Jean McMillan

He was nice looking, but not the type that I'm attracted to. But then, I've been married for 25 years, and my memory about that kind of thing is kinda hazy...

You're so right. That's why I said, "the re-education process is slow going." And even when surgeons and their staff get up to speed with patient education, it's entirely possible that patients who are so eager (as I was) to have WLS that they dismiss everything they hear and don't like will still end up wondering what went wrong. Information and anecdotal reports found on online forums like LBT have a lot of flaws that can be hard to sift through, but one of the best things Alex Brecher has brought to the WLS community is the open exchange of personal experience and the nitty gritty of what works for real life patients, and what doesn't.

And if we could lose weight, and keep it off, by consuming only liquids (like Protein shakes) for the rest of our lives, why have bariatric surgery in the first place?

WLS coverage will depend on the terms of your particular policy. I have excellent insurance that covered both my band removal and my sleeve revision. My understanding is that insurance may cover band removal if it can be shown to be medically necessary - that is, causing complications. If your policy includes a single WLS per patient's lifetime clause, it's much harder to appeal insurance denial. A few years ago I served on an ask-the-expert panel at a WLS conference. I sat beside Walter Lindstrom, MD, a surgeon and sleeve patient who recently established a WLS patient advocacy company that can help with an appeal should you need it. Their service isn't free, but it probably costs a lot less than paying for a revision out of your own pocket. Here's a link to the company's website: http://wlsappeals.com/how-we-help/fight-your-wls-insurance-denial/

As far as I know, the most common reason for doing band removal and revision surgery in 2 separate surgeries is to allow the body to heal before subjecting it to more surgery. I don't want to rain on your parade, but it's impossible to predict what your upper GI tract is going to look like when your new surgeon goes in there to remove your band. If there's a lot of scar tissue or inflammation, it might not be safe to proceed with the sleeve at that time. I had my band removed in April 2012. I went in to the operating room expecting to wake up with a sleeve, and I woke up with nothing - no band, no sleeve. Here's a link to a recent thread about the band versus the sleeve, on which I posted my own story. If you have any questions after reading it, please let me know. If I don't know the answer, I may be able to point you in the right direction. Just one more thing - I applaud you for getting a 2nd opinion about this. Your health is too important to allow a doctor to pooh-pooh your concerns.

I'd want to call them on that, by saying something like, "Can you explain why you label me as obese? Now that I have a BMI of 25.5, am I not on the upper end of the normal weight range for my height?" I'd also tell the specialist (as calmly as possible) that it's very hurtful for a doctor to use the obese label for a WLS patient and that you'd like him/her to treat you with more consideration and respect.

Congrats on the start of your WLS journey! My band surgery was easy, and a lot less painful, than other surgeries I've had, ranging from oral surgery to a hysterectomy to a breast reduction. And yes, I would do it again, because those few days of discomfort were well worth it in terms of the long term benefits for my physical health, mental health, and lifestyle.

I understand that you still feel huge. I know that feeling well. The mental weight loss journey takes a lot longer than the physical one. Who is labeling you as obese?

