Jean McMillan

Oooohh! Don't get me started on the instant gratification thing! Makes me craz(ier)!

When you started your bariatric surgery journey, did you realize how much work would be involved at every stage of the trip down the Bandwagon trail? As much as you might wish otherwise, the work that produces weight loss success and lifetime maintenance is hard, especially when you’re already worn out from health problems and from lugging all that excess weight around and from one diet failure after another. You have bariatric surgery hoping that it will make weight loss easier. What’s the point of surgery if you have to take on this tough job and never retire from it? THE WORK ETHIC I don’t hear the term “Protestant work ethic” used much these days, but I heard it a lot while growing up in the 1950’s & 1960’s in a Protestant home with hard-working parents. The Cliffs Notes version of the phrase is this: you must demonstrate your deservingness for salvation through hard work and frugality. That’s a big job, performed not only for the God who can save you but also fellow humans who play God by judging your performance. Religious beliefs aside, my personal belief is that hard work benefits the individual as well as the society in which she or he functions. The same principle applies to the work ethic of life after weight loss surgery. IS BAND SUCCESS TOO HARD? Every WLS patient is understandably irritated when a clueless acquaintance declares that “weight loss surgery is taking the easy way out”, but an opposite belief floats around in the bariatric community: that weight loss with the adjustable gastric band takes too much work. So which is it? Too easy, or too hard? Does doing something hard automatically earn you ethical or moral brownie points? Does doing something easy automatically brand you as lazy? I agree that success with the adjustable gastric band takes a lot of work, and I’m not convinced that success with other bariatric procedures is much easier, since regardless of what happens in the operating room, we’re all dealing with the same chronic and incurable disease – obesity. But for the sake of this discussion, let’s assume that a team of scientists in Switzerland (historically a neutral country, even when war was being waged everywhere else in Europe) has studied this matter and can somehow prove that success with the band is indeed harder than any other procedure. For the sake of this discussion, let’s say that band success is hard. It’s hard, sure, but is it too hard? THE VALUE OF WORK I don’t ever want to think I’m afraid of hard work. Nor do I want to believe that my attitude makes me morally superior to someone else, but it seems to me that there is something intrinsically good about hard work. How else can I keep myself moving forward, toward a better (and perhaps easier) life? I can’t rely on good luck to make my journey easier. Raffle prizes and lottery tickets aren’t going to pay the bills and keep (healthy) food on the table. The thorough pre- and post-op education I received from my bariatric surgeon and his staff made it clear to me that I was going to have to work hard, and make some hard lifestyle changes, in order to succeed with my band. I knew from the outset that I was taking on a big job. I was going to have to learn a lot, take responsibility for my health, and do some things I’d really rather not (like exercise) in order to make my band surgery a success. I realize that may make me sound like an insufferable paragon of virtue, so let me add an important and seemingly contradictory statement about myself: the reason I chose to have bariatric surgery was that losing weight “on my own” had been so difficult. I most certainly wanted to take the easier path to a healthy weight. I had spent 30 years messing around with weight loss “the hard way”, and not only was it hard, it was spectacularly unsuccessful. I was ready for a different, “easier,” and longer-lasting approach. DIVISION OF LABOR There’s nothing wrong with avoiding some hard work. My personal resources of time, energy, and knowledge are tremendous but not infinite, so in order to stay healthy and sane, I have to prioritize tasks and spend my resources on them wisely. In my family – the small community created by my husband, 10 rescue dogs, and 3 rescue cats – we also prioritize, so that the person assigned to each task has the better chance of doing it properly and finishing it. This is why I do not attempt to change the oil in my car, my husband does not attempt to sew draperies, and our dogs are in charge of the audio portion of our security alert system (for a demonstration of that, get yourself to Memphis, then drive north until you hear barking). But…there’s always a “but”…the purpose of weight loss surgery is to improve your health and your life. Why should someone else – your surgeon, your nutritionist, your personal trainer, your spouse or your hamster – be in charge of something that essentially belongs to you? Of course you need help from all those people (or critters), but if you’re a mentally competent adult, shouldn’t you be the team captain who keeps everyone focused on winning the game? If you don’t want to be the captain, is that because you secretly want an excuse or a scapegoat when and if you lose the game? That kind of thinking – a basic assumption that you’re going to fail no matter what – is such a huge issue that I’ll have to save it for another article. For now, please just nod your head and smile when I tell you that you can win at weight loss. PAIN & SUFFERING A corollary of the “I’ve suffered too much from obesity” view is “therefore I deserve to lose weight without any suffering at all.” I don’t happen to believe that I deserve to have every wish of mine granted, be it weight loss, fame, fortune, or naturally curly hair, without any exertion on my part, just because I’ve suffered, or even just because I’m alive. I find it satisfying to work for something I want or need, to earn it myself and thank myself for it. On the other hand, I don’t mean that I think we must all suffer in the sense of acute or chronic physical pain or inconvenience that entirely disrupts our lives. I mean instead that long-term weight loss success is going to require us to take a few side trips out of our comfort zones. You know the comfort zone, don’t you? At its center is your favorite armchair, a month’s supply of Reese’s peanut butter cups on the table beside you and the TV remote in your hand. So our WLS success may involve an excursion into the Unknown. For example, if we’ve never tried lifting weights, we don’t know how difficult or painful that might be, but if we don’t give it a try, we’ll never know and never benefit from doing it. There’s a 50/50 chance that we might actually like it. And sooner or later, we’re going to have to tolerate the discomfort of uncertainty, confusion, impatience, frustration, inconvenience, and/or disappointment. That kind of discomfort rarely lasts forever, though. I can testify that learning how to parallel park a car was not a fun experience and that I flunked my first driver’s test because of my parking ineptitude, but a year or so later, I had forgotten how hard it was and parked my car in whatever type of (legal) parking spot I wanted with skill that by then I took for granted. Here’s another example: the first time I participate in a step aerobics class, I fell off the step twice and had to wonder if I was ever going to get the hang of it, never mind enjoy it. Since I was too proud to give up and walk out while the rest of the class sneered at my failure, I stuck it out to the end of class, at which point it seemed vaguely possible that I might do better if I tried it at least one more time. So I went back to another class, and another one, and eventually found myself hooked on it. Now it isn’t just exercise (work), it’s fun (play). If you had snatched the Reese’s peanut butter cup out of my pre-op hand and told me to get my fat butt over to the gym for a step aerobics class, I would have laughed out loud. BUT WHAT IF? But what if your journey on the Bandwagon stalls, or your wagon rolls off a cliff, despite all your effort? What-ifs and coulda-shouldas aren’t going to do much to fix that wagon’s broken wheel, so what can you do to get yourself moving again? I highly recommend a LBT article (by me, of course) entitled, “When Your Bandwagon Stalls.” The article won’t solve all your problems, but it may help you look at them in a new and more effective way. After that, the hard work (of course) is up to you. Click here to check it out: http://www.lapbandtalk.com/page/index.html/_/plateaus-and-regain/when-your-bandwagon-stalls-r130 Unfortunately, hard work is not absolutely, positively guaranteed to produce success, but I’m convinced that it does improve your chances of success. It will lead you out of the desert of failure and into a jungle where every exotic flower smells of success. It will increase your knowledge and wisdom so that when the time comes to evaluate, regroup, and choose a new path if necessary, you can make a good decision. Decision making will be the topic of a future article, so stay tuned!

