Jean McMillan

Yup. Nine dogs. Or rather, nine who come into the house, and three who are outside dogs (who have comfy condos in our garage), for a total of twelve. And three cats. All of those critters are rescues. We live out in the country where people discard puppies and kittens like so much garbage, and we don't have the heart to let them starve.

Naomi, I know you mean well, but I think you've missed a few important pieces of data here. 1. The chief finding of the study you mentioned was that successful bandsters in Australia do drink (but not guzzle) while eating. Those findings did not explain why that's so. The "why" part is conjecture on the part of the study's authors. Also, I question their claim that "There is no pouch or small stomach above the band. There should never be food sitting there waiting." I agree with the last part of that ("There should never be food sitting there waiting") but I disagree with the first part and have no idea where they came up with the idea that there's no pouch or small stomach above the band. Yes, the band has been used in Australia a lot longer in the USA, but that statement completely contradicts everything I've read in Allergan and J&J literature and surgeon resource sites. And I have watched my own upper GI tract during several upper GI studies, and there was indeed a small stomach pouch above my band every single time, no matter what else was going on in there (or not) at the same time. The radiologist pointed it out to me on every occasion, so I wasn't misreading the images. And by the way, that pouch was a normal finding, not an anomaly. 2. According to American bariatric surgeons I've talked to or whose seminars I've attended or whose articles I've read, NO bariatric surgery patient should drink while eating. In fact, at a bariatric conference 2 years ago, I heard that stated by 3 different surgeons who were giving 3 speeches. All of them stated that failure to separate consumption of solids and liquids is the most common cause of WLS "failure" (that is, no or disappointing weight loss, or weight regain). Since many LBT/Bariatric Pal members live in the USA and have surgeons in the USA, I think it behooves us to follow the instructions of our American doctors. Or, go to Australia for surgery and every fill and unfill and all aftercare. Hey, if I had the money to do that, it might even be fun to travel there, but it would sure disrupt the rest of my life. But hey, a mere $8,000 per trip (not counting hotels, meals, taxis, surgeon's fees, etc.) would be nothing for us rich Americans, right? 3. Every bariatric surgeon I've encountered (in person, on the telephone, online) has stated that the band does not and should not control the movement of food and liquids from the esophagus into the stomach. If the band is far enough up to do that, it has slipped or the surgeon who placed it was incompetent. What controls the movement of food and liquid from the esophagus into the upper stomach (the fundus) is a sphincter at the base of the esophagus where it joins to the stomach. Continually eating in a way that causes food to be stored in the esophagus is asking for trouble. It can cause serious and permanent damage to the esophagus and the esophageal sphincter. 3. No bandster should ever, ever eat in a way, with or without liquids, that allows food to sit in the esophagus for more than maybe 30 seconds. The esophagus is not meant to store food for any period of time. It's designed to move food up or down (preferably down) only. If food is sitting in the esophagus, any liquid consumed after that is probably going to come back up rather than flushing through the stoma, because at that point the upper stomach pouch and the stoma created by the band are probably already jammed up with food. PB's (or regurgitation of food) usually come from the esophagus, not from the upper stomach pouch, for the very reason I mentioned above. The stomach is designed to stretch to accommodate food, while the esophagus will resist stretching until the food has to come back up or (over time) the esophagus becomes dilated - something we all want to avoid, because even if the band is unfilled and the upper GI tract given a good long rest, there's no guarantee that the esophagus will ever go back to its normal state. And no one should have to live the rest of their life with a malfunctioning esophagus or sphincter. Esophageal dysmotility problems caused by careless eating can become a serious health issue, with the patient eventually having to live on liquids, live with a a feeding tube, and/or hope that an attempt at surgical repair will help. Surgery in that part of the upper GI tract is not something to take lightly, because the scar tissue that develops after surgery can also interfere with esophageal function. I speak from personal experience here. I had an esophageal stricture (from reflux damage). I lived on liquids for months, was unable to revise to the sleeve at the first try because my surgeon couldn't get the small (about the size and shape of a Sharpie marker) bougie calibration instrument through the stricture, and eventually had to have the stricture dilated enough to make eating possible, but not enough to make the stricture disappear forever (it was still there when I had an EGD 6 months later). I think esophageal dysmotility has also been a problem for an LBT member known as MsMaui, and last I heard, even an unfill, months of upper GI rest, and band removal have not resolved her problem. 4. So in my opinion, the best way to avoid these unhappy events and their consequences is not to drink while you eat but to avoid keeping too much fill in the band; to practice good band eating skills: take tiny bites, chew very well, eat slowly, don't drink while you eat, avoid problem foods, learn and heed your unique satiety or "stop eating" signals, and give your body the respect it deserves. But what do I know? Jean

Oh, and another thing...how fast you lose weight depends on more than just your fill level. Men usually lose weight faster because they have greater muscle mass than women (but we women compensate with greater wisdom). Heavier people of either gender usually lose faster than lighter people because their bodies need more calories just to stay alive. And weight loss slows down for most of us as we get lighter, because we have less to lose and because our bodies are trying to fight the weight loss. Hang in there!

