Rules of the Road

What you need to know about living with the band

By Robin McCoy

When you begin the decision-making process to have Weight Loss Surgery (WLS), and specifically LapBand® Surgery, it is vital that you fully understand the changes you must make in your lifestyle. WLS is not a magic pill. Weight loss is something that you must work at to be successful. There are several rules and circumstances that someone who has undergone LapBand® Surgery, a “Bandster,” must follow and understand to see success and have a high quality banded life.

Drinking Before and After Meals

Not drinking during meals is, by far, one of the most important things to learn and is vital to your weight loss success. It is also one of the most challenging.

Stop drinking all liquids at least 30 minutes before your meal. This allows all that is in your pouch to drain through to the lower stomach. Therefore your pouch is empty when you eat allowing the food to fill you up properly.

Forgo all beverages during your meals. Drinking during a meal flushes the food through your band and the band is unable to function properly. Most people will have 2, 3 or even 4 glasses of liquid with meals. Servers in restaurants, trained to keep customers happy, will keep beverage glasses full throughout the meal. This is unhealthy for bandsters and sabotages their success. State firmly and clearly that you do not want a beverage. From personal experience, I know the often bewildered looks that follow the statement: “nothing to drink for me,” but diligence is the key. Like most changes required after the LapBand® procedure, not drinking with meals gets much easier with time. Having now lost over 100 pounds, I no longer have difficulty asking my server not to bring me a beverage!

Do not drink for an hour after a meal. The main reason is the same as drinking during your meal. Liquids wash the food through the band defeating its purpose. Another reason not to drink after a meal is if your pouch is full the beverage might not have anywhere to go…except backwards resulting in a spit-up. Suffice it to say that food and liquids making a return visit is not satisfying.

By starting this practice immediately, at the next meal, you will be well on your way to a successful banding experience.

Smaller Bites. More Chewing. Slower Eating.

Begin to recognize and understand what a Bandster Bite is. At your next meal look at your bite size. Look at the amount of food on your fork and remember it. Now, cut that bite in half. This is the Bandster bite size after surgery. Now, cut that bite in half. This is the size of a Bandster bite after the first fill or adjustment. After each fill the bite size will get smaller until the bandster is eating toddler-sized bites. The reason for this is so the bite can be chewed completely to a liquid before swallowing.

The next point is chewing. It is very important that food is completely chewed. Before swallowing ensure the food is a liquid. As the weight loss progresses the opening from the pouch to the lower stomach will be getting smaller. Therefore the food needs to be chewed more thoroughly. If a piece of food is too big to go through the stoma, or opening, it will get "stuck". This can be very painful.

Slower eating becomes inevitable. Eating too fast encourages bigger bites. The bigger bite means the food isn’t chewed properly and it can get stuck. As a Bandster with over 18 months in, I still find myself falling into this trap. I get excited, chatting with friends and just forget to pay attention.

A Bandster’s Eating Order

Lap-Band patients have a specific order in which to eat their food. It is important that there is enough protein in the diet to keep the bodies moving properly. Therefore, the protein should be eaten first. WLS patients need 40-60 grams of protein every day. This can come in a variety of ways. Protein shakes, cheese, fish, beef, chicken, soy. The challenge comes when only certain foods can be tolerated. Also, it is important that the protein is a “hard” protein (chicken, beef, and fish) if possible. It shouldn’t all come from protein shakes and cheese.

The vegetables should be eaten second, and carbohydrates/starches last (if there is room). Proteins last longer in the pouch and take longer to process through the band allowing you to feel full sooner and maintain satiety longer.

Hard proteins are the most difficult for a Bandster to consume. The hard proteins need to be more moist, more tender and chewed more completely than any other type of food. Generally speaking, proteins are the foods that get “stuck” most often and cause spit ups. This happens because the bite isn’t small enough and/or, because the protein hasn’t been chewed sufficiently before swallowing.

For the record, beef is generally the most difficult food for Bandsters to eat. Beef is one of the most difficult foods for humans to digest. It can take several days for a piece of steak to actually work its way through the digestive track. And that’s on an un-banded person! So, if you eat a piece of steak and it isn’t chewed it up completely, it can sit in the pouch for an extended amount of time. Further, the stomach acids that help an un-banded person process beef are not present in the pouch and therefore are not there to help the body break the beef down.