It's misleading, and irresponsible, and makes me wonder what other garbage they're feeding their patients.

[quote name=APPROVED Candace83' timestamp='1377181129' post='2041683] Well..My brain was playing jokes on me. I am fine...Band is perfect..no slip and no leak. I lost 12.5 lbs since my last appt July 17th and yesterday I weighed 352.3. I told the dr she would think I was crazy because I came in thinking the band wasnt working and I lost over 12 lbs in 5 weeks and she gave me a hug and told me it was fine to have those moments but everything is fine. She gave me a little bit more fluid and told me to not stress out because I am doing great. So thank you for the advice and the uplifting..but I feel better now. I needed good news yesterday because my dog passed away on Tuesday so the good news was very much needed. Your surgeon sounds like a sweetheart!

I take metformin for type 2 diabetes that I managed just fine with diet and exercise until my sleeve revision wreaked havoc with my blood glucose. I don't think the metformin is affecting my weight up or down. I'd love to stop taking it, preferably sooner rather than later. One of my weight loss goals was to reduce the amount of meds I have to take each day, and it's very frustrating to now be on more meds than I was with my long-lost band.

I love people who ask interesting questions!

You really need to ask your surgeon about that, and it might depend on whether you'd want to keep your band at the time of a revision. I've heard of band with plication as a first-time, combo procedure, but haven't heard of adding plication to an already-banded patient. To add plication now, I think your surgeon would have to remove your band, do the plication, and put your band back in place.

I hate those 4 pound weight jumps too, but they come and they go, and as long as your body weight's trending downward, you're doing fine. As for feeling less restriction, keep in mind is that as we lose weight, the visceral (internal) fat that clings to the stomach shrinks, so the band fits more loosely, and we need more fill to readjust the fit.

