Jean McMillan

I don't know how far you'd get with that. None of the papers I signed for my band surgery said anything about guaranteed results or guaranteed no complications. Have you talked with your surgeon about it?

Every dietitian and doctor I've asked about this has said that yes, starvation mode in WLS patients exists in that extreme calorie deprivation will eventually cause your body to do everything within its means to conserve calories and store fat for current and future use, but not in the sense that we're actually going to starve to death. That could contribute to weight loss plateaus, but it's not necessarily going to permanently stop weight loss.

Consider your butt kicked, but to be perfectly honest, a 1756 calorie day is not the end of the world, especially considering that you burned 961 of those calories in exercise and yard work. When I think back on how I ate pre-op, I easily consumed 1756 calories in a single meal!

I can't remember how often I was supposed to change the packing. At least once a day, for sure, using both the sterile gauze and the gel.

IN & OUT OF THE WLS CLOSET I was happy about my decision to have WLS and thrilled when my insurance company finally approved it. I shared this happy news with many friends, acquaintances, family members, and coworkers. I don’t know but I assume that they discussed it amongst themselves to some extent, expressed opinions or concerns, and perhaps worried about my decision, but none of them gave me frankly negative feedback. They might have been thinking it, but they didn’t say it. I very much doubt I would have reversed my decision if someone had said, “That’s too risky/it’s a bad idea/I don’t want you to/you’re crazy/or whatever.” I’m going to assume that you, the reader of this article, are an adult over the age of 18, with the right to vote, the obligation to serve in the military, and (at some point, depending on your location) the right to purchase and use tobacco and liquor. Unless a judge has declared you mentally incompetent (and that’s harder to accomplish than you’d think), you are the one who’s responsible for your body – for its care and nourishment and any medical treatments or procedures that affect it. So if you’re in the early stages of considering WLS, whose input are you going to trust to inform your final decision? A bariatric surgeon, or your dad? Your primary care physician, or your sister? Your therapist, or your hairdresser? And hey, I’m not slamming hairdressers. Mine could do very well indeed as a therapist, but she has a cosmetology license, not a mental health practitioner license. Last summer I was startled to hear a 50-something bandster state that she had gotten her husband’s permission to have plastic surgery. His permission? Huh? Does that mean he’s the only adult in that relationship, or what? I’m not against asking permission, mind you. I ask my boss’s permission to undertake certain tasks or projects at work; I ask the State of Tennessee for permission (i.e., a driving license) to drive a car; if I still lived in a suburban development, I might ask the zoning board for permission to add a room to my house; I ask the government of China for permission (i.e., a visa) to travel in that country. I’m an extremely independent person in many ways, so I have to stop and think carefully about what I might ask my husband permission to do. We have our own separate checking accounts as well as a joint account, so I might ask him for “permission” to spend a chunk of that joint account on a big purchase like a computer or a car. Everything else gets negotiated. I have a lot of experience in negotiation because of my business career. I negotiated things with everyone from my coworkers to my suppliers. But people who do that kind of thing for a living aren’t the only ones who negotiate, and negotiators aren’t necessarily politicians or manipulators trying to advance some evil cause. My own career as a negotiator probably started when I was a child who realized that good behavior often yielded a treat. My negotiations with my mother went something like this: It’s 7:00 o’clock on Thursday morning. Mom is brushing the tangled cobweb of my hair in preparation for braiding it. I am sniveling because the untangling hurts. The negotiation begins. Mom says: “Jeannie, if you stop whining right this minute, you can have Cocoa Puffs for breakfast.” Jeannie sees an opportunity and negotiates this agreement by asking, “Can I have chocolate milk on my Cocoa Puffs?” Mom sighs and yanks at a hank of hair. Jeannie snivels a little bit more. Finally Mom says, “Yes, you can have chocolate milk on your Cocoa Puffs.” Jeannie instantly shuts up. Negotiation over. It’s a win-win situation. Everybody’s happy… for maybe 15 minutes. In 15 minutes, Jeannie’s hair is finally tamed into two narrow braids and it’s time to choose an outfit for school. This time Jeannie begins the negotiation. “Can I wear my pink dress to school?” Mom says: “That dress is brand new. We’re going to save it for church.” Jeannie says: “I promise not to get it dirty.” And so on and so forth. Well, that’s enough time spent traipsing along Memory Lane. My point (and, like Ellen Degeneres, I do have one) is that the “yes or no” WLS decision is yours. Everything else (how to make it work best; what your family can do to help you; how much to tell your nosy coworker) needs to be negotiated with (or modulated by) the people who will be involved in your WLS journey on a daily basis and possibly renegotiated as time goes on and your needs change. The negotiation may be simple (“Will you take the kids to McDonald’s for lunch if I pick up your dry cleaning?”) or complex (“Let’s talk about how we’ll handle Thanksgiving Dinner this year”) or downright messy (“I feel like you’re trying to sabotage my weight loss.”). That’s life, isn’t it? BE CAREFUL WHAT YOU ASK FOR Getting feedback from others is usually a mixed bag experience. It’s