Jean McMillan

I didn't have to do a diet for insurance purposes, but I have never heard of someone being denied coverage for failure to lose weight on the pre-op diet. Your surgeon's insurance coordinator could probably give you better insight about this.

I don't know why long car trips do that. Air travel can have the same effect. I think it's a combination of disrupted routine, stress, sitting still for hours on end, and perhaps dry air if you're riding with the windows up and the heat or A/C on (or in a plane, the pressurized cabin has very dry air). It doesn't have to be a big deal, though, if you're prepared, drink plenty of liquids, and stop to get out of the car and move around every hour or so.

The book is $2 cheaper when you buy it from me, by clicking on my Bandwagon ads here on LBT, or by going to my website and clicking on one of the purchase options (credit card, PayPal) on the left hand side of the page. The site is: jean-onthebandwagon.blogspot.com.

Even if football puts you to sleep (right alongside me), your WLS journey has a far better chance of success if you understand that WLS is a team sport. The other day I saw a tee shirt with a great teamwork slogan: TEAMWORK: EVERYBODY ACHIEVES MORE I believe that slogan applies to WLS as well as sports. Weight loss success depends on the efforts of everybody on the bariatric team: you, your band, surgeon, nutritionist, psychologist, exercise physiologist or trainer. I also believe that I am the most important member of my bariatric team. In fact, I’m the captain. As captain, I checked out and selected each team member with care, knowing that they possess knowledge, experience, and skills that I don’t. As captain, I’m responsible for the team’s success or failure, and I get paid big bucks for that, in the form of pounds lost. I surround my team with strong, perky, loving cheerleaders recruited from my circle of friends, family and coworkers. I show up for every practice and every game. When we win a game, I cheer, and when we lose a game, I study what happened on the field and tell the team exactly what we’ll do better to win the next time. If you think that working as team captain is a tall order for you – well, honey, you got nothin’ on me! I hated team sports in school, never waved a pom-pom, never won any game except Scrabble, and I’m constitutionally a do-it-all-yourself gal. If I can captain a winning WLS team, so can you. The first step is to take personal responsibility for your success (or failure). If you can’t or won’t do that, you’ll have to find yourself another coach, because I can’t help people who can’t or won’t help themselves. I don’t know you, but I don’t believe for one minute that you can’t help yourself. The facts prove this. You decided to have or at least consider WLS. You did some research, joined LapBandTalk, and now you’re reading this article. If you didn’t care about yourself and your health, my guess is that you’d be sitting in a chair, watching TV, with one hand in a bottomless bag of junk food and the other hand clutching a can of soda. If you’ve done that in the past, it’s OK. I did too, but it’s in the past now. It’s over, because the big game has begun. And you know what? Weight loss surgery is more, much more, than a team sport. It’s worth every millisecond of effort you give it because it is a very big deal. This is your life, your health, your future that we’re talking about. Are you going to leave all that in someone else’s hands, or are you going to own it and work it until you get it right? You are? That’s great! Now everybody shout, loud and proud: “GO TEAM! GO ME!” and get your butt out on that playing field! Because the next slogan we’re going to learn is this: WINNERS TRAIN, LOSERS COMPLAIN

You might also want to look for something with protein in it, like Slimfast in bottles.

I'm sorry to hear about this. Sometimes a change in routine and stress (even during a fun vacation) can affect restriction. My only suggestion is to tank up on liquids and be very careful with your food choices.

I've always loved cooking and own a ridiculous assortment of kitchen tools and gadgets, but if I had to boil it all down to a few essentials, it would be: a mini food processor (for purees) a blender (for Protein shakes) a kitchen scale (because I'm terrible at eyeballing portion sizes) measuring cups and spoons (see above) salad plates (to use instead of big dinner plates) my cookbook, Bandwagon Cookery (180+ recipes, plus lots of tips for meal planning and making food band-friendlier