It's hard to give advice when we don't know what exactly about protein shakes is a problem for you. I just want to say that you should not stray from your post-op eating plan without permission from your surgeon and/or dietitian. Failure to follow the post-op eating progression is a common cause of band slips. Most of us don't think about what's actually happening inside when we eat any kind of food, but your stomach has to expand and contract to break even soft food down and transport it south, to your intestines. That movement can disturb your sutures, interfere with healing, and prevent your band from seating itself into proper position against your stomach. Hang in there!

I wonder if you've got some lactose intolerance going on. A lot of protein powders are made with whey protein (a dairy product). You could try a soy or other veggy-based protein product (ask at a GNC or similar store). And/or call your surgeon's office, tell them the protein drinks are making you nauseated, and ask them for suggestions.

Deciding who to tell about your WLS is a tricky business. Do you tell your friends, family, neighbors, hairdresser or dentist? What about all those coworkers? What (if anything) should you tell them? Coworkers occupy a unique position in our lives. They’re closer than acquaintances, but not as close as families and friends even though we generally spend more time with them than just about anyone else in our lives. Keeping your own private business private at your workplace can be a challenge under the best of circumstances, and it can be dangerous territory for someone having weight loss surgery. Any kind of medical procedure, from a root canal to open heart surgery, is so fascinating that it’s almost instantly transmitted via the office grapevine no matter how solemnly your good friend and coworker swears to keep it a secret. On Monday morning, I tell Amy about my upcoming band surgery in the hushed tones of utmost confidence, and she promises to tell no one. On Monday afternoon, Bud waves at me while passing through the hallway and says, “Good luck with your surgery!” How did that happen? Did Amy betray my confidence? No, not exactly. She called her husband Tim at lunchtime and told him because his mother is considering bariatric surgery, and Tim’s office mate overheard the conversation and called his cousin Dale to ask if it’s true that Jean’s having weight loss surgery…and so on and so forth. Pre-op, who (if anyone) are you going to tell you’re having bariatric surgery? You’ll have to explain your absence (not necessarily in gory detail) to your immediate supervisor and/or a human resources person, and (depending on your employer’s policies) provide a letter from your doctor excusing your absence. You are not obliged to divulge the details of your surgery to anyone; a letter from your surgeon (preferably not on stationery imprinted with “The Hometown Center for Surgical Weight Loss”), stating that you are under his/her care and will need XX days off work to undergo surgery and recovery, should be enough. Be aware, though, that the employer who provides your health insurance probably has access to more of your confidential medical information than you might like. In these days of the Information Age, it’s quite possible that Michelle Obama and the Prime Minister of Japan could discover the details of your weight loss surgery (assuming they even cared). I have no idea how to control that and suggest that you focus your privacy efforts at the local level. If you tell your employer’s human resources manager that you’re having bariatric surgery and later discover (or surmise) that she told the payroll clerk, the receptionist, and her sister Maybelline about it, it would be appropriate to let her know (in private) that she violated the confidentiality of your medical information, but it might not be worthwhile to start a war over it, especially because workplace wars tend to draw curious crowds and foster the growth of the office grapevine. As my wise friend Miss Pat says, “You gotta pick your battles.” Let’s look at a few possible pre- and post-op workplace scenarios. 1. You don’t tell your coworkers about the nature of your surgery, and/or the one coworker you tell keeps her lips zipped. Your cover story is that you’re having your gall bladder removed. Remember please that you have only one gall bladder, and if eventually the real one has to go, you’re going to have to come up with another story. Every other person in your workplace bends your ear with their own gall bladder stories and finally they all get bored with it and move on to the next burning issue, like the fact that Jack got written up for putting a photo of Beyoncé’s backside on his cubicle wall. You come back to work, life goes on, and everything’s fine until you decline an invitation to go out for pizza, or you sit down in the lunch room with a lunch so tiny compared to your pre-op meals that five observers jump to the conclusion that you’re on a diet again, and want to know all the details. Deal with the situation in a way that suits your style and doesn’t back you into an awkward corner. My response to the diet inquisitors would be something like, “I’m just trying to eat less and exercise more,” and then change the subject by saying, “Did you hear that (fill in the blank with the latest office gossip thread)?” or “Hey, when are they supposed to finish painting the lines in the parking lot?” or (as I recently told a coworker who exclaimed, “I don’t know why you even bother!” when she saw my tiny lunch), “Things must be mighty slow if my lunch is the most interesting thing you’ve seen all day.” 2. You’re like I was, so delighted to be having weight loss surgery that you tell everybody and their brother and their dentist and their mail carrier. Instant experts crawl out of the woodwork. Walking into the lunchroom gets to be like turning on the light in that ratty first apartment you had, where the bright light revealed an army of cockroaches swarming over the room. Before your surgery, the cockroaches (excuse me, coworkers) tell you every fractured and horrifying bariatric fairy tale they ever heard, tell you that they know you can lose the weight without doing something drastic like surgery, or proclaim that they would never do such a thing to themselves. If you are extremely patient (not my strong point), you can conduct your own personal bariatric surgery ministry by correcting the cockroaches’ misconceptions (I’m not sure that cockroaches even have ears, however). Or you can perform another version of the strategy outlined above and repeat the same phrase every single time they try to “educate” you. Say, “Thanks for your concern,” and change the subject. 3. After your surgery, you are no longer the center of attention. Life goes on, with occasional excitement when Jack once again gets written up, this time for repeating an off-color joke within the hearing of Mary Smith, the Senior Vice President of S.E.I. (Something Extremely Important). You gradually lose weight, pound after pound. You begin to buy new clothes, you change your hairstyle, you become more outgoing, and eventually several things happen: a) You wonder why no one has noticed your weight loss. Can’t they see the difference now that you’re 40 pounds lighter? What kind of friends are they, anyway? Remember, they’re work friends. Very likely they’re jealous friends, or self-centered friends (and so am I – I care a lot more about my weight than yours), or distracted friends (they’re thinking about their daughter’s need for expensive orthodonture, for example). You wish people would stop saying, “So how much weight have you lost so far?” You can answer honestly and deal with the feedback, or you can follow my example and say something lighthearted like, “20 tons!” or “Not enough!” or “My doctor’s thrilled with my weight loss.” c) The next time someone says, “I hope you’re done losing weight. You’re beginning to look sickly,” you want to smack them upside the head. Instead you can say cheerfully, “I’m sorry to hear you say that, because I’ve never felt better in my entire life.” d) Someone says, “You’ve lost 40 pounds? Really? I just don’t see it.” You run into the restroom and cry for 20 minutes. When you’re done mopping up mascara trails, march right back out there and give that jerk his or her comeuppance with a belated comeback like, “You have an IQ of 40? Really? I just don’t see it.” e) A former eating pal says, “You’re so stuck up now. You never some with us for lunch at Pizza-Rama.” You can respond by saying, “I’m sorry you feel that way, but I’m trying to avoid pizza right now. How about we have lunch at Veggy Heaven today?” If that “pal” frowns at the very idea of eating veggies and the only way they enjoy being with you involves food, you may have to write her/him off. Don’t worry, you’ll find another friend sooner or later, one who can appreciate you for who you are, not what you eat!