No one here is qualified to diagnose what's going on with you, so I'm glad you've got a team of doctors helping you. I just hope one of them is experienced in treating eating disorder and/or WLS patients. Now I'm going to tell you a story to prove to you that I know about anorexics' inability to see any problems with their eating behavior. I had an inguinal hernia repair in my late 20's. I had lost a lot of weight in the months preceding that surgery. the weight loss started with genuine upheaval over my divorce. One day I saw my soon-to-be-ex-husband, who took a look at me and said, "What's happened to you, Jean? Aren't you eating?" I got a lot of gratification from that comment. Way too much. Having the power to make Joe worry about my weight went right to my head. My divorce upheaval continued, with a new twist: I realized that I could, for once in my life, lose weight. In the morning I ate a carefully measured and cut piece of coffeecake (hey, I make no claims that this was a good nutritional plan). For lunch I ate 4 slices of raw green pepper. For dinner I ate 4 potato chips (see above remark). That's what I ate, day after day, and I did a 45-minute exercise class twice a day. I became obsessed with weighing less than 100 lbs. So after the hernia repair surgery, I woke up in the recovery room in a great deal of pain. I asked a nurse for pain medication, and overheard her conferring with someone else (a nurse? a doctor?) about the appropriate dose for someone my size. I was 5'3" tall. The nurses' conversation went like this: Nurse A: "How much does she weigh?" Nurse B: "I don't see it in her chart. What, maybe 110 lbs?" Nurse A: "Naw, not that much. More like 107?" I lost track of the conversation then because my mind was overcome with panic because they thought I weighed only 107 lbs. I felt as if I weighed 1000 lbs. They didn't understand how horribly fat I was, and how urgently I needed to weigh less than 100 lbs. My physical pain didn't matter in the least at that point, not compared to the pain of being as huge as I was. Or...as I thought I was. After my surgery, my weight loss stopped. My mom came to take care of me (and feed me), and my family doctor insisted that I come to his office twice a week to be weighed. I felt as if I was being tortured. I felt they were all cruel and insensitive...but if I hadn't had them to police my eating, I might very well be dead by now.

A common feature of anorexia is that, like you, the patient has a distorted view of how much she ought to weigh. That's one of the things that makes it so hard to treat. I don't know how tall you are, but if your ticker is up to date and your BMI is now 25.5, losing another 25 pounds would put you in the underweight category, and that's dangerous territory.

I've heard tell of gallbladder problems from losing weight too quickly after bariatric surgery, but that's all. I believe that electrolyte imbalance can contribute to kidney disease, and electrolyte imbalance and malnourishment are complications from anorexia, so I hope you're in the hospital getting treatment for your kidneys as well as the anorexia. Or at least getting dialysis. That's scary stuff. Take care. Jean

I chose the band because (at that time) of the reasons other members have mentioned, plus it just felt right for me - sort of gut feeling. I can't recommend the sleeve, and no matter what surgical procedure you have, sooner or later you're going to have to make some permanent dietary and lifestyle changes. I wrote at length about my experiences with the band and the sleeve on this thread, plus other member's responses to that thread might interest you: http://www.lapbandtalk.com/topic/165182-restriction-riddles/#entry1946776 There are 2 important things to know about the band. 1. it probably won't start working optimally until you've had a few fills 2. it requires a lot of aftercare, so even if your insurance covers that, you need to factor in time and money (including time off work) spent going back and forth to see your surgeon for fills and unfills.