The other day I saw a tee shirt with a great teamwork slogan: TEAMWORK: EVERYBODY ACHIEVES MORE I believe that slogan applies to WLS as well as sports. Weight loss success depends on the efforts of everybody on the bariatric team: you, your band, surgeon, nutritionist, psychologist, exercise physiologist or trainer. I also believe that I am the most important member of my bariatric team. In fact, I’m the captain. As captain, I checked out and selected each team member with care, knowing that they possess knowledge, experience, and skills that I don’t. As captain, I’m responsible for the team’s success or failure, and I get paid big bucks for that, in the form of pounds lost. I surround my team with strong, perky, loving cheerleaders recruited from my circle of friends, family and coworkers. I show up for every practice and every game. When we win a game, I cheer, and when we lose a game, I study what happened on the field and tell the team exactly what we’ll do better to win the next time. If you think that working as team captain is a tall order for you – well, honey, you got nothin’ on me! I hated team sports in school, never waved a pom-pom, never won any game except Scrabble, and I’m constitutionally a do-it-all-yourself gal. If I can captain a winning WLS team, so can you. The first step is to take personal responsibility for your success (or failure). If you can’t or won’t do that, you’ll have to find yourself another coach, because I can’t help people who can’t or won’t help themselves. I don’t know you, but I don’t believe for one minute that you can’t help yourself. The facts prove this. You decided to have or at least consider WLS. You did some research, joined LapBandTalk, and now you’re reading this article. If you didn’t care about yourself and your health, my guess is that you’d be sitting in a chair, watching TV, with one hand in a bottomless bag of junk food and the other hand clutching a can of soda. If you’ve done that in the past, it’s OK. I did too, but it’s in the past now. It’s over, because the big game has begun. And you know what? Weight loss surgery is more, much more, than a team sport. It’s worth every millisecond of effort you give it because it is a very big deal. This is your life, your health, your future that we’re talking about. Are you going to leave all that in someone else’s hands, or are you going to own it and work it until you get it right? You are? That’s great! Now everybody shout, loud and proud: “GO TEAM! GO ME!” and get your butt out on that playing field! Because the next slogan we’re going to learn is this: WINNERS TRAIN, LOSERS COMPLAIN

So true. A pre-op once asked me, "Why do I have to eat different food after surgery? Can't I lose weight by eating smaller amounts of cheeseburgers, fries, and potato chips?"

The liquid diet is a common feature of the bariatric surgery landscape, as widespread and despised as kudzu in the South. Since there’s no way around it, you might as well make the best of it by learning the reasons for it and trying the practical tips I’m going to give you. WHY A LIQUID DIET? Bariatric clinics use differing protocols for their patients’ pre-op and post-op diets. Why? When you finish explaining that, perhaps you could also explain the meaning of life? If you asked your surgeon or dietitian, the answer would probably go something like this: “We have adapted these procedures to suit the needs of the patients in our individual practice, based on our experience of what produces the best outcome and the fewest complications.” In the case of adjustable gastric band patients like us, you might expect the band manufacturers to dictate what are called “best practices” in patient education and care, but the fact is that if Allergan and Ethicon-Endo were to employ armies of band police to supervise every bariatric surgeon in the world, no one would be able to afford a gastric band. However those clinics’ protocols may vary, the liquid diet is extremely common part of bariatric patients’ pre-op and post-op instructions. Contrary to popular belief, the liquid diet is not intended to torture the patient. The main purpose of a pre-op diet is to reduce the size and improve the texture of the liver (any weight loss is a plus). The liver is a big organ whose left lateral segment lies on top of the part of the stomach where the band is placed. The pre-op diet uses up the glycogen stored in the liver, shrinking it and making it sturdier, less slippery, and easier to maneuver with laparoscopic instruments. This not only makes the surgeon’s job easier and quicker, it also reduces the risk of complications for you. If your surgeon doesn’t require a pre-op diet of any type, I would have to conclude that