Keep in mind that long term weight loss success depends as much on patient compliance (including careful food choices and eating skills, portion control, consistency with aftercare, resisting emotional and other non-physical eating cues) as it does on the surgical procedure. As I told you on another thread, I think you need to choose the procedure that seems best suited to your weight loss and lifestyle needs. I have the sleeve now and it is much harder to live with than my band was. For me, its only advantage over the band is that it doesn't require fills. Since I never found getting fills to be a terrible burden, I'm hard-pressed now to think of something else nice to say about it, so I'll be on my way now.

The adjustable gastric band (Lap-Band or Realize Band) is not all that new any more. The Lap-Band has been approved for use in the USA since 2001, the Realize Band since 2007, and other brands of bands have been used in the rest of the world since the 1980's. I had a band slip (resolved with a complete unfill) and a port flip (corrected with surgery), but I loved my band. You're correct that band surgery is reversible, though I wouldn't recommend doing that unless it was to treat a complication. Just because it's reversible doesn't mean that the band is easy to remove. RNY (gastric bypass) is also reversible, though not easily. VSG (vertical sleeve gastrectomy) is not reversible, and only the "switch" part of DS (duodenal switch) is reversible. Good luck with your decision. It's good that you're doing research. I suggest thatyou carefully weigh what other bariatric patients and a bariatric surgeon tell you, and pick the procedure that feels right for you, to meet your weight loss needs and your post-op lifestyle. Jean

I've been banded and sleeved, but I haven't had both at the same time. But I agree with Elcee, and I think that first, you need to discuss your weight plateau with your surgeon and dietitian.