I know this is hard advice to follow, but try not to compare yourself to others unless the comparison inspires you. Human beings are so unique - their anatomy, the band's effects on them, the band's effects in the same person over time (or even by the time of the day). Sounds to me like you're doing what you should be doing. It would be nice to cross the finish line first, but you'll cross it eventually!

We need to answer a lot of questions to properly address this issue, which is a common one, by the way. When was your surgery? What is the capacity of your band? How much fill do you have in it now? When was your last fill? Are you losing weight? Are you experiencing physical hunger? Do your meals keep you satisfied (i.e., no physical hunger) for at least 3-4 hours? Are you having any eating problems (PB's, stuck episodes, sliming)? Are you emphasizing solid food and avoiding liquid calories? Have you discussed this with your surgeon and/or dietitian? Jean

I'd like to see that article and learn more about that study and whoever published the findings you mention.Lightheadedness, puking, nausea and diaphoresis may indeed be signs of something serious...such as not having consumed any nourishment prior to the workout, no matter how fit you are, or how highly aggrandized your mental condition.

Bless your heart. I tried a HIT class a few times and had to call it quits. I'm not surprised that you puked after some of that inhuman torture. I agree that you need some food before any workout, and especially before an extreme workout. When my band was extra tight in the morning, I would do a Protein shake before my workout. Everything I've read on this subject agrees that carbs (for energy) and protein (for endurance) are important pre-workout, and that protein (for muscle repair) is important post-workout. If your band still feels tight after your workout, I'd do another protein shake. Otherwise I'd have a Protein Bar. Good for you for taking on workout challenge like that and sticking to it!

You should puree all animal/fish protein, fruits or veggies that aren't already of smooth, moist consistency. You don't need to puree stuff like yogurt and cream of wheat - they're already of puree or mushy consistency. But you really need to check in with your nutritionist and/or surgeon to find out what foods they consider to be puree/mushy. Some bariatric clinics have different rules (wondering why that's so is basically a waste of time, but I can give you a Cliff Notes version if you like). For example, one clinic might allow small-curd cottage cheese in the puree phase, but the clinic across the street might tell you to puree the cottage cheese. (Cottage cheese pureed with sugar free pudding mix and/or pureed fruit and your sweetener of choice is pretty good, or you can use ricotta cheese instead of cottage cheese).

The first thing I ate after I got through the liquid stage was a scrambled egg. It was divine! Michelle, a WLS patient (she had RNY)has a wonderful blog with lots of great meal and snack ideas. Here's a link to the section on pureed/mushy foods: http://theworldaccordingtoeggface.blogspot.com/2007/08/pureed-foods.html

I just had another thought...one way you could deal with physical hunger while eating only 60 grams of protein a day is to eat smaller amounts more frequently during the day. When I was banded, I ate 6 small meals/snacks a day. I tried to always combine protein and carbs in each meal or snack. That worked well for me. Now I have to eat 8-10 times a day (thanks to you know what), and when I manage to combine protein and carbs each of those times, I have less hunger and more energy throughout the day.

That sounds like a fairly low Protein goal, for the very reason you mention - dealing with physical hunger. Have you discussed your concerns with her? Does she have any suggestions for other ways to manage physical hunger? My own and most other bariatric surgeons I've encountered recommend at least 70 grams of protein a day for women. My current surgeon recently told me that I should consume at least 90 grams of protein a day for several reasons: my physical hunger is ferocious (thanks to my sleeve), I work out a lot, and I've been experiencing unintentional weight loss (I'm 18 lbs below my goal weight). Appropriate macro-nutrient (protein, carb, fat) intake also depends on the patient's height, weight, age, gender, activity level, and health problems. I'm 5'2" tall, 114 lbs, 60 years old, female, very active, anemic (thanks to my sleeve) and diabetic. If you're still in the early stages of your weight loss journey, probably heavier than I am, and surely younger than I am, I would expect that your basal metabolic rate (the number of calories you need to consume just to stay alive) would be quite a bit higher than mine, which is another reason I think that 60 grams of protein a day is too little. But... I'm not a dietitian or any other kind of medical professional, so I hope you'll be able to discuss this further with your dietitian and/or surgeon and come up with a workable compromise. Jean P.S. - When I was first diagnosed with type 2 diabetes, several years before my band surgery, the dietitian I saw at that time told me that most Americans eat far more protein than they need, and that I should consume no more than 60 grams a day. Since then I've heard bariatric dietitians and surgeons say that the maximum 60 grams of protein recommendation is outdated and that all bariatric patients need more than that to help with healing and to maintain good health.