he or she is mighty confident in their surgical abilities, but I would also want to ask them how often they have to abort a surgery or convert from a laparoscopic to an open incision technique because of problems handling the patient’s liver. The purpose of the post-op diet is to keep you nourished while you and your upper GI tract recover from surgery. Although AGB surgery is usually minimally invasive (when done laparoscopically), it does require incisions and some internal dissection, as well as manipulation of your internal organs. All this can cause swelling. One day your stomach was fat, dumb and happy. Now it's got a collar around its neck. In order for it to digest food in any form, your stomach muscles must expand and contract to break the food down and move it along to your lower GI tract. Expecting your stomach to do that comfortably and safely while wearing its brand-new collar just isn’t wise. So to allow everything to heal properly, and the band to seat itself against your stomach in the correct position, most surgeons require patients to follow a staged post-op diet, starting with liquids. What happens if you don’t follow your post-op recovery diet? Food can get stuck in the stoma or esophagus and cause an obstruction and/or vomiting. Vomiting can disturb the position of the band, which can cause the band to slip. Peristalsis (the muscular action of moving food through the digestive system) can disturb the position of the band, and that can cause the band to slip. So don't do it! "But I already cheated!" you say? It's not the end of the world, but don't do it again! "But I'm starving!" you say? That's too bad, but that isn't the end of the world, either. Not, it's not fun, but hunger is not a good excuse for cheating your health in such a major way. I'd guess that seven of ten bandsters starve their way through the liquid diet phase. If you absolutely cannot bear the liquid diet for another second, or you think you might be genuinely allergic to your protein shakes (which could be lactose intolerance rearing its ugly head), call your surgeon or nutritionist before you put something in your mouth that isn't on the approved list. And by the way, the same advice applies to following a liquid diet after each fill you get, so you might as well perfect your liquids survival technique now because you’re going to need it over and over again in the future. SOME PRACTICAL TIPS FOR SURVIVING YOUR LIQUID DIET Don't worry about how many calories you're consuming, but stay away from milkshakes, ice cream, frappes and fancy coffee drinks. Drink protein drinks (protein will keep you going longer than sugary stuff like fruit juice). If you don't like the smell or taste of protein powder, try putting the drink in the freezer long enough for it to get slushy, and/or put it in a covered beverage container. Sometimes it's the smell, not the taste, that's bothersome. If you don't care for sweet tastes, try unflavored protein powder (from various sources including Unjury®) or Unjury® chicken soup flavor protein powder (www.unjury.com). Add Unjury® chicken soup flavor protein powder to blended creamy soups (follow the Unjury® heating instructions or it will clump up and refuse to dissolve). Add fat free half-and-half or milk to prepared chicken bouillon or broth for a creamy drink. Add unflavored or fruit-flavored protein powder when making sugar-free gelatin. Check out the recipes at the Unjury website. Be aware that “unflavored” doesn’t mean the protein has no flavor, so the end product isn’t going to taste exactly like the original. Buy your favorite soup from a local restaurant, strain out the solids, and drink the broth (Chinese hot and sour soup is wonderful this way). Buy or make bean soups, puree and thin them with broth, water, or milk. The pureed soup must be thin enough to pass through a drinking straw. Add powdered non-fat milk to soups and shakes to boost the protein. Crunch on sugar-free popsicles, slushies, Italian ice, or ice chips. Don't hang around people who are eating real food. Experiment with the temperature of your liquids - cold may feel or taste better than hot, or the other way around. To prevent boredom, experiment with recipes for protein shakes (you'll find at least a million recipes online). Keep busy! This is a good time to address holiday cards. Who cares if it’s the middle of June? AND IN THE TMI DEPARTMENT… A few final words about your liquid diet. Don’t panic if consuming liquids sends you running to the bathroom more often than you’d like. LIQUIDS IN = LIQUIDS OUT. If that happens to you, ask your doctor to suggest a safe, effective OTC anti-diarrheal medication. And remember: This too shall pass. In more ways than one.