Can greater eating satisfaction lead to greater weight loss? I CAN’T GET NO! We all want satisfaction, don’t we, in everything we do or experience. As Americans, we consider satisfaction part of our birthright. But does weight loss success require us to eat dull, flavorless food for the rest of our lives? The British want satisfaction too. In 1965, Mick Jagger and the Rolling Stones recorded a song that (among others) I just could not get out of my impressionable 12-year-old head. The first verse is: Can't get no satisfaction I can't get no satisfaction 'Cause I try and I try and I try and I try I can't get no, I can't get no As song lyrics go, that's pretty inane, but as far as I know, Mick Jagger has never claimed to be a poet or intellectual. I now suspect (as I did at age 12) that Satisfaction has a sexual ("I can't get no girlie action") as well as a political theme. Today I'm going to use what you might call my artistic license (that I got by sending an application and $75 to the International Artistic Vehicle Department) and drive Mick Jagger's car down a new road. THE SATISFACTION FACTOR In their book titled Intuitive Eating, authors Tribole & Resch tell us that to overcome our eating problems, we must discover the satisfaction factor. They write: "The Japanese have the wisdom to promote pleasure as one of their goals of healthy living. In our fury to be thin and healthy, we often overlook one of the most basic gifts of existence--the pleasure and satisfaction that can be found in the eating experience. When you eat what you really want, in an environment that is inviting and conducive, the pleasure you derive will be a powerful force in helping you feel satisfied and content. By providing this experience for yourself, you will find that it takes much less food to decide you've had 'enough'. In many ways, I think Tribole & Resch are on target. My weight loss surgery has forced me to take tiny bites, chew very well, and get every molecule of flavor and pleasure out of each mouthful of food, and as a result, I do get a lot more satisfaction out of my meals now. That’s one of the wonderful things about my post-op experience. If you told me that all I could eat for the rest of my life is stale crackers and lukewarm water, I’d be off my bandwagon in one swift leap. But can eating for the satisfaction factor really overcome my eating problems and make them a distant memory? I don't think I overlooked the pleasure and satisfaction from eating back in the bad old days. Rather, I sought it in the wrong places and gave myself such massive daily overdoses of food that it lost its power to please even while it gained more power to drive me. Kind of like an addict needing bigger and bigger doses of a drug to get that precious high feeling: an addict whose hunger for that high drives him or her to a life of crime. I never committed a crime for the sake of food, but otherwise I behaved like an addict. I was ashamed of my food issues and eating behaviors and worked to keep them secret even while even a casual observer could see just from my size and shape that something in me had gone off its track a long time ago. One of the reasons I wanted to hide my food problems was my fear of being judged by others. I don't think I was being paranoid. Even now, I have (slim) acquaintances who react to obesity in others as if it's an awful, shameful crime instead of a chronic disease. They see a super morbidly obese woman heaving herself out of the motorized shopping cart at Wal-Mart and whisper, "How could she let herself get that way?" Well, those “normal” acquaintances (and many others) just don't know the "how" of obesity, do they? But we do. The sight of that obese woman bothers me, too, because I know far too much about what her life must be like, and I'm filled with compassion and pity and frustration when I watch her struggle to reach a package of Double Stuff Oreo cookies on the supermarket shelf. The sight of that obese woman in a motorized shopping cart, and the overfeeding of America is a hot political topic now, but I hate politics, so I’ll pass up that aspect of obesity for now, and just suggest that you give some thought to whether your own healing should involve “becoming normal,” and whether or not WLS will send you down that road and keep you on track for the rest of your life. Me? I feel that I can’t afford to ignore my past as an “abnormal,” obese person, because of that short, fat blonde girl who lurks inside me, just waiting to get out. What do you think?

Great topic! Some of my favorite NSV's are: I can cross my legs; I can shop for clothes in regular size departments/stores; I don't have to use the handicapped stall in public restrooms; there's plenty of room in airplane and theater seats now; I can sit on the floor and get up again without needing a crane to lift me; I wore a bathing suit in public while on vacation; I bought my first short skirt in 30 years and even wear it in public; people I tell about my weight loss say, "I never would have guessed you were ever that big."

I had a port revision because my port flipped over after 2-1/2 years of no problems. I didn't even know it until my surgeon and her NP began having trouble accessing my port. My surgeon didn't know what could have caused it to flip, partly because she's not the one who did my band placement. She says it could have been a failed suture, or stress on the abdominal fascia during a workout. Anyway, after the revision it stayed put and since she relocated my port deeper (so I no longer had a bulge there) and away from my waist (where it used to rub against my clothes, kitchen counter, etc.) I was happy with the results. I can't comment on the 1% chance of needing a port revision because I'm not a statistician or medical professional, and not inclined to believe statistics anyway (a boss once told me, "figures can lie, and liars can figure"), and can't comment on whether your port is pressing on a nerve (never heard of that), but I've encountered quite a few people whose port flipped. I understand why you're not feeling too swift about this turn of events, but a port revision is not the worst thing that could happen to a WLS patient. Hard as it may be to imagine, a year from now that revision will be a distant memory.