Just because you CAN eat anything doesn't mean you SHOULD. Your stomach is still healing...your band is still settling into place against your stomach...and failure to follow the post-op diet progression is a common cause of band slips. So unless your surgeon has told you it's OK to eat solid protein, veggies, and fruits at only 3 weeks post-op, I think you may be eating solids prematurely.

Oh, one more comment (for now). The sleeve is the new darling of the bariatric surgery community. If I were a surgeon, it would probably appeal to me too. I wouldn't have to pay a penny to a band manufacturer for gastric bands, wouldn't have to bother with fills or much patient education or aftercare (which tend to be things that don't interest surgeons who'd rather spend all their time in the operating room). It would be an interesting new procedure to try and perfect, until the next new thing came along. In my opinion, the band is a high-maintenance deal for both the surgeon and the patient. That doesn't make it a bad procedure, nor does it make the sleeve a good procedure. OK, I'll get down off my soap box now and go figure out something else to eat to keep that hunger down for another 40-60 minutes. Eating 16 times a day sure keeps a girl busy doing the one thing she had hoped to set aside when she had WLS.

Oh, one more comment (for now). The sleeve is the new darling of the bariatric surgery community. If I were a surgeon, it would probably appeal to me too. I wouldn't have to pay a penny to a band manufacturer for gastric bands, wouldn't have to bother with fills or much patient education or aftercare (which tend to be things that don't interest surgeons who'd rather spend all their time in the operating room). It would be an interesting new procedure to try and perfect, until the next new thing came along. In my opinion, the band is a high-maintenance deal for both the surgeon and the patient. That doesn't make it a bad procedure, nor does it make the sleeve a good procedure. OK, I'll get down off my soap box now and go figure out something else to eat to keep that hunger down for another 40-60 minutes. Eating 16 times a day sure keeps a girl busy doing the one thing she had hoped to set aside when she had WLS.

I'm sorry to hear about your problems. It can be very frustrating to try to find a tolerable fill level. I think you're wise to at least consider a revision, because no one should tolerate reflux. It's not just an unpleasant inconvenience. It can cause some serious and permanent damage to your upper GI tract. Speaking as someone who (not entirely by choice) revised from the band to the sleeve because of damage from reflux, the sleeve is not a great choice for someone who's had problems with reflux. I managed to ignore that when making my revision decision. Most sleeve patients experience reflux after surgery even if they never had it before. If you've already had reflux, removing the band will probably help reduce or eliminate it (though RNY is the only WLS procedure that can "cure" reflux), but until (and if) your body realizes it doesn't have to produce much stomach acid any more, it will go on producing enough for a full-size stomach. And there's no guarantee that it'll resolve. My sleeve surgery was in August 2012 and I'm still dealing with reflux. It's not as bad, thanks to omeprazole twice a day, but it's still there. Nor has my tiny sleeve reduced the production of ghrelin, the hunger hormone that the sleeve is famous for banishing. So thanks to my sleeve, I am now constantly hungry (probably heightened by all that acid) no matter how much or what or when I eat. My sleeve has given me a bunch of other health problems that I'd be happy to tell you about. I know plenty of ex-bandsters who love their sleeves, but that love may be related to the relief they feel at the absence of problems their bands were causing or aggravating. Kind of like the happiness you feel when you stop banging your head against the wall. But at this point in my life, having lost 75% of my stomach forever, the best I can say of the sleeve as compared to the band is that it doesn't require fills. It is what it is, like it or not.

I'm sorry to hear about your problems. It can be very frustrating to try to find a tolerable fill level. I think you're wise to at least consider a revision, because no one should tolerate reflux. It's not just an unpleasant inconvenience. It can cause some serious and permanent damage to your upper GI tract. Speaking as someone who (not entirely by choice) revised from the band to the sleeve because of damage from reflux, the sleeve is not a great choice for someone who's had problems with reflux. I managed to ignore that when making my revision decision. Most sleeve patients experience reflux after surgery even if they never had it before. If you've already had reflux, removing the band will probably help reduce or eliminate it (though RNY is the only WLS procedure that can "cure" reflux), but until (and if) your body realizes it doesn't have to produce much stomach acid any more, it will go on producing enough for a full-size stomach. And there's no guarantee that it'll resolve. My sleeve surgery was in August 2012 and I'm still dealing with reflux. It's not as bad, thanks to omeprazole twice a day, but it's still there. Nor has my tiny sleeve reduced the production of ghrelin, the hunger hormone that the sleeve is famous for banishing. So thanks to my sleeve, I am now constantly hungry (probably heightened by all that acid) no matter how much or what or when I eat. My sleeve has given me a bunch of other health problems that I'd be happy to tell you about. I know plenty of ex-bandsters who love their sleeves, but that love may be related to the relief they feel at the absence of problems their bands were causing or aggravating. Kind of like the happiness you feel when you stop banging your head against the wall. But at this point in my life, having lost 75% of my stomach forever, the best I can say of the sleeve as compared to the band is that it doesn't require fills. It is what it is, like it or not.

