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Nancy--What a beautiful post. Thank you for sharing that. I've had similar changes to my self-esteem and feeling of self-worth. It's great to feel like myself again. Janeen 10/18/02 Dr. Ren, NYU Medical Center 306/207/206mg/165g

I understand your reasons, Sue! If it weren't for the great group over on the band board, I'd peace out too for the reasons you stated. Good to know we can reach you over here--you are definitely missed! Janeen

Hi Cindy, You might be too tight. You should be able to eat solid foods, just not much of them. However, you could also just not be chewing as much as you need to with a really good fill. If you can get liquids down, that's a good sign. Practice chewing a lot during meals for a week--chew 25 times, put your fork down for a minute in between bites. If after a week, you can still only drink liquids, and it's been 5 weeks since your fill, I'd call your doctor and discuss having some fill taken out. It's not a big deal at all to have it taken out--no more than putting it in, as long as your doctor is experienced. Hope this helps!! By the way, what is an italian soda? If it has carbonation, you might want to talk to your doctor about--most doctors have us stay off carbonated beverages. Good luck! Janeen 10/18/02 Dr. Ren, NYU Medical Center 306/221/206mg/165g

I can sleep on my stomach just fine. I can feel the port, but just in a "I know it's there" kind of way. It's not uncomfortable, or remotely painful, for me. Janeen 10/18/02 Dr. Ren, NYU Medical Center 306/222/206mg/165g

Megan- Wow--this post really hits home for me. In fact, I could have written this post last year. I was banded in October of 2002, and I started (or re-started) counseling in May of 2002, in preparation for this journey. Everything you just said, I would have said. I didn't talk about my emotions--ever--but I loved talking about other people's feelings and what they were doing! I also was a comfort eater--that's what I turned to instead of talking through my feelings. And like your therapist, mine had me start working on new outlets right away. Now, things are so different for me. Really, I'm amazed all the time at just HOW different they are. I always thought I had a group of good friends--but I never knew how great they were. I never let them be there for me. I limited those friendships, because I didn't let them share *me*--I only shared them. When I started opening up, sharing with my friends, and family, it was like a whole new world opened up to me. A world where comfort eating is, while not completely gone, a rare occassion. What am I afraid of now? Not much. I feel so in control of my life and my weight. Now, I'm not done with my journey--I've still got a long way to go. But I just feel good--good about me, good about my journey, good about the possibilities before me. I hope that gives you some hope for the future! Janeen 10/18/02 Dr. Ren, NYU Medical Center 306/225/206mg/165g

This actually brings up a point that *really* concerns me. It seems that many people are just signing up to be banded, without doing adequate research. This is not directed towards anyone in particular, but I have noticed that many people get the band, and are then shocked that they have no restriction pre-fill, or that they aren't supposed to drink when they eat, or that it sometimes takes more than one fill to do the job. I just wonder--how can someone have major surgery w/o knowing what they are getting into?? Banding is not just a quick solution--you have to be educated about the journey, and you have to be prepared for it mentally. Most people who get the band have really thought it through. But those who haven't really concern me. Larry, it's unfortunate that this man has only lost 5 pounds, but the good thing about the band is that he *can* change his course. Perhaps by following your lead, he will find his way to success. First things first though--he sounds like he would without a doubt benefit from some serious therapy. Maybe you could gently suggest it. Good luck to him, to you, and to us all! Janeen 10/18/02 Dr. Ren, NYU Medical Center 306/226/225mg/165g

Mary--That's perfectly normal that you're eating more. Actually, it is GOOD for your weight loss that you're eating more! Right after banding, you were on liquids, right? So you were probably getting in around 600 calories a day. This is fine for a little while, but your body needs the calories--it needs the energy in order to lose weight! So you will be fine--you might not lose any for a week--even two--but it WILL come off. And when you get the right level of fill, that is when it will really start coming off! Babs--I hear ya about not staying away from the scale! Sometimes I have to put mine in the closet, it's too irresistable! But it's such a nice surprise when you don't weigh yourself for a few weeks, and then bam! 5 pounds are gone! Anyways, don't beat yourselves up--give your body some time to get used to this. Good luck! Janeen