I'm sure your surgeon would be relieved to hear that I approve of his advice! Following a liquid diet when you've been having eating problems and difficulty adjusting to a new fill is a good idea that I advocate often. It gives your upper GI tract a chance to calm down so that the next time you try solid food, you should be able to eat and enjoy it more easily. But I think we have to be cautious about that approach because it can delay facing up to the fact that we might need an unfill.

Yeah, calorie counting can become a "can't see the forest for the trees" thing!

You're not a failure. This whole thing is brand new to you, and you still have a lot to learn. If I were you, I'd contact your surgeon's on-call partner and schedule a small unfill. liquid and soft calories just do not provide the early and prolonged satiety that you need, and keeping your band too tight can cause complications like band slips. Also, try to be patient about the weight loss. I know that's hard, but losing 16 lbs the first month is very fast, and the plateau you've experienced then is quite likely due to your body's effort to readjust your metabolism. It may be thinking, "Oh, no! We're going to starve to death! Better slow this engine way down!" Because the body perceives calorie restriction as potential starvation, tt's possible to cause a plateau by eating too few calories. I've heard so many people say they started to lose again after they started adding more (healthy) foods to their daily intake. I love my summer fruits and veggies too, and complex carbs like that can also help weight loss because the Fiber content helps keep you satisfied while its doing all kinds of good stuff for your health. Hang in there!