Envy and jealousy are part of the human package, but is your envy of others using up energy that could better be devoted to weight loss? THE EVILS OF ENVY For reasons that seem obscure to us in the year 2012, Shakespeare called jealousy the green-eyed monster when he wrote the play Othello in 1604. I don't think Shakespeare believed that green eyes indicate evil...my husband has beautiful green eyes and not one evil or envious bone in his body. Historians explain that in Shakespeare's time, green was the color sickness and also the color of unripe fruit that can cause its eater so much pain. But envy is definitely a monster when it takes charge of my brain and measures everything I do, everything I am and everything I own against the actions, talents, and possessions of other people. In this monster's grip, I am unable to think rationally, and I waste an enormous amount of time and effort on resentment and self-pity that does absolutely nothing to improve my own situation...in fact, it undermines my situation. When I had weight loss surgery, I had been obese for so long that I had stopped being jealous of naturally slim people. I felt that they belonged to a different human tribe. So I was surprised to find myself sitting in a support group meeting a few months after my band surgery thinking evil thoughts about another bandster who had lost 50 pounds already. I had "only" lost 35 pounds. What was wrong with me? Why was she blessed with superior band success? I was a good girl too - a very hard-working and deserving girl. It just wasn't fair! Then in a far-off corner of my cloudy little brain, I heard my mom saying, "I never told you life would be fair." No, she hadn't told me that life is fair. She had reminded me over and over again that life is hard and that bad things happen to good people...kind of a grim view of life, but mom was nothing if not honest. At first I resisted those blunt words of hers. Mom's life was hard, but I vowed that my life would be different, better, happier. But how? How would the different and better things happen if God didn't send a shower of glittering gold coins and success down onto my eager, upturned face? And again I remembered Mom. In my mid 20's I complained bitterly to her about a work acquaintance who seemed to get all the praises, all the raises, all the promotions. I'll call her Debbie (a popular name when I was born). Mom said, "Why don't you just ask Debbie how she does it? If she's a fake like you think she is, her answer will confirm it. If she's for real, maybe you can learn something from her." At the time, I didn't have the chutzpah to follow Mom's advice, but I did begin to pay closer attention to Debbie's work habits and behavior. Over the next few months, I reluctantly admitted that she did deserve some of her accolades. Some of them still seemed undeserved and unfair, the result of her pretty face and outgoing manner. It wasn't until I was in my 50's that I realized that a lot of good luck shone down on Debbie from heaven simply because she expected it to. What a novel idea! Now when people ask me the secret of my success with the band, I want to say something like, "It happened because I demanded it." Like I had written out a purchase order for a 90 pound weight loss, put it in an envelope, addressed it to God, and threw it up in the air for him to catch and fulfill. But if that's too metaphysical an explanation for you, I do have some more down-to-earth ideas about it. THE BEAST WITHIN ME Like Shakespeare, I call my jealousy the green-eyed monster. It’s the malevolent beast who chews on my heart when I'm jealous or envious. Officially, though, jealousy and envy are different things. Jealousy is what you feel when you fear that something or someone (like your spouse, or the job that you and a coworker named Debbie are competing for) will be taken away from you. Envy is what you feel when you want something or someone that another person already has: their weight loss success, their bank account, their fancy car, their 9-bedroom home. In my experience, both jealousy and envy get me on a never-ending, tiresome treadmill of comparison and criticism. It becomes an obsession so blinding that I can't see any of the good things happening in my life. I compare myself to others, like my ex-husband's beautiful and devoted female lab assistant, or Debbie's MBA degree that I'm sure will earn her the promotion I want, or Marcia's 148 pound weight loss which is 100 pounds more than mine. Adding up my skills, talents and accomplishments results in a negative number every time, and those flashing red numerals reinforce my often unrealistic concept of all the pluses on Debbie's and Marcia's side. I hate them for it. I hate myself. Instead of making a new plan, I end up planning an appropriately painful (if unlikely) demise for my rival. Hearing me say that I hate myself may surprise you. I'm well aware that I have the reputation of being a Little Mary Sunshine, or the relentlessly cheerful storybook heroine, Pollyanna, who triumphed over every adversity with a smile on her face and a "thank you" on her lips. Am I telling you to deny that you're envious, to smile even as your rival receives a round of applause at the Weight Watcher's meeting when she reaches her weight goal? After all, I've implied that you're suspicious of successful people and bear a grudge against them, as if you're the child who didn't win a prize playing Pin the Tail on the Donkey at your sister's birthday party...your evil sister who not only won the prize but also received hundreds of marvelous birthday presents and the first piece of birthday cake, the big corner piece with all the extra pink frosting roses on it. Your evil sister who deserves to get food poisoning from that cake and die a horrible, slow, painful death, after which you will move into and redecorate her bedroom with Justin Bieber posters. Am I saying that you should just grow up and get over it, or that you're weak and spineless for feeling something as unworthy as envy? No, actually, I'm not. I'm just suggesting that this one time you try stating your wish plainly, preferably out loud, and framed as intent instead of as secret longing. Give up the "I wish Jean would gain 500 pounds and have to be transported with a crane." And no, saying, "I wish I were as successful as Jean" won't work either, though it's certainly better than devising cunning punishments for me. Try something more like, "I will lose another 62 pounds and celebrate that next year just as we're celebrating Jean's success today." Tell that to your reflection in your mirror and to a friend who'll be sure to say, "Go for it!" WHY ASK WHY? I'm an analytical as well as an optimistic person (I choose to see that as a felicitous if conflicting combination of my parents' strongest traits), and when evaluating myself, my past, and my prospects for the future, I tend to get stuck on the "Why? Why am I this way? Why am I acting like this?" and on and on and on. But as the old Budweiser commercial said, “Why Ask Why?” Don't torture yourself by asking, "Why am I so envious? Why can't I let it go and be the positive, optimistic person Jean says I should be?" The asking probably won't get you very far. The answer could just be as simple as, "Because you're a living, feeling human being." Nothing wrong with that! Although I majored in art and like art museums for an hour or so, it's boring to spend a lot of time with inanimate (if beautiful) marble statues. I want friends who are flawed (like me) and capable of both deep feeling and high aspirations. On the other hand, don't spend too much time with the loyal, well-intentioned people who feed your envy by saying, "You're so right, she doesn't deserve that success, she hasn't worked nearly as hard as you have, and did you know she has six toes on her left foot and even worse halitosis than my poop-eating dog?" Oops! Did I say "poop-eating dog"? Indeed I did. Which brings me (finally) to my final point. Try to see the humor in the situation. Admit it, if Tracey Ullman were up on the stage acting out the part of an envious character and using your very own words, you'd be laughing your a** off now.