Remember each and every person is different so you will have to test your own waters. Some Bandsters have no trouble with beef whatsoever; others won’t go near it. From personal experience I know that each Bandster will figure out what he or she can or cannot tolerate through trial and error. Trust me when I say that tolerances change; one day ground beef is fine and the next you realize it isn’t any longer. You must be willing and able to adapt to sudden changes in your body’s ability to process certain foods.

The Constant Quest for Restriction; Not enough vs. too much

Restriction. No one can really describe it but everyone wants it. You have restriction when your band is adjusted to the point where you can eat 3-5 bites of well-chewed food and you are full. When this happens you have what is called good restriction.

You are too loose, or open, if you don’t feel full after just a few bites. You are able to eat more on a consistent basis than before. Maybe your weight loss has slowed or stopped. This is when it is time for a fill, or adjustment, in your band.

You are too tight when you can eat very little solid food or worse—none at all. If you are so tight that only liquids go through your band or you are spitting up too often this is too tight. If you can’t keep liquids down this is a medical issue and you must get some removed. You run the risk of becoming dehydrated. Being too tight is not a good thing!

Not only are you not getting the nutrition your body needs to function properly but it can also bring on a slippage in your band. If this happens you will require minor surgery to repair it.

Now that you know a little about what restriction is, let’s get a little deeper. There are three points to learn:

1. The first thing to understand is that every banded person feels restriction differently. So to compare yourself to others is difficult.

2. Also the amount of fluid in the band and the stomach’s reaction, or restriction, to it is a varied as the Bandsters reading this now. Everyone’s stomach is a different size and reacts to the band differently. It is fine to compare fluid levels but don’t get too caught up in “I have this and they have that”.

3. Finally, your level of restriction can change day to day. It can change meal to meal in some cases.

You are now asking, “How in the heck do I deal with that?” My answer is trial and error and learning about your band.

Let us go back to the beginning. Immediately after surgery you will feel restriction. The surgeon usually doesn’t put any fluid in your band during the surgery. The restriction you feel is the swelling of your stomach and it’s adjustment to the band that has suddenly been wrapped around it. You won’t get your first fill until 4-6 weeks after surgery.

You will be on clear liquids and they will fill you up quickly for the first few days. Then they will stop filling you up you will begin to feel hungry. About this time you will be allowed to eat mushy foods like mashed potatoes, creamy soups, etc. You will find that you eat just a few bites and you are full. This is great! Who knew a ¼ can of soup would be enough? This is going to be a piece of cake.

It isn’t going to last. Shortly this won’t satisfy and you will be moving on to solid food. That feeling of restriction comes back. A slice of turkey and you are stuffed!

This doesn’t last either. At about 4 weeks, sometimes earlier, you will start to feel hunger again. You feel like you are eating everything. Your weight loss has slowed or stopped. You start to freak out. “Where is my restriction?!” you cry.

This is a difficult time but one that every Bandster gets through. Just be patient and let yourself finish the healing process. Watch what you eat and know that you are not eating anywhere near what you were pre-band. The unfilled band supplies a certain amount of restriction and you won’t hurt your progress.

Your first fill will bring you back to the restriction point right after surgery. You will eat a few bites and feel full. You will start losing weight pretty quickly. You want to make sure you are eating your protein first, vegetables second and any starches last. This will ensure satiety.

This fill will usually last several weeks. Then it starts to loosen up. Your second fill is the one that usually kicks a Bandster in the butt. This is where they learn what not chewing thoroughly and taking bites that are too large can do.

And so it goes. Some Bandsters need one fill others need more. I had 4 over the course of the first year. I heard of one woman that lost 80 pounds on her first fill. This is why I stress not comparing yourself to your banded friends. It brings on frustration and we have spent enough time in our lives comparing ourselves to others. Now is the time to stop.

One of the largest environmental factors that make our band feel tighter is stress. I never truly understood what Bandsters were talking about when they said stress was tightening their band. That is until I started the process of buying a house. The stress of the pending inspection and what they might find had my band so tight I was barely eating. My band was so tight I cancelled my fill appointment.

Let me say right now that I learned from this experience and you need to make sure you are getting the right vitamins in to ensure your health. I wasn’t in any danger but I was very tired and was bruising like crazy! Well, the inspection went well. I got my house and my band opened back up. Food started going through more smoothly and I started eating better.

Other environmental factors can be tiredness, excitement, sadness, or just the fact that it is morning. Many Bandsters find they can’t eat until after 11 AM every day.