The band can seem very fickle at times, giving you restriction riddles instead of restriction answers. How can we solve those riddles? RESTRICTION RIDDLES Restriction is the holy grail of bandsters, but even when you find it, it may not cooperate with you all day every day. Its fickle nature may allow you to eat one food on Tuesday but not on Wednesday. It may not show up until 2 weeks after a fill, or it may disappear 2 weeks after a fill. You end up puzzling over riddles like delayed restriction, disappearing restriction, and/or variable restriction. DELAYED RESTRICTION Although the fluid injected into the port during a fill travels immediately to the band, it can take several weeks for you to notice an increase in restriction. This may be because you spend a few days after a fill progressing from liquids to purees to soft to solid food, and then you're extra careful when eating: on the alert for more restriction. When we relax this vigilance, careless eating will eventually remind us (again) that we have a band with more fill in it. Delayed restriction is frustrating, I admit. You get a fill and want instant results. But all you can do is pay close attention to your body's signals as it adjusts to the tighter fit of the band. It is pointless to try to judge your restriction in the two to three days immediately after a fill, when you're on a liquid or pureed diet, because optimal restriction is experienced when you're eating solid foods. DISAPPEARING RESTRICTION At times during my weight loss surgery journey, I have asked myself, "Where the heck did my restriction go? Did thieves sneak in during the night and steal it?" In addition to thieves and elves, the following things can make your restriction seem to disappear overnight: 1. A few days to a week after a fill, the swelling and irritation caused by the fill calms down and the fit of your band feels looser. 2. In the first few weeks after a fill, you re-learn your band eating skills and unconsciously adjust to the new fill level so that you experience fewer negative symptoms. 3. As you lose weight after a fill, the visceral fat around your stomach shrinks, so the fit of your band doesn't feel as tight. 4. The position of your band against your stomach subtly changes due to normal body processes (see below). 5. Your band loses fluid due to evaporation, leakage, or inadvertent removal during a fill. Please note that in #1 and #3 above, I said that the fit of the band feels looser or tighter. The band itself does not loosen or tighten by itself. Only a fill, unfill, or manufacturing defect can do that. The band is not like a rubber band that stretches out over time and eventually snaps. WHY IS RESTRICTION SO VARIABLE? Sooner or later, every bandster discovers that the band is a fickle mistress. In the course of a week, it can feel too loose, too tight, or just right (kind of like Goldilocks and the Three Bears). The food that worked fine on Monday may get stuck on Tuesday. On Wednesday you can hardly eat at all, and on Thursday you could eat an entire wedding banquet all by yourself. Friday you're back to Square One. These variations are maddening but fairly normal. The stomach is living tissue that expands and contracts to aid digestion. It's affected by weight loss, the time of day (morning tightness is common), the time of month or fluid retention, medications, illness, dehydration and stress. The pressure of the band against the stomach can cause the stomach wall to thin out, so the band feels looser. And although the band and the stomach are sutured together, the position of the band can shift enough to affect your experience of restriction. Remember: the #1 factor affecting the amount of food you can eat is what type of food you eat. You will feel more restriction when you eat solid food (like animal protein), less when you eat soft food (even healthy stuff like yogurt and cottage cheese), and virtually none when you drink liquids (even healthy ones like protein drinks).

I love edamame, and they provide Fiber and protein along with the flavor, but are you asking if it's good to eat edamame as your only protein source? If so, personally I wouldn't do that, for 3 reasons: 1. food boredom always leads me astray 2. my body needs a variety of protein sources to meet my nutritional needs (for Vitamins & minerals) 3. dense animal, fish, or seafood provides better satiety than softer protein sources (like edamame, tofu, cheese, beans)

Hey, if I want salt on my popcorn, why should a unicorn make do with unsalted popcorn?!

Please don't agonize about facing your surgeon again. Most surgeons hate to see patients disappear and are happy to welcome them back. Your surgeon already knows you have a problem with food and eating. If I were you, I'd ask for a band refresher course along with that fill, including spending some time with a dietitian to figure out a detailed eating plan and talk about the foods or cravings or other things that you struggle with. As Cheryl said, it takes guts to own up to your band "failure". People who can't or won't admit to that have a much harder time of getting on track and staying there. You can do this! Jean

Good question. My original band surgeon told me that neither the stomach nor the band are fixed, unchanging objects like metal pipe with welded joins and closures. Dr. Paul O'Brien, an Australian surgeon who is one of the pioneers of clinical use of the band and author of The Lap-Band Solution, there can be a slight loss of fill over time (his example: 7.0ml can drop to 6.7ml in 6 months - a loss of about 4%), not due to leakage. In his book, Lap-Band for Life, Dr. Ariel Ortiz Lagadere reiterates that the band can lose up to 4% of its fill over the course of six months because some fluid can evaporate. Has anyone ever proved this fluid loss due to evaporation to be scientifically accurate? I doubt it. I mentioned the possibility of evaporation in Bandwagon and the book was vetted by a bariatric surgeon, Dr. Ross McMahon of Swedish Weight Loss Services in Seattle, WA. I hope that his failure to contradict the evaporation theory gives it a kind of backhanded credence, but it could be that he overlooked it.

Just for the record: Sleeve patients can dump also. Or at least I do. My surgeon says that's because my sleeve is too small to hold food long enough to start digesting it, so the food gets quickly dumped into my duodenum, causing a rapid and extreme blood sugar spike and miserable symptoms to go along with it.

Hurray, CG! You're a weight loss ROCK STAR!

