The Lap Band Zone I : "Entering the zone"

By Aaron Grossman, Babyboomers.tv Staff Writer, "More Salt Than Pepper"

Thursday, July 9, 2009 10:45 am GMT

I got on the examining room scale which is connected to a device that measures weight, body mass index (BMI) and whatever else you can obtain from stepping on a scale. The nurse and I both looked at the weight reading. Her eyes widen. My eyes tear up. My wife high-five’s me. I had lost 14 pounds in 8 days.

Lest you think I just came out of the hospital after a debilitating illness, let me clarify; I had Lap-Band bariatric surgery a week before the weigh-in. So, before we get into the personal issues of why I decided to have bariatric surgery, allow me to explain the difference between the Lap-Band and the Gastric Bypass procedures.

Lap-Band Vs. Bypass Bariatric Surgery The objective of both techniques is to create a stomach “pouch”, called a stoma, which will facilitate a feeling of fullness after eating a small amount of food. In the beginning, bariatric medicine had the Gastric Bypass breakthrough. This is a procedure which involves separating a small piece of the stomach at the receiving end of the esophagus and stapling it off from the rest of the stomach. A small pouch is created that holds about ¼ cup of solid food or about 2 ounces of fluids.

Food entering the stoma bypasses the large stomach and moves straight to the small intestine through a connecting tube inserted during the operation. The procedure involves abdominal surgery. Al Roker, Carnie Wilson and Star Jones famously went through Gastric Bypass surgery.

Meanwhile, a different and less invasive bariatric procedure gained popularity over in Europe, South America and Asia about 15 years ago - Lap-Band surgery. The “Lap” is for laparoscopy which is how the procedure is executed. Through 5 tiny holes, an inflatable banded tube is inserted laparoscopically and placed around the top of the stomach which is connected by a tube to a “port”. The band has a locking mechanism which securely holds the band in a circle around the stomach. The port sits just underneath an epidermal layer in the lower abdomen and is used to make adjustments to the Lap-Band by inserting or removing saline solution.

Lap-Banding does not use cutting, stapling or bypassing of any organs like Gastric Bypass surgery. Patients in North America are moving over to Lap-Banding as it allows the stomach to return to normal size if one chooses to have it removed. Gastric Bypass is irreversible. Sharon Osbourne, Khaliah Ali (author & daughter of Muhammad Ali) and Brian Dennehy have had Lap-Band surgery.

My surgeon, Dr. Larry Gellman explains the benefits and the responsibilities of having either bariatric procedure this way: The operation you will have can only work with your commitment to change your lifestyle, particularly with regard to diet and exercise. The surgery can make it easier to change your behaviors to more positive ones. 90% of Gastric Bypass patients lose 50-80% of their excess body weight. 90% of Lap-Banding patients lose 40-60% of their excess body weight.

Most people with hypertension (high blood pressure) and/or diabetes no longer need medications. Return of normal periods for young women with abnormal or absent menses. Males will have greater and improved sexual function. Improved sleep by reducing period of sleep apnea. Slowing of disabling effects of arthritis. More energy. Enhanced appearance, physical and mental outlook.

Why I Chose Lap-Banding My decision was not made lightly. It IS surgery, after all and you really have to watch what you eat as well as how you eat it for the rest of your life. I have, however, had a steady increase in risk factors during the last 7-8 years when my weight just ballooned out of control: elevated cholesterol levels, high blood pressure and, most recently, sleep apnea. Next stop: Type II Diabetes. So I asked my internist / cardiologist what he thought of Lap-Banding. “Might as well put a shock collar around your neck to zap you when you overeat.”

Mind you, I love my doctor and he believes in me as he’s watched me lose a lot of weight during the 16 years he’s been my physician. He’s also watched me gain it back and then some. More revealing is why I even went to a world-class cardiologist when I was just 42 years old (and 100 pounds thinner than I am now.) My father had recently passed away, at 73, from congestive heart failure after many years of suffering from angina. His younger brother had died, at 67, about six months earlier and their older sister left this world a few months after my dad. Both siblings also died from cardiac issues. My grandfather had a stroke at the age of 67.