Can you talk to your doctor in a way that makes your needs clear and that helps you understand what you need to do to take care of them? LET ME MAKE THIS PERFECTLY CLEAR… Or maybe not so perfectly. How about adequately? It should come as no surprise when I tell you that I love languages, especially English. My mother was an English teacher who once told me she'd rather I become a streetwalker than misuse the English language. I'm sure I'd have earned a whole other maternal lecture if I had become a streetwalker, but Mom's insistence on clear written and spoken communication was one of her greatest gifts to me, not just in my writing but also in my business career and social relationships. Despite all that, I've had many frustrating encounters with other English speakers who couldn't seem to grasp my meaning no matter how plainly I felt I had expressed it. That's because effective communication involves more than facility with words. This truth came home to be during a lengthy, complicated business negotiation with the owner of a Japanese manufacturing company from which my employer bought steel components. Mr. Hota brought his own translator, but I suspected that he understood a fair amount of English because he sometimes replied to me (in Japanese) before his translator had begun to translate what I'd said. Mr. Hota was calm, his face perfectly blank, he spoke no English, and I spoke no Japanese; we met in my company's conference room, not his; and yet somehow he was gaining the upper hand in a negotiation worth $3 million. When I told my boss, "I can't communicate with Mr. Hota," he said, "Yes, you can, but not necessarily with words." Communication can be difficult even amongst people who share a native tongue, be it English, Japanese, or Urdu, with results that range from comical to frustrating. When the other person is your doctor and 5 minutes of his/her time cost $200-$300, and your own most puzzling questions or symptoms are the topic of discussion, frustration can turn to fury. But what do you do with that fury? The doctor is an authority figure, an expert whose advice or care you urgently need. You could say, "That's it. I'm outta here!" and flounce out of the office. If the doctor were an automobile mechanic, it probably wouldn't be too difficult to find another mechanic to help you, but finding another doctor who's qualified, accepts your insurance plan, is taking new patients, and can give you an appointment sometime in the next decade….? That's not so easy. WHERE DO WE GO WRONG? Because of my interest in communication and my part-time retail job, I could tell you dozens of stories about communication problems. While I began this article complaining about people who can't seem to understand even the simplest sentence I utter, I could also complain about people who can't seem to make me understand the sentences that they utter. The fact that I'm hearing-impaired makes clear communication all the harder, but I can provide living, breathing witnesses to some of the funny and frustrating encounters I've had with customers at the department store where I work. I’ll do almost anything for a laugh, but when the communication is between you and your doctor and your health is at stake, the miscommunication story is not so funny, is it? So just whose fault is the failure to communicate? Yours, mine, your doctor’s, or Alexander Graham Bell’s? SHOW & TELL Back in the Stone Age when I was in elementary school, we had Show & Tell Days. Betsy (future veterinarian) showed us her hamster and described what he liked to eat. Joey (future geologist) showed a large piece of quartz he'd found and described what he'd learned about how it was formed. Jeannie (aspiring art teacher, future author) showed a potholder she'd made and gave a fascinating and heartfelt lecture on how to weave a potholder. Paul (aspiring magician, future attorney) showed us a card trick he'd learned. As grownups, when we go to the doctor "presenting" (as the docs would say) with a symptom, we play an adult version of Show & Tell. If we have a rash or a bruise, we can easily SHOW the doctor what's wrong. But often the problem is invisible, even to x-rays and blood tests, and sometimes a rash is only the tip of the medical iceberg. In that case, the TELL part of our presentation is extremely important. Our doctors are not mind-readers, their patients are each unique, and graduating from medical school does not automatically make a person perfect or infallible. As far as I know, there are no sensitivity training classes or even bedside manner courses in medical school. So we patients are trying to communicate and connect with a scientist, not a fortune teller. Communicating with doctors is a special interest of mine because of the extremely frustrating experiences I had while seeking a diagnosis and treatment for my chronic pain. It seemed to me then that my vaunted communication skills were completely ineffective when I was standing or sitting before a scientist in a white coat. I was slow to realize that many of the docs I consulted viewed me with suspicion because of my communication style. They distrusted me because I had "inappropriate" knowledge: how to pronounce medical terms, the correct names for various parts of my body, and the names of medications commonly used to treat symptoms like mine. I tried different approaches, different communication styles, as I went from one doctor to the next, until finally I found one who was at least willing to hear me out before passing judgment, and whose subsequent treatment of my pain has been very effective in no small part because of the way we interact. WHEN YOU TALK TO YOUR DOC On the face of it, communication is a simple process. It consists of a message, the sender of the message (who encodes the message), and the receiver of the message (who decodes the message and gives feedback about it). All three of those components have to be functioning in order for communication to take place. This is why I once got spanked for asking my father for $5 while he was asleep, then helping myself to his wallet: he neither heard my message (he was snoring too loudly) nor gave me feedback about it (permission to take the $5). While communication is a two-way process, you can only control part of it, so when you talk to your doc, it’s your responsibility to phrase your message clearly (and politely). If you have trouble expressing yourself to your surgeon, consider bringing a more eloquent friend or family member with you to appointments. When you think of questions in between visits, write them down immediately, and bring your list to your next appointment (or telephone conversation). It is always OK to ask members of your bariatric team about anything at all about your weight loss surgery (questions, concerns, problems, symptoms, side effects, complications, frustrations, and even opinions), but don't expect answers to things like, "Are you a Republican or a Democrat?" If you're not sure if your question is related to weight loss surgery, go ahead and ask anyway. I always preface this kind of inquiry with, "I'm not sure who I should talk to about this, but maybe you can point me in the right direction." I know that not every medical thing in your mind is easy to say out loud, but while the issue burning in your mind might be embarrassing to you, you're not going to get very far with it if you hold it inside. Your doctor isn't going to laugh at you or tell your next door neighbor what you said. What's the worst he/she could say? "I don't know"? Don't dwell on whether he/she thinks you're an idiot for asking this question. You have no control over other people's thoughts, only your own, and you're not a mind-reader either. If you are truly the most challenging patient your doctor has ever had, you may actually be fulfilling a medical school dream of his/hers. If you need to make a critical comment, phrase it carefully and constructively. For example, instead of saying, "I'm sick of having to wait three hours to see you every time I come here," consider saying, "Could I avoid a three hour wait to see you if my next appointment is in the morning instead of the afternoon?" If that doesn't produce a satisfactory response, proceed to the next level with a stronger statement, like, "I'm extremely distressed about having to wait for three hours every time I come to see you." But don't burn your bridges with threats and accusations until you have another doctor lined up. Finding a new surgeon can be a time-consuming and expensive process (take it from one who knows that firsthand), so give your doc a chance to help you before you march out of the waiting room door and step alone into the big, bad bariatric world!

Who's the "everyone" trying to talk you out of weight loss surgery? Have any of them actually had weight loss surgery? Have any of them lost 255, 175, or even 100 lbs by any method? And if they lost that weight "on their own", without weight loss surgery, how long have they maintained their weight loss? I think it's wonderful that you've lost 175 lbs on your own, and losing another 80 lbs is a worthwhile goal, but if you've been stalled for a year, I'm not sure the on-your-own approach is going to take care of that last 80 lbs any time soon. On the other hand, you do need to be realistic about what adjustable gastric band surgery will do for you. It's not going to turn the weight loss switch back on for you. When properly adjusted, the band will provide you with early and prolonged satiety, but good food choices, portion control, dealing with emotional eating urges, and exercising will go on being your own responsibility. I won't try to persuade you to go ahead with surgery or give up the idea forever. I hope that losing 175 lbs has already given you many health benefits, and I would hate for you to consider yourself a failure if you don't lose the additional 80 lbs. Good luck!