RESTRICTION RIDDLES Restriction is the holy grail of bandsters, but even when you find it, it may not cooperate with you all day every day. Its fickle nature may allow you to eat one food on Tuesday but not on Wednesday. It may not show up until 2 weeks after a fill, or it may disappear 2 weeks after a fill. You end up puzzling over riddles like delayed restriction, disappearing restriction, and/or variable restriction. DELAYED RESTRICTION Although the fluid injected into the port during a fill travels immediately to the band, it can take several weeks for you to notice an increase in restriction. This may be because you spend a few days after a fill progressing from liquids to purees to soft to solid food, and then you're extra careful when eating: on the alert for more restriction. When we relax this vigilance, careless eating will eventually remind us (again) that we have a band with more fill in it. Delayed restriction is frustrating, I admit. You get a fill and want instant results. But all you can do is pay close attention to your body's signals as it adjusts to the tighter fit of the band. It is pointless to try to judge your restriction in the two to three days immediately after a fill, when you're on a liquid or pureed diet, because optimal restriction is experienced when you're eating solid foods. DISAPPEARING RESTRICTION At times during my weight loss surgery journey, I have asked myself, "Where the heck did my restriction go? Did thieves sneak in during the night and steal it?" In addition to thieves and elves, the following things can make your restriction seem to disappear overnight: 1. A few days to a week after a fill, the swelling and irritation caused by the fill calms down and the fit of your band feels looser. 2. In the first few weeks after a fill, you re-learn your band eating skills and unconsciously adjust to the new fill level so that you experience fewer negative symptoms. 3. As you lose weight after a fill, the visceral fat around your stomach shrinks, so the fit of your band doesn't feel as tight. 4. The position of your band against your stomach subtly changes due to normal body processes (see below). 5. Your band loses fluid due to evaporation, leakage, or inadvertent removal during a fill. Please note that in #1 and #3 above, I said that the fit of the band feels looser or tighter. The band itself does not loosen or tighten by itself. Only a fill, unfill, or manufacturing defect can do that. The band is not like a rubber band that stretches out over time and eventually snaps. WHY IS RESTRICTION SO VARIABLE? Sooner or later, every bandster discovers that the band is a fickle mistress. In the course of a week, it can feel too loose, too tight, or just right (kind of like Goldilocks and the Three Bears). The food that worked fine on Monday may get stuck on Tuesday. On Wednesday you can hardly eat at all, and on Thursday you could eat an entire wedding banquet all by yourself. Friday you're back to Square One. These variations are maddening but fairly normal. The stomach is living tissue that expands and contracts to aid digestion. It's affected by weight loss, the time of day (morning tightness is common), the time of month or fluid retention, medications, illness, dehydration and stress. The pressure of the band against the stomach can cause the stomach wall to thin out, so the band feels looser. And although the band and the stomach are sutured together, the position of the band can shift enough to affect your experience of restriction. Remember: the #1 factor affecting the amount of food you can eat is what type of food you eat. You will feel more restriction when you eat solid food (like animal protein), less when you eat soft food (even healthy stuff like yogurt and cottage cheese), and virtually none when you drink liquids (even healthy ones like protein drinks).

I don't think there's any such thing as a final fill. For one thing, as you lose weight, the fat surrounding your stomach (and other internal organs) shrinks, so your band feels looser and you need more fill. And also, your stomach is a living thing that expands and contracts to help digest food and move it into your intestines. And you're a living thing with a body that's affected by lots of different things that can affect restriction: hydration, medications, time of day, time of month, stress, illness, etc. etc. etc. So you never know when you might need Fluid added to or removed from your band. And that's OK, because one of the wonderful things about the band is adjustability. In the past, I've gone for months without a fill, then began to feel like I needed one. I asked my original surgeon about that and he said it's very common. It doesn't mean your band is or isn't working, just that life is about change. Living that way can require some extra effort, and extra attention paid to how your body feels, but in my view, that's a much better way to live than to live with the 92 lbs I used to lug around everywhere.