My DNA profile does not exactly recommend a healthy heart into my nineties unless I work very hard at it. So I asked my physician who he would recommend if I wanted to investigate Lap-Banding. I went for the initial consult with Dr. Gellman and I pretty much liked what I heard. But, I still was saying to myself: “Hey, why get your stomach banded when you can just follow their Spartan diet on your own and lose weight the same way?” Oh, have I mentioned me and diets?

I was a chubby kid. It was ordained, you see, because my folks are Holocaust survivors and the family motto ostensibly was “food is love.” Mom took me shopping in the “Husky” department at Alexander’s on the Grand Concourse. I slimmed down in my teens and managed to stay there for a while. I weighed 155 when I got married at 27. But anyone who’s known me my whole life is aware of my struggle which really escalated after I put down cigarettes when I was 36.

I was one of those guys who lost a ton of weight for my daughter’s Bat-Mitzvah (weighed in at 174) and, later, my son’s Bar-Mitzvah (weighed in at 190.) But the pictures hanging on our den wall are “fakes” --- despite my obsession with fitness, I still could not help overeating. There is a rigorous set of protocols you go through in between the initial consult and the Lap-Band procedure itself.

Among these are psychological as well as nutritional counseling. The nutritionist’s visit was particularly illuminating because you are asked to list the number of ways you’ve tried to lose weight and how often. She handed a grid to fill out. Ready for mine? Weight Watchers: 8 times High Protein Diet (such as Atkins): 6 times Cabbage Soup Diet: 6 times Registered Dietician: 4 times Psychotherapy: 4 times Herbal supplements: 3 times Liquid Diets: 3 times Prescription diet pills: 2 times Non-prescription diet pills: 2 times Overeaters Anonymous: 1 time Physician-supervised Diet: 1 time Hypnosis: 1 time Starvation: 1 time Diet books: too many to count.

Anyway, you get the idea. I went through the other pre-operative protocols which included an Upper GI series, stress test, Colonoscopy, Endoscopy, Echocardiogram and several other procedures. I attended support groups of both pre-op and post-op Lab-Banded patients. I reached out to friends of friends who had the procedure. I spent untold hours surfing the web and reading community board posts by pre-op and post-op patients. I wrestled with my diet demons.

And then, a really close friend needed quadruple bypass surgery. He’s fine now, 6 months later. But that was it for me. I don’t want to have my sternum cracked open. I want to minimize or eliminate my risk factors. I want to live and return to “normal” eating. And, I decided that the only way a serial overeater like myself can do it is by banding my stomach down to a small pouch.

What Now? Actually, this is the interesting part. I have to re-train my “stoma”, the pouch, how to process food. So, I’m in Stage One: a liquid diet, wherein I drink 4-6 oz. of broth and protein shakes at regular intervals. After 2 weeks, I move into Stage Two where I can eat soft foods (like scrambled eggs) and thicker drinks of pureed foods (cooked chicken, etc.) In about 6 weeks, my pouch will be ready for regular food --- vegetables, fruits, soft proteins like chicken and fish.

For now there is no caffeine (dehydrates you), booze (irritates the pouch) or much of anything else. There will never again be carbonated beverages, hard crusty breads, steak, or anything fibrous or too tough to pass through the stoma pouch. Interestingly, my surgeon told me on that wonderful weigh-in day that Weight Watchers is an ideal “diet” to use for the rest of my life because the portions are controlled and correctly sized for Lap-Band life. By writing this, I’m coming “out of the closet”, so to speak.

I wasn’t going to tell too many people that I had this procedure. As a matter of fact, I picked up that piece of advice on a post-op message board on the web. “Just say you’re eating less and exercising more.” But, you know what? I’m not ashamed of the choice I’ve made and don’t mind chronicling my progress for you, dear reader.

So stay tuned … there will be periodic updates. For now, I’m actually looking forward to the next weigh-in, to getting my cholesterol monitored and to having my blood pressure checked. Most of all, I am glad to be emerging from the dark tunnel of overeating misery in which I’ve been stalled. For more information on Lap-Banding and where to find a bariatric surgeon near you, click on www.lapband.com.

For information on my surgeon’s practice, click here . Or, Google or Twitter “Lap-Band Bariatric Surgery.”

NEXT IN THE SERIES: Dealing with “civilian” responses to Lap-Banding