wonderful to get the positive stuff and uncomfortable to get the negative stuff. It’s also very frustrating when your announcement elicits no response at all. What if you tell your sister, “I’ve decided to have weight loss surgery,” and all she says is “Oh.” What’s that all about? She’s shared her thoughts about your hairstyle, your boss, your kid’s struggles with math, your parents’ new car, your high blood pressure and now she has nothing to say about something as momentous as weight loss surgery? If you’re like me, your mind gets busy filling in all the empty spaces with scenarios and speculation. My own little mind is always full of running commentary (most of it – well, some of it – never uttered aloud). When I’m exercising, I’m planning what to wear to work that day. When I’m driving to work, I’m considering the best way to write the first or fifth or fifteenth sentence of my next article. When I’m driving home at the end of that day, I’m replaying a conversation I had with a coworker and fiddling with what I could have said better. So when I encounter my complete opposite (someone who has nothing to say on a matter that’s important to me), I cast my fishing net into my teeming mental pond, scoop up a dozen squirming fish, and off I go into Wonderland. “Wonderland” as in the land where I wonder, and wander, on an endless circular track. Around and around Jean goes, and where she stops, nobody knows, least of all Jean. The official term for that is “projection”. You project your own internal drama onto someone else’s blank white movie screen without having the first clue about what’s really going on behind that blank screen. You’ve known your sister all her life, ever since she supplanted you as the baby of the family. That’s what, 35 long years? After 35 years together, you might think you could predict her reaction to almost anything, but it’s also quite possible that you cannot correctly read her mind. Your suspicions about her reaction to your weight loss surgery announcement may be accurate, but you’ll never know that unless you specifically ask her. That’s more or less what happened to me when I first began discussing weight loss surgery with my husband. We had been married for 20 years, so he had two long decades of experience with his wife launching herself into risky situations (be it a new job, an overseas trip, adopting a pet, redecorating a house, taking fen-phen). He had been amazingly patient through all of that, not just because he loves and supports me but also because he knows that hell hath no fury like Jean with an obstacle in her path. So when I said, “Today I made an appointment to go to a bariatric surgery seminar,” and he said nothing in response, a dozen things ran through my mind. He thinks I should be able to lose weight by dieting. He doesn’t want me to lose weight because he likes fat girls. He thinks this is another of Jean’s wild goose chases and if he leaves it alone, she’ll get over it and move on to some other project…and so on and so forth. What was actually going on in his head was probably more like, “I wonder if there’s more rice in that saucepan, but if Jean forgot to buy soy sauce again, I won’t have another helping because I can’t eat rice without soy sauce. If Jean has weight loss surgery, will we ever get to eat rice with soy sauce again? Will we be living on warm water and melba toast? Did I remember to fill the cat’s water dish before I came in the house? We really need to get the cat fixed but I don’t want another argument about whose turn it is to take a critter to the vet. Oh no, Georgie’s puking in the living room again. If I ignore it, can I get Jean to clean it up? I’m going to write SOY SAUCE on the grocery list in big letters so Jean won’t forget to buy it. Maybe if I ignore the weight loss surgery thing, it’ll disappear, like Georgie’s puke”…and so on and so forth. I’m not trying to make my husband’s thought processes sound asinine (for a taste of truly asinine thinking, you really need to listen to a few minutes of my own stream of consciousness). I’m just making the point that our minds are full of stuff that may be worthwhile or interesting to us but doesn’t necessarily have to be shared in detail with everyone around us, and that nobody but the Amazing Kreskin can hear someone else’s thoughts. When my husband finished his dinner (without a second helping of rice) that night without making any response to my bariatric ambitions, I asked him, “So what do you think of the idea of me having weight loss surgery?” And he said, “I’m not crazy about it, but if you really believe it will help you, I’ll do my best to support you.” And what did I say to that? All I said was, “Thank you.” I could have said a lot of other things. I could have said, “Why aren’t you crazy about the idea?” I could have quizzed his knowledge about weight loss and weight loss surgery. I could have asked him if he would still love me and desire me when I was thin. I could have gone on and on for hours, while adding to my own anxiety and creating a host of brand new anxieties in his poor head. But instead I said, “Thank you,” because his promise of support was all I needed to hear at that time, and we had a lifetime of conversations ahead of us. And I said “Thank you” because when I’m in the planning stages of something big that will require a group effort, I try not to invite discussion that will derail the whole project even before its engine starts. You may have a different style, and you may think I was postponing a discussion that should be tackled immediately, but my approach is: one step at a time. I don’t try to build Rome in one day. I pick up one brick, walk it over to where I want the wall, put it down, and go back for another brick. Eventually the wall (or Rome) gets built. IN & OUT OF THE BAND CLOSET My feelings about sharing my WLS journey with other people have changed as time has gone on. For three months