Are you a compliant patient? All the time, some of the time, or none of the time? This is a practice that matters to me…does it matter to you? What’s the big deal about it, anyway? WHAT DOES PATIENT COMPLIANCE MEAN? The term “patient compliance” is a funny one for someone like me, who in some areas of her life doesn’t have the patience required for compliance. Maybe that’s just my funny little brain playing with words again. What does patient compliance mean? A compliant patient is one who follows or completes with their physician’s diagnostic, treatment, or preventive procedure(s). For example, John Doe’s blood work shows high LDL cholesterol and triglycerides (diagnosis: hyperlipidemia). He’s a compliant patient because he faithfully takes the medication his doctor prescribed, avoids eating saturated fats, and increases his exercise in order to lose some weight. His mother-in-law has high blood pressure (hypertension) and is recovering from a stroke, so in order to prevent the medical problems that challenge her mom, John’s wife Jane follows her doctor’s recommendation to reduce her own salt intake and join John for a daily walk. Their obese son Mark, who is scheduled to have bariatric surgery in two weeks, is compliant as he carefully follows his surgeon’s pre-op liver shrink diet to prepare for the surgery. Their sun-worshipping daughter Mary just had a suspicious mole removed and complies with her dermatologist’s recommendation to use sunscreen every day and give up the tanning bed. A highly commendable family, aren’t they? What about you? Are you a compliant patient? All the time, some of the time, or none of the time? Compliance is a practice that matters to me…does it matter to you? BARIATRIC PATIENT COMPLIANCE Most bariatric surgeons agree that the #1 cause of disappointing weight loss or other WLS “failure” is patient non-compliance with the surgeon’s protocol. In contrast, many adjustable gastric band patients (the disappointed ones, anyway) agree that the #1 cause of band “failure” (however they experience it) is that the band doesn’t work, no matter what (if any) protocol you follow. How can we reconcile such opposite views of WLS failure? What can surgeons do better or differently to improve patient outcomes? We already know what patient compliance means, so let’s take a look at the term “protocol.” In a general sense, protocol is a set of conventional principles and expectations that are considered binding on the members of a particular group, be it professional, social, or political. It’s also the formal etiquette and code of behavior, precedence, and procedure for state and diplomatic ceremonies. Protocol is a big deal to the British Royal Family, as witnessed by the flutter over the Queen’s order that Kate, the Dutchess of Cambridge must, as a former commoner, show reverence to the ‘blood princesses’. She is expected to curtsey to those born royal, such as Princesses Beatrice and Eugenie – both in public and in private. Although the media did a lot of speculating about Kate’s putative humiliation over this order, the importance of royal protocol can hardly be a surprise to a British citizen who marries into the Royal Family. In the medical world, the term protocol refers to the plan for a course of treatment – a physician’s diagnostic, treatment, or preventive procedure(s) like those followed by John Doe and his family. And like Kate Middleton, a bariatric patient can hardly be surprised over their surgeon’s insistence that they follow that protocol. Any surgeon worth his/her scalpel educates patients about that protocol from the time of an informational seminar to the day of a band patient’s first fill, with updates as time goes on. That’s why I feel impatient when I hear (very, very often) that new bandsters are shocked and vexed over the requirement that they follow a liquid diet immediately before and after their surgery, as well as after fills. “How can that possibly be a shock?” I ask myself. Did the patient sleep through their pre-op education, or were they so focused on the vision of themselves in a size 0 that they forgot the work that must be done to arrive at that size? Or (please say it ain’t so!) did the surgeon or other medical professionals in that bariatric program not spell out the details of their protocol when the patient was preparing for surgery? And then there’s the whole “Why does my surgeon say eat only ½ cup of food when my friend’s surgeon says eat 1 cup of food at a time?” dilemma. As I explained in Bandwagon, surgeons establish (and fine tune) patient protocols based on their own experience with their own patient population. If band manufacturers hired teams of auditors to ensure that every bariatric surgeon in North America used the exact same protocol, no one would be able to afford a gastric band, and very few surgeons would bother using the band for their patients. And a brand-new gastric band sitting in its package is completely useless until a trained and experienced surgeon implants it in a patient. Allergan and Ethicon Endo aren’t surgeons; they’re manufacturers of medical devices. So while speculating about the great variation in WLS protocols might be mildly entertaining, it’s not going to do a whole lot to get you closer to that size 0. If you choose a surgeon you trust and respect, you also choose to abide by their protocol, and enjoying that protocol is beside the point. I spent decades enjoying my own weight loss and weight gain “protocols” so much that by the time I was 54, I needed weight loss surgery. So whose protocol is healthier or more effective, mine or my surgeon’s? I lost 92 pounds by following a surgeon’s protocol. Is there a problem with that? I think not. OK, hang on a second while I climb off my soap-box. Ah, that’s better. Here I am again, standing on the ground, surrounded by living, breathing (if distant) WLS patients. It’s not fair to generalize about any of us, is it? But generalize I must in order to make a few more points. THE DOUBTING THOMAS I think some of us are by nature more likely to ignore, question, or defy authority figures, while others accept authority without voicing