Is maladaptive eating slowing or sabotaging your weight loss? Let's take a look at how that happens and what we can do to change it. WHAT IS MALADAPTIVE BEHAVIOR? The term “adaptation” brings Charles Darwin to my mind. His theory of evolution is considered heresy where I live, but whatever your personal belief about the origin of the human species, you’ve probably observed many times that humans and other living things have an amazing ability to adapt their behavior, and even their forms, to better survive and thrive in its environment, and that as the environment changes, so do the creatures living in it. Here in Tennessee, the weather is getting hot enough to send us into our closets to bring out the shorts and sandals and bathing suits we need to comfortably survive the summer. At the same time, our dogs and cats are shedding the extra fur they’d acquired to keep them warm during the winter. The humans are adapting their dressing behavior and the cats are adapting their forms to adjust to hot weather. This is adaptation in its positive sense, but adaptation also has a dark side. Defining “maladaptation” requires us to assume that certain behaviors are normal, while others are abnormal. That does not necessarily mean that normal is healthy and abnormal is unhealthy. Someone (or something) is considered “normal” if they conform to a widely accepted standard or practice, and abnormal if they deviate from the norm. A behavior can be identified as maladaptive or abnormal only in the context of an environment. It is not intrinsically wrong or evil, and its degree of deviance or abnormality depends on things like cultural and social rules and norms (cannibalism may be a normal behavior in one society, but not in another), systems of psychological and medical thought (a mentally ill person may be “abnormal”, but able to function despite that); as well as political beliefs and ideals (in a democracy, the practice of communist principles is considered “wrong”). I’m going to try to bypass all those interesting but knotty aspects and give you definitions and examples that don’t require a PhD in sociology or psychology to decipher them. Some maladaptive behavior is disruptive to society because it interferes with group functioning. A child “acting out” at school in reaction to the stresses he experiences at home is an example of this. His frustration with his home life turns into anger that fuels temper tantrums in the classroom. His behavior is maladaptive because it doesn’t eliminate the stresses at home and creates a whole new spectrum of stresses and problems at school as his teachers and fellow students react to his aggression. He can’t learn lessons in school that he needs to learn because his “bad” behavior gets in the way. Other maladaptive behavior is expressed in an inward fashion. A shy, anxious art student is horrified when her painting teacher publically critiques her painting and tells her and the rest of the students that her artwork is exactly what they should not be doing. The art student loses confidence in her talent and changes her major to another subject. Her behavior is maladaptive because it makes it much harder for her to achieve her original goal of becoming an art teacher. My own definition of maladaptive behavior is this. It’s a nonproductive behavior that prevents you from adapting to situations, or changes in yourself or your environment, in a healthy way. It can begin as an attempt to deal with or avoid an unpleasant experience but it does not solve the original problem and eventually becomes dysfunctional. You adjust to a situation in a way that makes sense at the time but that eventually misdirects your energy and focus, and interferes with your personal and interpersonal functioning, your health, and your ability to achieve your goals. At the start, the behavior feels like a helpful, even positive response to abnormal, difficult, or negative circumstances. As a bandster, I used both old and new maladaptive eating behaviors. My decades-old behaviors, like eating to deal with stress, did not disappear on the morning of my band surgery, and 5 years later, I’m still working on changing that. I also developed new behaviors in response to the experience of having an adjustable gastric band. The long-term result of these maladaptive behaviors is unintended and undesirable. The maladaptive eating tactic may seem to solve a current problem while it's actually creating future problems: slowed or stopped weight loss, weight gain, band slippage, band erosion, and so on. SOFT CALORIE SYNDROME & OTHER DANGERS A classic example of bandster maladaptive eating behavior is known as Soft Calorie Syndrome. I discovered the perils of this syndrome for myself when I traveled to New York City to attend a trade show when I was about 8 months post-op. I had gotten a fill the day before I left, and by the time I got to New York I had realized that my band was too tight for me to tolerate. I couldn’t eat any solid food, so I spent the next 3 days eating soft, high-calorie, low-satiety foods like soup, milkshakes, and ice cream. I was just trying to survive long enough to go home and get an unfill. My eating behavior achieved a temporary goal (comfortable survival) while sabotaging my long term goal of losing weight. In fact, I gained weight during that trip and ended up feeling disappointed in myself. A frustrating aspect of maladaptive behavior is that it’s often easier to see in others than it is in yourself, but even someone who’s fully aware that her or his behavior is counterproductive may feel helpless to change it. If I had a dollar for every time a bandster has confessed to eating to relieve stress or boredom, I’d be a wealthy woman now. Emotional eating tends to be so longstanding and deep-rooted that it takes on a life of its town, like a devil lurking inside us who seductively whispers, “Chocolate! Chocolate will make you feel soooo much better!” when you’re too vulnerable, tired, or upset to make a different or healthier choice. When I was being treated for PTSD years ago, a counselor asked me to make a list of behaviors and activities that I could choose to do instead of engaging in self-destructive ones. At first the exercise seemed contrived and silly, but eventually I realized its usefulness. I was