I'd recommend getting used to the scale not budging. Happens to me all the time--I'll go a week, even two weeks, w/o losing a pound. And then all of a sudden, I'm down 4 or 5. It's just our bodies, reacting to the fact that we've changed our eating behavior so radically! Think about it. Pre-op, most of us ate a lot. Post-op, you're most likely watching what you eat, and you're eating a lot less of it. The body gets confused and thinks it's starving, so it holds onto the calories, causing you not to lose an ounce. Then it realizes it's ok, and lets those calories go. So don't sweat the numbers so much--if you can, weigh yourself once a month, instead of every week. If you're like me, and that is impossible, then just try to realize that it's all going to happen for you. My weight loss has been slow and steady, and I'm at just about 80 pounds down--just .5 to go (I never put .5s in my stats, I always round up--don't want to tempt fate, I guess!). And that's at a rate of about 8 pounds a month. 1-2 pounds a week doesn't sound like a lot, I know! But 10 months later, I've got an 80 pound weight loss to feel great about. And you will too, just try to believe in yourself! Good luck! Janeen 10/18/02 Dr. Ren, NYU Medical Center 306/227/225mg/165g

DUDE! I was just about to get Wendy's chili, and now I can't!!! Arg!!! Janeen

I've definitely experienced this. When I first decided to have surgery, I only told a few people. Then I was about to tell another friend, and she was like--Oh, Person X already told me. Of course, I felt really upset and hurt that Person X had told anyone else. But when I questioned her about it, she told me that she didn't realize I wouldn't want our other good friends to know--she just assumed that since she was so happy for me and proud of me, that I'd want our other good friends to know. Once I understood where she was coming from, the anger faded away. Janeen