I don’t know if this satisfies your curiosity of what restriction is or what you are to do with it. I do hope you understand that everyone is different and it is a learning process. You will learn what it feels like for you to have good restriction and when your band is talking to you.

Being “stuck” and “spitting up”

As WLS patients we have a few fun words we use. Some are nice and some are not. You will hear “PB” which means “Productive Burp”. I prefer the simple term “spit up”.

What does “stuck” mean? Stuck means that what you have eaten won’t go through the opening between your pouch and lower stomach. This is called your “stoma”. The bite is too big to go through (meaning you didn’t chew it enough), it isn’t something that moves smoothly through the band (lettuce), or you just ate too darn much. When a bite of food goes through your esophagus and hits your pouch it has one of two places to go…through the band or back. If all is well it will go through with no problem either now or later. If it can’t make it to the pouch or through the stoma it will result in a spit up.

Understand that this is something that will happen to you and to every bandster out there. Call it a side-effect or whatever you like but it will happen. The questions are what causes a spit-up, what it feels like, what to do when it happens, and how to avoid them. Remember, things can change day-to-day, heck even meal to meal. This is the nature of the beast. Frustrating? Yes. Small price to pay? I think so.

What causes a spit up is easy. The bite it too big, you took one or two too many bites, you didn’t chew properly, or it is simply a food that you can’t tolerate right now. It is up to you to determine which of the above it true. Trust me… you will learn to determine this.

What does if feel like? You will know. The best way I can find to describe the feeling is when you drink a big gulp of water and it goes down with air. You get this pain in your chest that makes you feel like something is going to bust out. That is what it feels like when something is stuck. It can be minor or it can hurt like a son-of-a-gun. Some bandsters say their bodies tell them when they are finished eating and need to stop. Some Bandsters start to salivate which is their body’s way of washing the food through. Some, me included, get a heavy sigh or exhale; this tells us we are full. Don’t worry; you too will learn to read what your body is telling you…even if you don’t now.

What should you do when it happens? Stop eating is the first thing. It doesn’t matter if it is your first bite or your fifth. A spit up is your body’s way of telling you that you are full. This is your band in full-alert. It is telling you that you are done and to put the fork down. Many times you can stop eating and just wait it out. Until you are used to it you might get the “deer in the headlight” look. Soon you will just adjust. If it doesn’t go away then you need to deal with it.

Dealing with it means excusing yourself and heading to the bathroom. A spit up is just that. I compare it to a baby spit up. It should never be what you classify as vomiting. This is hazardous for a Bandster and should be avoided as it can cause slippage. There is a very large difference in spit ups and vomiting.

How to avoid them? Well, that comes with experience and a willingness to acknowledge when your “food police” tells you to stop. Very quickly you should learn when your band tells you to stop. I found that after my 2nd fill my band was at attention and told me when I was full. This is when I experienced my first spit ups and found foods that I could no longer tolerate.

One of the most difficult things to get your mind around is just how little you will be eating. Your band tells you that you are full but your brain engages and says, “You haven’t eaten nearly enough!” So you take that extra bite or two. Then there it is…the feeling in your chest…your eyes get big…and saliva fills your mouth.

The biggest point I want to get across to you is that, while normal, spitting up is not necessarily a good thing. You don’t want to be doing it every day and certainly not every meal. If this is happening you need to take a good look at what you are eating, how big your bites are, how much you are eating and to what level you are chewing. Be aware at the beginning and it will become more of a habit soon enough.

Surgery Is Not a Magic Pill

Surgery is not the magic pill we have all been waiting for. You will not wake up thin. You must be willing to meet the band half way. You will lose weight at a different pace than your friends. You must change your behavior for this to work. It is a tool—and nothing more. An electric mixer is easier than mixing by hand but you still have to follow the recipe for the cake to taste good.

Right now you should be asking yourself one question—“Am I ready to go the distance?”

It can be a joyful journey with the highest of highs. Moments that are so thrilling and uplifting that you don’t think you will ever come down. It is also a frightening journey as we venture into unfamiliar territory of who we are and where we are going. You are not going down this path alone. There are many Bandsters ahead of you on this path that are ready to help you along the way and take you with them to the next level.

So I ask, “Are you ready to go the distance?”

Thanks! THis is so helpful. I am being banded next Monday and am printing this so I can use it as a reference.

Bonbon

thanks great post!!