since the actions my surgeon and I took in response to these complications were swift (in the case of the slip) and sensible (in the case of the port flip), neither one of them ever endangered me – not in terms of my health, and not in terms of my quality of life. In fact, they seemed quite minor to me compared to other problems that my fellow humans face every day – a terminal cancer diagnosis; a fatal automobile accident; a crippling disease; the loss of a partner; parent or child – that except for the occasional moment of frustration or angry, “Why me, God?”, I just kept trudging onward. Perhaps another person with a different world-view and/or different expectations would consider a band slip grounds for divorce. I can’t criticize people who choose divorce, whether it involves their spouse or their band. Only I can decide what’s acceptable and tolerable for me, and others must decide that for themselves. But if you walk down the church aisle three minutes before your wedding begins thinking, “If I don’t like marriage, I can always get a divorce,” perhaps you don’t belong in the church in that fancy get-up in front of all your family and friends after all. At this (fairly advanced) stage of my life, I’m convinced that God or the universe throws nails on the road before me as a way to get my attention, make me stop and get my bearings, make me enjoy the scenery and make me appreciate how far I’ve traveled so far. So I do my best to learn what I can from each challenging situation with the gastric band that’s complaining or my husband who’s vigorously brushing his teeth or the dog who’s chewing on a chair leg. For all I know, my greatest goal in life is to be a champion cleaner of bathroom mirrors!

Was this pain in your stomach, or your abdomen? Your stomach is at the top of your abdomen, and your band is at the top of that, so any sensations related to your band would probably be felt in your chest, not your abdomen. And if your port is also near your chest, then the feeling in your abdomen probably has nothing to do with your band or your port.

I'm sure that was disconcerting, but freaking out won't help fix it. It's possible that you popped a suture, but since you're so recently banded, it could just be that the act of rolling over pulled a bit on your healing abdominal muscles. Was this weird sensation located anywhere near your port (the biggest incision)? The port is stitched into the abdominal fascia and it's very hard to avoid putting stress on that area when rolling over in bed. Even if you did pop a suture there, your port may still be accessible for fills, and you won't know that until you go to the doc for your first fill. For the sake of peace of mind, why don't you call your surgeon's office?

I think you should ask your nutritionist or surgeon about that. My pre-op diet was low, low sodium - no canned or processed foods, no cured meats (like ham or deli meats)or sausage. It's my understanding that a low sodium diet helps your body burn up the glycogen it has stored in the form of adipose (fat) tissue, much of which is located in the liver. That, and weight loss, helps improve the texture and size of your liver so that it's easier for your surgeon to maneuver during band placement.

My starting BMI was 39.5, but I want to tell you that recently the FDA approved the Lap-Band for patients with BMI's of 30+. Approval of surgery for you will depend on your particular insurance policy, so why don't you give them a call and find out what your weight loss surgery coverage is and what, if anything, you'll have to do to qualify. Some policies require the patient to do a 6-month medically supervised weight loss diet, for example. Good luck! Jean

Congrats on starting your journey to good health!

I don't know who or what Darlene Zebley is. If you're in Georgia, you can use the surgeon finder feature here on LBT (click on SURGEONS at the top of the page) to locate surgeons near you, then call their offices to find out if they're accepting patients whose surgery was done in Mexico.

Sounds like sloppy recordkeeping by your surgeon's office. I'm glad you insisted on persuing the cause of your eating problems. It's possible that emptying your band and giving your esophagus and stomach a week's rest could help relieve whatever has been causing the vomiting. Good luck, and keep us posted. Jean

Elcee, I was hoping for revision at the end of April, but my surgeon's so-called patient advocate is spectacularly unhelpful so I feel like for every step I take forward, she sends me 2 steps back. I'm not going to think about the post-op liquid diet until I absolutely must. It won't be fun, but it's certainly not as difficult as some other challenges I've faced in the past, and it's for a good cause. I agree with you 100% - there's nothing like an unfill to make you appreciate how much your band was doing for you and you may have been taking for granted! And I've really been enjoying eating raw veggies and fruits again.