Pretty good article...http://www.washingtonpost.com/wp-dyn/articles/A25474-2003Jul21.html?nav=hptoc_h A Kinder Cut? Obese Patients Weigh Safety, Effectiveness, Lifestyle Issues of Lap Band, Bypass Surgeries By Sandra G. Boodman Washington Post Staff Writer Tuesday, July 22, 2003; Page HE01 After his weight ballooned to 285 pounds, John Bischoff, a veteran of failed diet and exercise programs, figured he had no alternative to a gastric bypass that would permanently shrink his stomach. His internist suggested it. A surgeon told him the operation might alleviate his hypertension and lower his worrisome cholesterol level as well as his weight. The retired America Online executive was about to schedule the surgery when he mentioned it to his daughter, a nurse practitioner. "She looked at me like, 'What, are you crazy?' " recalled Bischoff, 56, who lives in Loudoun County. "She said it was radical surgery, life-altering, and there's no reversing it." Bischoff's daughter instead suggested a new, less invasive and reversible weight-loss operation called adjustable laparoscopic banding, which restricts food intake without cutting or stapling the stomach or permanently rerouting the intestines, as does bypass surgery. That appealed to Bischoff, who had the "lap band" surgery six weeks ago at Reston Hospital. Surgeon Eric D. Pinnar made a series of one-inch cuts in Bischoff's abdomen, through which he inserted an inflatable hollow silicone band around the top of Bischoff's stomach. The band reconfigured the organ into an hourglass shape, drastically shrinking the top. This serves a dual purpose: It limits the quantity of food Bischoff can eat and quickly triggers a feeling of fullness that lasts for several hours. Four hours after the 60-minute procedure, Bischoff was walking around his hospital room. The next day he went home. A week later he was back on the golf course. So far he has lost about 22 pounds, at a rate of one to three pounds per week, the amount Pinnar recommends. "I think this surgery is a great option," said Bischoff, who said he has suffered no complications, isn't hungry and eats a fraction of what he used to. "The big thing for me is that it's controllable." Bischoff said he was willing to trade the possibility of lesser weight loss for the band's adjustability. As Bischoff loses weight, the device can be periodically tightened or loosened to allow more or less food to pass through it. Adjustments are made by controlling the amount of saline Pinnar inserts into itthrough a portal implanted under the skin of Bischoff's abdomen. The port is connected to the band by a slender plastic tube. In the two years since it was approved by the Food and Drug Administration (FDA), the adjustable band, widely used in Europe and Australia, has emerged as a kinder, gentler -- and less effective -- alternative to gastric bypass. Although bypass patients usually lose more weight rapidly -- sometimes a pound a day -- the operation carries a higher risk of death and permanent complications than the band. The reason lies in the nature of the gastric bypass procedure: The most common operation, known as the Roux-en-Y, not only reduces the amount of food that can be eaten, but also causes significant malabsorption of calories and nutrients. Malabsorption places patients at greater risk of anemia, osteoporosis and bone disease, problems that can usually be prevented by taking high doses of Vitamins. About 20 percent of bypass patients also require further surgery to correct complications, which can be life-threatening; the mortality rate from bypass is estimated to be about 1 percent. The mortality rate after the band is roughly 0.1 to 0.2 percent. Some band-related complications can be reversed by removal of the device, which requires another operation. An FDA official said manufacturer Inamed has reported seven deaths and 97 serious injuries associated with the band between 1999 and 2002. An Inamed official said that about 15,000 U.S. patients have received bands. Recipients include television personality Sharon Osbourne, singer Ann Wilson of Heart and actor Brian Dennehy. Whether the lap band will become popular enough to compete with gastric bypass surgery remains to be seen, particularly because bypass operations are increasingly being performed laparoscopically rather than through a single large incision, enabling patients to recover more quickly with less pain. Both band and bypass procedures are recommended by federal health officials only for selected patients who are morbidly obese: those approximately 100 pounds or more above their healthy weight. That description fits nearly 5 percent of American adults. A Growth Industry In the past two years, the number of Americans turning to weight loss, or bariatric, surgery has skyrocketed. The American Society for Bariatric Surgery, the trade association for weight loss surgeons, estimates that 103,000 Americans, most of them women, will undergo obesity surgery this year, compared with approximately 40,000 in 2001. This explosive growth reflects the accelerating epidemic of obesity, which affects more than 25 percent of the U.S. population coupled with growing media coverage of the problem and of celebrities' surgeries (most recently the laparoscopic gastric bypass performed on "Today" show weatherman Al Roker). It's also spurred by the lack of viable long-term weight-loss alternatives for the morbidly obese. There is also growing evidence that surgery works: A recent analysis by the Cochrane Review, a respected British collaborative that disseminates research about the safety and efficacy of medical practices, examined 18 clinical trials involving nearly 1,900 morbidly obese patients. The group found that bypass surgery resulted in greater weight loss and more improvement in health problems like type 2 diabetes than conventional diet and exercise programs. But which surgery works best for what kind of patient? And what are the long-term risks and benefits? So far no one knows. The National Institutes of Health (NIH) is poised to fund a $15 million program in which investigators at several medical centers will spend five years attempting to answer these and related questions. "Hopefully at the end of this we'll have some answers," said Susan Yanovski, executive director of the National Task Force for the Prevention and Treatment of Obesity at the National Institute of Diabetes and Digestive and Kidney Diseases, the NIH branch overseeing the effort. Hospitals aren't waiting for answers. Many are attempting to capitalize on the extraordinary growth potential of bariatric surgery, which Health Care Strategic Management, an industry newsletter, has characterized as "a real moneymaker for a hospital that does it right." Many are recruiting surgeons and racing to add obesity surgery programs to lure patients, whose procedures are increasingly being reimbursed by insurance. Also at stake is the most lucrative quarry: the self-pay patient like Bischoff, who spent $15,000 of his own money after his insurance company refused to cover lap band surgery, which it and other insurers have deemed experimental. Months-long waiting lists, particularly for bypass surgery, are common, because fewer than 1,000 surgeons nationally are believed to be performing gastric bypass. Michael A. Schweitzer, a bariatric surgeon at Johns Hopkins Hospital, says he is so busy he is booked for the next year. "I would say