not able to think clearly and make good choices when in severe emotional distress. All I could think of was razor blades. My index card of alternate behaviors reminded me that I could telephone a friend, go for a walk, take a bath, listen to music, pet a dog, and the like instead of playing with sharp objects. Now, I very much hope that you’re not dealing with severe emotional distress (which I would wish only on my worst enemy), but I do believe you can benefit by making your own list of alternatives to emotional eating. Carry a copy of that list with you everywhere you go and keep a copy in an easily-accessible spot at home (I tacked mine to my bulletin board). TRUTH OR CONSEQUENCES In the 1960’s and 70’s, contestants on the “Truth or Consequences” game show would try to answer ridiculously obscure trivia questions and be forced to perform silly stunts in punishment for getting the answers wrong. The host ended each episode by saying, “Bob Barker saying goodbye, and hoping all your consequences are happy ones!" The relief or pleasure or other immediate consequences of a maladaptive behavior may seem like happy ones, but they generally short-lived, so the behavior must be repeated over and over for the benefit to be felt. As with an addiction, it takes more and more of the behavior or substance to cause relief or pleasure. An anxious person, whose mother lost a leg to gangrene (death of flesh) from bacterial infection in an untreated injury, naturally fears germs. She washes her hands thoroughly and often, especially after touching anything that might harbor germs. At the start, her own home is clean and safe, but because her hand washing doesn’t remove her basic fear, eventually she must practice it all day, every day, over and over, even in her own home, until her skin is scrubbed raw. She sees the abrasions her scrubbing has caused as more vulnerable to germs and increases the hand washing. Soon the hand washing excludes all other activities and she dares not leave her home. The salutary practice of hand washing has become a maladaptive and destructive behavior. Unlike the hand washing or other compulsive, fear-based, abnormal and ritualistic behavior, maladaptive eating is rarely perceived as strange. Eating is socially acceptable as long as the meat on your plate belongs to a different species. It’s also something that’s easy to do in secret, while you’re alone in your car or your bathroom or wherever you go to escape other people. But when you do it over and over again, your repetition of the behavior cements it into a wall around you, keeping you locked inside instead venturing forth to find relief elsewhere. And should you confess to this maladaptive eating behavior, people who don’t use food in this way simply cannot fathom why you would do it. They say impatiently, “Put the fork down! Step away from the table! Just say no to chocolate!” Ah, if only it were that simple, that easy… SMALL-TIME CRIMINALS Some maladaptive behavior arises from ignorance, misconceptions or misunderstanding. Take the case of Martin. He received minimal pre-op education, so when he found himself PB’ing (regurgitating) on a daily basis after his 3rd fill, he assumed that this was simply a fact of life for bandsters. His problem is ignorance. The same thing happened to Annie, who assumed she was doing something wrong but was too shy, ashamed and embarrassed to ask her surgeon about it. Her problem is misconception. And when PB’ing intruded into Carol’s daily life, she believed it was like vomiting, caused by “a stomach bug”, so it never even occurred to her that her eating behavior might be causing it. Her problem is misunderstanding. All too often, a maladaptive behavior seems like such a small “crime” – it was just one ice cream cone – that the bandster minimizes its importance without realizing that the cumulative effect of a series of small crimes can be just as destructive as a single big one. It’s kind of like ignoring the posted speed limit when you’re driving your car. You shudder at the news of a fatal car accident when an acquaintance driving at 70 mph in a 35 mph zone loses control of his vehicle and crashes into a telephone pole. In that instance, ignoring the speed limit is clearly a bad choice. But when you’re late for work (again), run a few yellow or even red lights (again), and drive at 70 mph in a 35 mph zone (again) in your eagerness to get to work on time, and nothing bad happens, speeding doesn’t seem like such a terrible crime…until the day you can’t stop in time to avoid the car turning into your path and end up as a bleeding mess choking on dust from your car’s air bag while an ambulance carries off the person you killed because of your maladaptive behavior. IS THIS BEHAVIOR GETTING YOU WHERE YOU WANT TO GO? A bandster once confessed, “I eat pretty good all week and then I allow myself a junk food day...a bad mistake on the weekend since that usually means a junk food weekend...once I start, it’s so hard to stop and of course weight gain is the result and I end up beating myself up. I'm never going to be where I want to be if I continue this behavior.” I want to repeat that all-important last sentence: “I'm never going to be where I want to be if I continue this behavior.” That, my friends, is the take-home message of this article. Take it to heart, take it home, and take it out and study it often. Ask for help in identifying and dealing with your maladaptive eating behaviors. Take them seriously, but don’t build them into mountains right in the middle of your path to success. Sometimes the solution or treatment for a big maladaptive behavior can be a small piece of common sense. One of my favorites is: Don’t keep trigger foods in the house. If chocolate is your bête-noir (the black beast that’s the bane of your existence), you’re not going to be able to gorge yourself with it the next time you’re feeling weak if there is no chocolate in your house. Yes, I know you can hop in your car, ignore the posted speed limits, and pull up in front of the Chocoholic Market in a matter of minutes. That’s why we have to be vigilant, honest and aware. And remember this, from page 299 of Bandwagon: It takes anywhere from 18 to 254 days of daily repetition to make a new behavior automatic….so, practice, practice, practice!