before and about 18 months after my band surgery, bariatrics was the #1 subject in my mind at least 75% of the time. I had to exert effort to not talk about it constantly. If I hadn’t discovered online WLS forums, where I could talk about it constantly with other people who talked about it constantly, I think my head may have exploded. I didn’t talk about WLS with every single person in my everyday circle of friends and acquaintances (for example, I decided not to tell my church friends about it, mostly out of laziness), but most of the people who knew me as obese also knew about my surgery. When I had lost my excess weight, the focus of my life began to shift to other things. Yes, bariatric surgery was still important to me, and so fascinating that I wrote a 500+ page book about it, but as my interests and activities grew and changed, I acquired a whole new set of friends, acquaintances, and coworkers who had never known Fat Jean. It didn’t occur to me to tell them I’d had WLS any more that it occurred to me to tell them I’d had a hysterectomy or hemorrhoids. If the subject of weight loss or dieting or exercise came up, I was willing to talk about those topics, but not necessarily in the context of weight loss surgery. I guess you could say I was in the band closet then, though I won’t admit to hiding in there. I still wanted to talk about bariatric topics, but not with the general public. I made two new friends during that time who know about my band surgery. One of them had heard about it from her mother (a former coworker of mine) and the other heard about it from me. Otherwise I was kind of enjoying being perceived as a “normal” woman by people who couldn’t even imagine me as a fat woman. But one day my feelings changed. I opened the door of my band closet and peered out. It was time to get out of there. Here’s what happened. During an exercise class at my fitness studio, another (naturally slender) student began making fun of fat people, and a few more people there chimed in. They just couldn’t imagine how someone could “let themselves go” like that. It sounded to me like these well-meaning people were saying that obesity is a choice – that the fat people had made a conscious decision to overeat, under-exercise, and gain an unhealthy amount of weight. It sounded to me like these well-meaning people were saying that fat people don’t have the willpower or intelligence to maintain a healthy weight. And suddenly I heard myself say out loud, “Those people aren’t proud of their fat. Don’t be making fun of them.” After a minute or two of mumbled objections, those well-meaning people fell silent, and soon the conversation took a new direction. Months later, when I was about to publish Bandwagon Cookery, my friend, instructor and personal trainer, Caroline, suggested holding a book-signing event at the fitness studio. At first I was wary of the idea. It would require me to step out of the band closet and expose my bariatric secret to a community of people who had never known Fat Jean. It would require me to step out of my comfort zone and into the limelight. I’m not afraid of public speaking – I actually enjoy it in most circumstances – and I’ve told my WLS journey story plenty of times, but mostly to bariatric patients and professionals. At Caroline’s loving insistence, we hosted the book signing, which was well-attended by women for whom weight management was an interest but for whom obesity was not an issue. One of them had a sister who was banded, but the rest of the guests were blank slates when it came to bariatrics. I want to share with you what I told this audience after announcing that I had weight loss surgery, something that I felt they needed to hear before I could tell my nitty-gritty obesity story: “I need to talk about the elephants in the room. The elephants are the beliefs that many people have, that obesity is a moral failing and that weight loss surgery is taking the easy way out. Obesity is not a choice, nor is it evidence of inadequate willpower. It’s a chronic and incurable disease caused by a combination of genetics, environment, and behavior. Weight loss surgery is the only effective long term treatment for obesity available in the United States today. And weight loss surgery is by no means the easy way out. Weight loss is hard work with or without the help of surgery. Has my weight loss been easier because I had bariatric surgery? Of course it has. That’s one of the reasons I chose surgery – because without it, my previous weight loss attempts had been so difficult and so ineffective. “I’m glad to have my Lap-Band, but it’s just a little piece of plastic, a tool that reduces my appetite. When I stick my hand in a bag of potato chips, my band doesn’t yank it out again. When my alarm goes off in the morning and I want to roll over and go back to sleep, my band isn’t what gets me out of bed, into workout clothes, and into this fitness studio. When I’m thinking that I need a 2nd helping of mashed potatoes, my band doesn’t shout, “Don’t do it, Jean!” When I’m sad and thinking that buying and eating a gallon of ice cream would make me feel so much better, my band doesn’t hide my car keys on me. “I am the one who makes decisions about what I eat and how I exercise. I am the one who’s responsible for making good food choices and changing my eating and exercise behavior. So I get the credit for my weight loss, and I’m the one who has committed to maintaining that weight loss for the rest of my life.” Looking back, I’m not sure how much of an impact that speech had on any of my listeners, but it had an impact on me. Hearing myself say those words affirmed my important and life-changing decision to have bariatric surgery. Whatever you do as you go forward on your weight loss journey, be proud of what you’re doing. It’s a courageous thing. If no one else congratulates you for the undertaking, you should still pat yourself on the back for it.