the demand for surgery has increased logarithmically," said Arlington surgeon Hazem Elariny, who said he performed the Washington area's first laparoscopic gastric bypass at Fairfax Hospital several years ago. "A lot of it is due to patient interest in the minimally invasive laparoscopic approach." Minimal Invasion Although patients are seeking out doctors who perform gastric bypass laparoscopically, there's a dearth of evidence to show that laparoscopy is superior -- and widespread agreement that it makes a difficult operation even tougher to perform. "This is very, very hard surgery," said New York laparoscopic surgeon Christine J. Ren, an assistant professor of surgery at New York University School of Medicine. Ren, who has performed more than 300 laparoscopic bypasses, noted that proficiency varies widely. "There are surgeons who are used to doing open procedures who are going to a weekend course, doing it on a pig and then operating on people," she said. Laparoscopic training is now usually part of residency training for surgeons, and advanced skills can be acquired during a one-year post-residency fellowship. But most doctors older than about 45 typically have little or no training in laparoscopic techniques, which require a surgeon to manipulate special instruments inserted in small incisions along with a tiny camera. Images from the camera are projected on a monitor the surgeon watches during the operation rather than peering into an incision. There is little dispute that the learning curve for laparoscopic bypass is steep. A recent study of 188 University of Massachusetts Medical Center patients published in the Archives of Surgery found a significant decrease in complications after 120 procedures. That conclusion was echoed by Swiss researchers who recommended that "only surgeons with extensive experience in advanced laparoscopy as well as bariatric surgery should attempt this procedure." With the Band It's much easier to achieve proficiency in lap band surgery. An official of Inamed, the California company that makes the only approved device on the market (a second band is in clinical trials) estimated that it takes about 25 procedures to become proficient. The cost of the band and gastric bypass are roughly equivalent, doctors say, although the latter often requires a longer hospitalization. Although surgeons agree that band surgery is easier and probably safer than bypass, it tends to be less successful: Most band patients lose much less weight. One reason may be that the device requires recipients to confront those twin demons of weight loss: diet and exercise. Patients who don't do both will gain weight. And many scientists believe that bypass operations trigger hormonal changes beneficial to weight loss, a hypothesis NIH researchers will be studying. In the FDA clinical trials, 299 band patients lost an average of 36 percent of their excess weight, about half the amount that bypass patients lose. Seven percent of band patients lost no weight and some even got fatter. "You can defeat this operation with high-calorie liquids such as milk shakes," said Reston surgeon Eric Pinnar, one of the few Washington area surgeons who performs only lap band surgery for weight loss because he regards it as less risky than bypass. "This really focuses patients on what they're eating." But not always. Because the band does not cause malabsorption or a related phenomenon called the "dumping syndrome" -- an extremely unpleasant reaction that includes nausea, sweating, fainting and diarrhea that most bypass patients experience if they eat sugar -- it's not hard for band recipients to revert to their old bad habits, especially if they love sweets. Ice cream, soda and chocolate slide easily through the band without triggering an aversive reaction. Bread and other carbohydrates tend to be harder to digest and can cause reflux or regurgitation. And while band-related complications tend to be less serious, they are common. Although the band is intended to be permanent, 25 percent of patients in the FDA trial had the device removed, often because of side effects, which 89 percent of patients experienced. These include abdominal pain, nausea and vomiting, and heartburn. Some surgeons say that recent refinements in technique may decrease the rate of complications but others predict that inferior weight loss will limit the procedure's popularity. Ren, who has done 450 band operations, said she tells patients that the device is a tool, not a panacea "A lot depends on the patient's motivation," she said. "I tell patients, 'You're going to get where you want by making healthy food choices and exercising. That's a lot easier to do when you're not hungry.' " "I think the lap band is a good operation for the right patient," said Schweitzer, an assistant professor of surgery at the Johns Hopkins University School of Medicine who has done 50 band procedures and more than 500 laparoscopic bypasses. "For most patients, gastric bypass is the best procedure," particularly those who crave sugar or have a body mass index (BMI), a ratio of height and weight, above 50. (A woman who is 5 feet 5 inches tall and weighs 300 pounds would have a BMI of 50.) Aimee Lindquist, 23, of Fairfax said she chose the band over bypass because she worried the latter might be too drastic if she wanted to become pregnant. Since her surgery four months ago, Lindquist has lost half of the 80 pounds she hopes to lose. "The best thing is that I'm no longer obsessed with my weight. I take it as it comes," she said. Her biggest adjustment has been slowing the pace of her eating. A typical dinner, which currently consists of about half of a Lean Cuisine meal, now takes her about 30 minutes to eat because she must chew her food so thoroughly. If she doesn't, she will probably throw up. Daryl Newhouse, 42, of Gaithersburg said she knew the band wouldn't work for her because she craves sweets. She said she spent several months researching various surgeries and chose laparoscopic over open bypass "because I thought the risks were lower and the recovery period was faster." Newhouse, who said she weighed 125 pounds when she graduated from college, gained about 10 pounds annually over the next 20 years. A veteran yo-yo dieter, she carried 320 pounds on her 5-foot-10 frame when she underwent surgery in April 2002. "I was definitely a sugar addict," said Newhouse, an editor at legal publisher Lexis-Nexis who felt she needed the negative reinforcement the dumping syndrome has periodically provided. So far, she said, she has lost 125 pounds. Newhouse said she would like to lose 20 more and get down to 170, a weight she considers her ideal. Her only complication has been hair loss, which occurred six months after surgery and has stopped. She no longer suffers from type 2 diabetes, hypertension, stress incontinence, arthritis or sleep apnea, all of which plagued her before her operation. Her life now, she said, is immeasurably better. Most days she takes four-mile walks with her dog, something that would have been a physical impossibility a year ago. "Even my dog has lost 20 pounds," she said. Bischoff said he is looking forward to getting down to 210 pounds, which is what he weighed when he was discharged from the Marine Corps several decades ago. "I want to be around to see my grandchildren grow up," he said. © 2003 The Washington Post Company

Thanks Alex! Very clean, cool site! Janeen