Is it true that weight loss with the band is basically the same as weight loss with a diet? And if it is, why have surgery at all? From time to time, a bandster will comment (sometimes in the context of a complaint, sometimes just in surprise or confusion) that weight loss with the band is basically the same as weight loss with a diet. They’re disappointed by this. They expected WLS to make weight loss easier than it is with dieting, and while that's true, it's only part of weight loss success. They may hold the mistaken belief that the band itself is what causes weight loss, but that’s not true either. The band is just a piece of plastic. Although it’s inside the patient’s body, it does not directly affect the way nutrients from food are ingested or metabolized. It releases no weight loss instructions into the patient’s bloodstream, nervous system, or endocrine system. It doesn’t directly affect the patient’s eating behavior or exercise habits. It doesn’t compel the patient to make good food choices, limit portion sizes, eat slowly, or resist the urge to graze or binge because of boredom, stress, cravings, etc. After reading that long list of what the band doesn’t do, you may be thinking that it’s a mighty expensive and not very helpful weight loss tool. Why go through the risk, trouble and expense of WLS when you could achieve the same results with plain old dieting? HALF EMPTY OR HALF FULL? Here’s some news that may shock you: I lost 100% of my excess weight by dieting after my band surgery. My dietitian gave me a food plan to follow, and I followed it. It never occurred to me to do otherwise or to complain about that because my bariatric team had made it clear that I, not my band, was going to have to make some significant lifestyle changes in order to succeed. It wasn’t until after the excess weight was gone, after a big unfill to treat an irritated esophagus and stoma (after swallowing a large, corrosive antibiotic capsule), that I realized how much my band had been helping me by reducing my appetite and giving me early (if not always prolonged) satiety. I had been taking my band for granted – out of sight, out of mind. I suppose it’s possible that I had been experiencing a placebo effect; that my band worked for me simply because I believed it would. If so, it was a remarkable and long-lived placebo effect. It wasn’t until my band was being refilled after a complete unfill (to treat a band slip) when I was 3 years post-op that I experienced a stunning, “Oh, so this is what it’s all about!” aha moment. My experience of restriction then was quite different than it had been the first time around, because I understood more about my band’s effects and how to optimize those effects, and because my body had changed so drastically since my surgery. Whether your 8-ounce water glass is half empty or half full, it still contains 4 ounces. Getting the most out of those 4 ounces is largely a matter of attitude adjustment. You can accept that you have 4 ounces, then make the best of it, or you can give up all together and spend your life in wistful regret. You can find another way to fill your WLS glass – complain to your surgeon, or the band manufacturer, revise to a different WLS procedure – or give up altogether and spend your life in angry regret. Taking the “half full” viewpoint may be easier for me than for others because I’m an opportunist who actually enjoys making a silk purse out of a sow’s ear. Webster defines “opportunist” as one who uses the art, policy, or practice of taking advantage of opportunities or circumstances, often with little regard for principles or consequences. Since I do have immense regard for principles and consequences, perhaps I’m not a classic opportunist. But I see nothing wrong with taking advantage of opportunities and circumstances when my own careful plans aren’t working or have led me into unknown territory. Resourcefulness has been a handy life skill for me. BUT I WANT IT TO BE RIGHT THE FIRST TIME I do know what it’s like to be disappointed with a purchase, though, be it a band, a blouse, or a bicycle. I want the item I purchase to be suitable, if not perfect, for its intended use. During a shift at my retail “day job” the other day, I helped a customer whose garment size wasn’t in stock. She didn’t want to order that garment – she wanted it now, so much so that she considered buying the wrong size and having it altered to fit her. Before I could volunteer an opinion, this woman uttered the very words I was thinking: “I hate to pay good money for something new and have to alter it. I just want to buy it and wear it.” If I were a better (or pushier) salesperson, she might have bought that garment, but I’m not and she didn’t. If your adjustable gastric band hasn’t (yet) lived up to your expectations, you do have my sympathy. It’s not easy – if even possible – to return a disappointing medical implant, and it’s maddening to have to “alter” it (by dieting, for example) to make it work for you. I could tell you (unhelpfully) that your expectations were not realistic, but it’s also possible that your surgeon educated you well, you’re a “compliant” patient, and yet your band just isn’t up to snuff. According to Doctors Jerome Groopman and Pamela Hartzband, authors of Your Medical Mind, “Medicine is an uncertain science.” No one, not even your doctor, can say with certainty what impact a condition “will have on an individual’s life or how someone will experience the side effects from a particular treatment. Each of us is unique in the interplay of genetic makeup and environment. The path to maintaining or regaining health is not the same for everyone.” Doctors Groopman and Hartzband go on to describe what they call the ‘focusing illusion’. “In trying to forecast the future, all of us tend to focus on a particular aspect of our lives that would be negatively affected by a proposed treatment. This then becomes the overriding element in decision making. The focusing illusion neglects our extraordinary capacity to adapt, to enjoy life with less than ‘perfect’ health. Imagining life with a colostomy, after a mastectomy, or following prostate surgery can all be skewed by the focusing illusion. We cannot see how the remaining parts of our lives expand to fill the gaps created by the illness and its treatment.” Despite carefully-devised formulas and scoring systems (intended to direct resources and money to those most likely to survive) for calculating a patient’s chances of surviving a treatment or illness, doctors are lousy at predicting outcomes. A study in England found that one out of 20 ICU patients who doctors predicted would die actually lived, and most of those who survived had a good quality of life. I don’t think that’s a sign of medical incompetence. I think it’s a sign of the unquenchable human spirit and its enduring will to survive and even thrive against all odds. One of my life goals is to survive and thrive, no matter what. That’s an ambition you can’t get from a medical device or bottle of medicine. It comes from within you, and if you think you don’t have it, or not enough of it, I suggest that you look again. You might be pleasantly surprised.