or even thinking a question. In the former case, we need to cultivate trust in the doctors who want to help us, while in the latter case, we need to cultivate enough trust in ourselves to dare to ask those authority figures for better or more detailed explanations of their instructions. I’m more on the defiant, or Doubting Thomas, end of the patient spectrum, but a few years ago I read a statement that struck me (out of the blue) as very true: SOME THINGS MUST BE BELIEVED TO BE SEEN I extrapolated that statement from a religious context into the context of my WLS journey (at that point in my life, I could extrapolate almost anything into the context of my WLS journey). When I had Lap-Band® surgery, I was convinced that I was a total failure at weight loss. Going into that operating room, I had to believe something I’d never seen myself do: that with the help of my band, I could succeed at weight loss and maintenance. And I did. Because truth can take a while to reveal itself, I think people like me need to ask ourselves, “What possible harm could befall me if I do follow an instruction whose proof of efficacy I can’t see right now?” Let’s go back to a previous example: your doctor tells you not to eat more than 1 cup of food at a time. You know you can easily eat 2 cups, so if you really want (or think you need) to eat all that, and no immediate negative consequences result from doing that, why shouldn’t you just go ahead and do it? Why should you blindly follow your doctor’s seemingly arbitrary and unreasonable instruction to stop eating after you’ve consumed 1 cup of food? It’s your doctor’s job to explain the “why” behind that instruction, but if she/he hasn’t done that to your satisfaction, and he/she isn’t sitting at the table with you and that plate of delicious food, I suggest that you consider what terrible thing would happen if you put away the extra cup of food for now. Will you starve to death? Really? What else might happen? Will you surrender your liberty, be forced to vote for your doctor’s favorite presidential candidate, or (worse) be compelled to clean his toilet every Saturday for the next 20 years? Oh, no. No, no, no. He’s your doctor, not your teenaged son, so let’s consider another, quite serious consequence of following his instruction. Maybe, just maybe, nothing bad will happen at all. Maybe even something good will happen. Just because your compliance doesn’t yield an instant reward doesn’t mean it won’t yield a future reward. What might that reward be? How about weight loss and the avoidance of side effects or complications? Doesn’t that sound good to you? Sure sounds good to me. I do much better at following instructions if I understand them, but I’m here to tell you that in almost 5 years of banded living, I didn’t truly begin understand my surgeon’s and dietitian’s protocol until I’d been following it for 6 or so months, and the scope of my comprehension expanded more over the next few years. In the meantime, I lost those 92 pounds I mentioned earlier. The lesson there is that you don’t have to completely understand or believe in a protocol for it to work, as long as you follow it as best you can. THE BELIEVER Now I want to talk to the folks at the other end of the patient spectrum, the obedient ones who wouldn’t even think of defying the advice of an authority figure. Their WLS journey can be bumpy too, even when they slavishly follow their doctor’s protocol, and here’s why. One of the problems with blindly following instructions that you don’t understand is that sooner or later you’re going to find yourself in a situation no one thought to warn you about. You won’t instantly know what to do, and you may waste precious time on unnecessary blood, sweat and tears. You may even end up doing something harmful. Without at least an inkling of the principles behind your doctor’s protocol, you’ll have a hard time coming up with a stopgap measure to help you survive a surprising and stressful situation. If you worry that any decision you make on your own will be the wrong one, ask yourself: “What’s the worst that could happen if I do nothing right now? What will happen if I do the ‘wrong’ thing?” Will you die? Surely not. If you’re able to breathe, ambulate, drink water, state your name and what year it is, and blood isn’t pooling in your shoes, you’re going to survive at least long enough to call your surgeon, leave a message, and wait for a call back. So unless the decision requires someone to dial 911 to speed you to the emergency room (if you can’t breathe, move, swallow, talk, remember your name or the year, stop the bleeding, or if something else life-threatening is happening), take a deep breath! And another one, and another one. Ah, that’s better! People on the Believer end of the patient spectrum are often reluctant to ask questions of their doctors because they’re afraid they’ll look stupid or make the doctor angry. I can only repeat the old saying that the only stupid question is the one you think but don’t ask. It’s extremely unlikely that your doctor is going to spank you if you ask (again), “Why can’t I take ibuprofen for my headache?” If your doctor seems irritated by a question like that, it may be because you’re trying their patience, or it could be because they’re having a bad day (worried or annoyed about something completely unrelated to you or their job, wishing they hadn’t eaten the whole pastrami sandwich for lunch, didn’t sleep well last night, etc.). It could also be because their bedside manner needs work. If that’s the case, you can set out in search of another surgeon, put up with the original surgeon’s rudeness, or do your part to lead that doctor towards kindness. If the answer to your question starts looking like a time-consuming project that your doctor doesn’t have time for right now, it’s perfectly okay to say something like, “Is there someone else in the office who could work with me on that?” or “Would it be better to make another appointment to talk about this?” THE DOCTOR Doctors, like other people, come in all shapes, sizes, and temperaments, and with varying communication skills. They’re not all made