Your band caused 2 herniated discs? Discs in your spine? Which of your doctors suggested that your band was the cause of that?

I had to do Lovenox shots for 3 weeks (I think). I'd never given myself an injection before but it wasn't at all difficult. The needle is tiny and the Lovenox came in pre-measured disposable syringes. I was told to inject it into my thighs (they didn't want any injections near my healing incisions) and believe me, there was plenty of flab there. The Lovenox stung going in, and the needle left bruises (I bruise easily anyway), but it turned out to be no big deal. It did, however, make me glad I don't have to do several insulin injections a day for the rest of my life.

How can you socialize and stick to your food plan? Sooner or later you'll find yourself in a situation where you have little or no control over the food served. That doesn't mean you have to abandon all your band eating skills or go hungry. The key is to have plans, even for unpredictable situations. Social eating poses all kinds of challenges to the bariatric post-op. How to resist the dessert cart? How to refuse an extra helping of potatoes that Mom mashed especially for you (with just a little gravy)? How to chat with nine people and still concentrate on taking tiny bites? One recommendation applies to all social eating situations: do not experiment with new foods. You don't know how well they'll go down and you don't want to disgrace yourself in public. This has been a challenge for me because I love to try new foods, especially when I travel, but taking food risks in public is just not worth the potential pain and embarrassment. How easily you can pull off social eating will depend in part on whether your hosts or fellow guests know about your weight loss surgery (a topic worthy of an article of its own, so stay tuned). Sometimes I think my new eating habits are harder on my friends than they are on me. For example, a few months ago I went out to lunch with a group of women, including a friend (we'll call her Kathy) who knew me when I was fat and knows I had weight loss surgery. This was not the first time I had dined with Kathy since my surgery, so I was a bit surprised to realize that she was studying me as I ate. "Is there a problem?" I said. "I'm sorry, I shouldn't stare," she answered, "But I just can't get over the way you eat now." "Isn't it great?" I said with hearty enthusiasm. "Um, yeah, I guess so." There was an awkward pause. Then she rallied and said, "So how many dogs did you say you have now?" I have survived many post-op social eating occasions with acquaintances who don't know about my weight loss surgery (and I'd rather keep it that way). Most of them keep their opinions about my eating (if they even notice it) to themselves. Sometimes they ask, "Don't you like the food?" (I answer honestly, yes or no), or "Are you diabetic?" (yes), or "Are you allergic to nuts? (no). Sometimes I have to use Kathy's change-the-subject method of getting out of an awkward moment (asking the hostess for the recipe, or a portion of dessert to take home, works well as both a compliment and a distraction). Advance planning is crucial for successful social eating. Try to find out what will be served and decide what you'll eat. Eat something before you leave home, because the old advice to save your calories for the party is risky business for a post-op. Imagine how irresistible the buffet table is going to look if you haven't eaten for 10 hours. You're not just risking extra calories at that point - you're risking a stuck episode, a productive burp (regurgitation), or sliming - because you're too hungry to eat carefully. If at all possible, bring some food that you can eat and share with the other guests (tell the host or hostess you're going to do this or it might get whisked away and stashed in the refrigerator). If you know alcohol is going to be served, bring a pitcher of a non-alcoholic beverage you like and announce that you thought everybody might like to try your special punch or fruit tea or whatever it is. Stand-up can be easier than sit-down affairs because everyone is busy balancing a plate, cutlery, beverage and conversation and it's easier to sneak off and ditch the food without being seen. At sit-down meals, I'll grab my plate and a neighbor's (making sure it's empty first, of course) and head for the kitchen saying, "Do let me help clear the table" or "Can I get you anything while I'm up?" (that's hard to pull off in a restaurant, though). Speaking of stand-up affairs, finger food is a terrible idea for bandsters. Human teeth are just not designed to take a small enough bite of anything solid enough to be held in the fingers, so proceed with caution. Whether you're standing up or sitting down, cutting up your food into tiny pieces and occasionally moving it around your plate with your fork are good ways to camouflage your spare post-op eating style. And one last piece of advice: please do not give your uneaten food to your host's dog (or cat, or potted plant), no matter how hungry the dog claims he is. You have no way of knowing if the food is even safe for the dog. My dogs are four-legged garbage cans, and they have even worse judgment about food than I do!