I don't know how the plication aspect affects fills. Will be interested to hear what your experience is. 1. but how much do they put in the first time? Depends on your surgeon's protocol & your band size, plus more (see question #3) 2. is there a set (amount)? Not that I've ever heard of. 3. what do they base it on? Your weight loss, your symptoms/side effects (if any), what and how much you're able to eat, and how long your meals keep you satisfied (in terms of physical hunger). 4. do you feel sick to your stomach afterwards? If you mean do you feel nauseated, no, I never did. Other than my reaction to the general anesthesia, nothing related to my band ever made me feel nauseated. Eating mistakes occasionally made me PB, but that's not the same as vomiting and I experienced no nausea. 5. can you request very small amounts instead of 1 or 2 cc's? Sure. Your surgeon may have other ideas about appropriate fill level amounts. If you're not comfortable with a fill amount he wants to use, tell him. Presumably he'll be willing/able to explain why he feels that amount is appropriate.

My favorites: 1. Combine 3 scoops Click Vanilla Latte protein powder, 1 cup unsweetened almond milk, 1 cup cold water. Blend and serve over ice. 2. Combine 1 cup cold brewed coffee, 1 cup fat free milk, 2 tbl sugar-free caramel or vanilla syrup. Serve over ice.

I agree with the others. That night choking business is serious because if you aspirate stomach contents (food, bile, etc) into your lungs, you're going to be in big trouble. Even a tiny unfill can relieve the symptoms without compromising your restriction.

Yes, a complete unfill and 6-week rest period cured my band slip. Whether surgery is needed to correct a band slip will depend on how bad the slip is and how it slipped (up or down). If your only symptoms were reflux and eating problems, the unfill may do the trick for you. When the lower portion of the stomach moves up above the band (called a prolapse), often caused by vomiting, the blood supply to the stomach can be compromised. That causes severe pain and possible death of the prolapsed portion.

I know a number of people who've had their bands removed due to complications (me included) and all of them regained weight. Why do you want your band removed? I mean, is there a medical reason to remove it? Or are you just afraid that leaving it in there will cause you problems in the future?

Welcome, and congrats on the start of your weight loss surgery journey! You'll find lots of info here just by cruising the forums and asking questions as they come to you.

Are you on a liquid diet? If so, liquid in = liquid out.

Ask your surgeon for a prescription for anti-nausea meds.

You go, girl! I'm really impressed that you've been working out at home, because I'm so terrible at that - I use my fitness studio membership as my exercise "conscience".

No, I didn't have an irrational fear of something happening to me, maybe because I'd survived so many other surgeries by the time I was banded. But I can tell you that you are absolutely not the only person that's ever felt that way, and everything seems harder when you're on a liquid diet. It's hard to deal with irrational fear. You can sit it down and try reasoning with it, but it generally doesn't listen to reason and doesn't follow any rules of logic. Maybe you could just give it slap upside the head. And then take a deep breath. It's going to be OK!

I haven't had an umbilical hernia (I do have a hiatal hernia, but that's another story), and I'm not a doctor, but I can't see why that would delay your band surgery, and your surgeon might even be able to repair the hernia while you're anesthetized for band placement. Good luck!

He may not be getting updates from your PCP unless you specifically tell your PCP to update him and sign a waiver to allow them to share your medical info. That must have been a mighty painful fill to prevent you from getting another one in 3 long years, and it's hardly surprising that your weight loss has been disappointing because the band doesn't usually work very well without fills. I wouldn't give up on it too quickly, though. You can ask for a shot of lidocaine to numb your abdomen to make another fill more comfortable.