Bandwagon Cookery is fabulous. Easy for me to say, since I'm the author. Two other books come to mind: Eating Well After Weight Loss Surgery and recipes for Life After Weight Loss Surgery. I prefer Eating Well, but it doesn't say how much is in a serving, so it's hard to judge portion sizes. Recipes for Life does specify serving sizes (such as 1/2 cup, 3 ounces, etc.). Bandwagon Cookery does (of course) specify serving sizes & nutritional info for each recipe, includes modifications for each post-op diet phase, and has a lot of tips for meal-planning, food shopping, cooking for a family, strategies for problem foods, and some hilarious (of course) stories about food and cooking. I also subscribe to Cooking Light and Eating Well magazines. I get lots of ideas from them. I also like Ellie Krieger's cookbooks. Not targeted to WLS, but delicious, healthy, and easy recipes. I don't think it's essential to use only WLS cookbooks. Like you, I get food boredom very easily, so the more recipe sources, the better. If you can only buy one cookbook, please do buy Bandwagon Cookery, whose very modest profits are used for food and veterinary care for the 12 dogs and 3 cats here at the 9 Dogs Howling ranch. Speaking of which, the dogs just sounded an alarm. I'd better go see if there really is an army of fire-breathing dragons in the yard.

Bandwagon Cookery is fabulous. Easy for me to say, since I'm the author. Two other books come to mind: Eating Well After Weight Loss Surgery and recipes for Life After Weight Loss Surgery. I prefer Eating Well, but it doesn't say how much is in a serving, so it's hard to judge portion sizes. Recipes for Life does specify serving sizes (such as 1/2 cup, 3 ounces, etc.). Bandwagon Cookery does (of course) specify serving sizes & nutritional info for each recipe, includes modifications for each post-op diet phase, and has a lot of tips for meal-planning, food shopping, cooking for a family, strategies for problem foods, and some hilarious (of course) stories about food and cooking. I also subscribe to Cooking Light and Eating Well magazines. I get lots of ideas from them. I also like Ellie Krieger's cookbooks. Not targeted to WLS, but delicious, healthy, and easy recipes. I don't think it's essential to use only WLS cookbooks. Like you, I get food boredom very easily, so the more recipe sources, the better. If you can only buy one cookbook, please do buy Bandwagon Cookery, whose very modest profits are used for food and veterinary care for the 12 dogs and 3 cats here at the 9 Dogs Howling ranch. Speaking of which, the dogs just sounded an alarm. I'd better go see if there really is an army of fire-breathing dragons in the yard.

You can't understand how someone can gain their weight back? To answer that question, let me refer you back to your previous statement that obesity is a chronic condition. No weight loss surgery cures obesity. All it does is treat it. It sounds as if you're looking down your nose at people who've been controlling their food intake rather than letting the band do it for them. Controlling food intake is one hallmark of responsible adult behavior. Just because that's hard for obese people to do doesn't mean we ought to avoid it. But then again, maybe you're one of the people who "took the easy way out."

I agree that obesity is a chronic disease, but I think your statement that your surgery prohibits you from overeating is oversimplified and perhaps misleading. Expecting the band to limit how much you can eat is old school thinking. In the past few years, the bariatric medical community has realized that eating until your band has reached (or exceeded) its food capacity is a mistake that invites complications. The band's true mechanisms are to reduce hunger and appetite, and to create early and prolonged satiety. It may not do all of those things for everybody all of the time, but it should do some of those things for most people most of the time. Note: I didn't pull this view out of a magic hat. I got it from several bariatric surgeons and my rep at Allergan.

Sure sounds to me like you have enough documented band problems to prove medical necessity.

I'm not sure if you were asking me or someone else how big I was before my band surgery, but I'll tell you anyway. I'm 5'2" and my highest recorded weight was 231 (it was probably more during the years that I refused to step on a scale). I was 212.5 lbs at the time of my band surgery and lost all my excess weight (90 lbs) in a year.

Try posting your question in this Washington State support group: http://www.lapbandtalk.com/forum/61-washington-local-lap-band-support/. Good luck!

You're looking fab and doing great! And your marriage sounds well-balanced. Hub likes the junk, and you've got the trunk!