from the eternally patient, smiling, avuncular Marcus Welby mold, and not all of them are motivated solely by the desire to help other people. They’re often just as fascinated by science as by altruism. Like you and me, they work to earn money, and if their pay seems ridiculously high, just ask one of them how much money they borrowed to get through medical school, and how much they pay each year just for medical malpractice insurance. In many ways, I’m a “you get what you pay for” kinda gal. If 3 doctors quoted band surgery at a total of $13,000 to $15,000, and a 4th doctor quoted only $4,000, I’m not sure I’d feel safe with a bargain basement surgeon (nor would I assume that the $15,000 surgeon was the best). Last I heard, no courses in Bedside Manner or patient communication are required of, or even offered to medical students. Doctors must exchange important information with patients whose own communication skills vary greatly, and they must take a patient’s measure, choose a treatment plan, and explain it to the patient using a minimum of enigmatic medical terms, all within a matter of minutes before they rush off to the next patient or task. Doctors must rely on support staff to do hundreds of things to keep the doctor’s boat afloat, and it’s entirely possible that they have no idea how rude or careless or wonderful some of those people are because so much of that goes on in a way that’s invisible to the doctor. And which would you rather your surgeon focus on: the ink cartridge for the Xerox machine, or the pain in your abdomen? In medical folklore, surgeons are infamous for possessing a God complex, with big egos, enormous self-confidence, and an excess of superiority. When you think about it, it does take a lot of chutzpah to cut into another human’s flesh and fiddle with their innards in the effort to fix a problem., so it doesn’t surprise or bother me much that some surgeons have a hard time coming down to the lowly level (perceived or real) where their patients trudge through the mud of ordinary human existence. In many types of surgery, that’s not a big problem because the surgeon sees the patient maybe 3 or 4 times: the initial consult, the surgery, and 1 or 2 post-op follow-ups. Then the patient goes on their merry (we hope) way and the surgeon scrubs up and dashes into the operating room to cut into someone else’s medical problem. General surgery is usually a fix-it-and-go thing. If your diseased gall bladder gets tossed away and forgotten, do you really care if that also means your abdominal pain is also a thing of the past? But bariatric surgery, which treats a chronic and incurable disease that’s a highly complex tangle of physical, behavioral, and emotional problems, is a different matter. Successful bariatric surgery is not a fix-it-and-go proposition (and that’s reason #99 that I would hesitate to ever have surgery outside the United States, knowing that I have no local surgical back-up or support). Bariatric patients need far more education, aftercare and support than most other types of patients. I’m convinced that one of the causes of WLS failure (however you define failure) is inadequate patient education, aftercare and support. And on top of that, adjustable gastric band patients need even more education, aftercare, and support than most other bariatric patients. While I believe that too many general surgeons have been jumping on the gastric band-wagon without fully understanding the needs of those patients, it’s not fair to say that they’re all being careless or negligent when they fail to give patients what they really need. Unless they’ve had bariatric surgery themselves, they just don’t know what it is to walk in our shoes. They might consider the implanting of a gastric band to be an interesting and possibly lucrative addition to their practice without realizing that surgical expertise is only part of what the band patient needs. Doctors and other people with very high self-esteem can be hard for us ordinary mortals to deal with, but it’s a mistake to assume that they’re looking down on us. They may not be looking at or thinking about us at all, not because they don’t care about us but because their minds are so enthralled by and preoccupied with medical science. My father was a brilliant scientist whose head was so far up in the clouds that I often wondered what planet he was on. At the same time, I know he loved me when he noticed me (and I know now that nothing I could do would change that). In a sense, doctors who get heavily involved with their patients are doing those patients a disservice. The Hippocratic Oath exhorts doctors to “do no harm,” not to mop up your tears or hug you when things go wrong. If that seems harsh, consider this: doctors actually need to keep some emotional distance from their patients in order to treat them well medically. Without that distance, it would be very hard for them to make rational decisions about patient care. That’s why it’s considered poor practice for doctors to treat themselves or their loved ones. I’m not saying that it’s okay for doctors to be cold and heartless and should be excused for bad behavior. None of them are perfect (and neither are we, the patients) and you won’t find me worshipping at the altar of the AMA or the ASMBS. I’ve encountered some wonderful doctors and surgeons in my lifetime, and some bad ones too. The average American bandster might see 3-4 doctors on a regular basis (a few times a year): a primary care physician, a gynecologist (if you’re of that persuasion), a dentist, and maybe a chiropractor or a specialist like an eye doctor. The average American bariatric surgeon probably sees 20-30 patients a day (perhaps a few thousand per year). Since I’m not a mind-reader, and no one cares as much about my weight loss journey as much as I do, I figure it’s my responsibility to refresh my doctors’ memories each time I see them. I might wish that I didn’t have to repeat over and over again that (for example) I’m hearing impaired and need my doctor to look at me when he speaks, but that’s a minor issue compared to some of the bigger ones I face as a mature adult.

Keep in mind that physical hunger isn't just a function of your fill level. It's also related to your food choices. Solid food provides early and prolonged satiety, while liquid & soft foods (even "healthy" ones like protein shakes, cottage cheese, yogurt, SF pudding, etc.) or "slider" foods (such as thin, crispy foods - potato chips, thin crackers, popcorn) do not. Try to emphasize dense fish (halibut instead of flounder, for example), animal protein (like poultry, pork, beef), non-starchy veggies, and fruits.

Burning at the back of the throat can be a sign of reflux, and reflux can be a sign that your band is a bit too tight. A small unfill can relieve that. Also, when I had esophageal dilation, one of the symptoms I had (that I didn't know was related to dilation at the time) was burning, pressure, and general discomfort at the back of my throat. It turned out that my esophagus had stopped moving food into my stomach, so the food sat in my esophagus for far too long - it was literally just at the back of my throat. It's definitely something you should tell your surgeon about. In the meantime, you can try taking omeprazole (available over the counter) and make sure you're using good band eating skills - take tiny bites, chew very well, eat slowly, etc.

Heartburn is often a sign that your band is a bit too tight. A small unfill could relieve it without compromising your restriction. I would definitely tell your surgeon about it. In the meantime you could try taking omeprazole (an acid reducing medication available over the counter).