Wow. All I know about closing that hole is that it'll take a lot of patience. I had 2 holes that refused to close after my breast reduction and had to keep packing them with the gel and sterile gauze for several months. They did eventually close, though. Good luck!

Welcome, Trixie. I live in NW TN and am also a patient of Dr. Weaver's. She is wonderful! She didn't do my original band surgery, but I wish she had. My PCP was not on board either but I called his nurse to request a referral letter, and she wrote it, printed it out, and somehow got him to sign it. If that hadn't worked, I would've asked my gynecologist, who was/is very supportive about WLS. I wish I could give you a recommendation for a WLS-friendly PCP, but there must be thousands of PCP's to choose from, and if they aren't part of your insurance policy's provider network, you may not get very far with them. I feel compelled to tell you something about the St. Francis bariatric surgery program. They don't do a great job of support for bandsters because most of their patients walk in asking for the bypass. Some of the information about the band given out at the St. Francis support group meetings and nutrition classes is inaccurate or misleading. Don't get me wrong - I think very highly of St. Francis - but if you hear something there about the band that worries or puzzles you, feel free to ask me for another (non medical professional) opinion.

The sleeve surgery involves putting a staple line along the stomach to create a small, banana-shaped (or sleeve) stomach, after which the surgeon cuts away and removes the rest of the stomach. In plication, the surgeon reduces the size of the stomach by making a pleat in it and securing it with staples. So no part of the stomach is permanently removed. I know 3 people who've had the band with plication. One has lost an enormous amount of weight (but she has a lot to lose - started at almost 500 lbs), one I've kind of lost track of, and the other just had her surgery last month. I'll ask her to drop in on this thread and give you her comments about it. The band with plication has very good results so far, but it's too new to have accumulated any stats about long-term weight loss and possible complications.

Yes, I'm afraid I have. I had a complete unfill in February and since then have gained 25 lbs. I haven't been pigging out, but I'm physically hungry most of the time and eating bigger portions.

LOL! That reminds me of the famous time President Johnson lifted his golf shirt to show a reporter his incision from gall bladder surgery! Big to-do over that one!

Welcome, Krissy! The best way to get answers to your questions is to read lots of posts here on LBT. Everybody's experience with the band is unique, so the more you read, the better understanding you'll gain about the range of band experiences,. I'll take a shot at giving you some answers right now. Advice/Information? I could write a book to answer that one. Oh, wait! I did write a book! Down time after surgery? At the time, I was working from home at a sedentary job, and started back to work about 3-4 days after surgery. I assume that as a nurse, you're required to lift/assist patients, so your down time may be longer - maybe a few weeks? How did I do post-op? I lost 90 lbs in a year. That works out to 1.8 lbs/week, and the average weight loss rate with the band is 1-2 lbs/week, so I think I did pretty well. I have sagging skin but according to several plastic surgeons, that's related more to my age than my rate of weight loss. In terms of pain, my band surgery wasn't bad compared to my abdominal hysterectomy and breast reduction surgeries. Complications? I had a band slip (fixed by a complete unfill and 6 week rest period) and a port flip (fixed by outpatient surgery). I had my band removed this April because of bad reflux that I've apparently had for over 20 years in its "silent" form. It was aggravated by my small 4 cc band (no longer used in the USA). I'm planning to revise to the sleeve in the next month or so because my surgeon thinks putting another band in me is asking for trouble. Congrats on starting your weight loss journey!

You were awake for it? yeesh! I had general anesthesia for my port repair.

As you lose weight and your fat cells shrink, you're going to be able to palpate (feel by touching your abdomen) your port more easily. I couldn't feel my port at all for a few months - way too much flab covering it! Later I could feel it and was happy about that except when it chafed at my waistband. I liked feeling my port and knowing it was doing its job!

My port flipped. After something like 2 years of easy fills, it was harder and harder to access. My surgeon was able to access it under x-ray, but doing fills that way was ridiculously expensive in terms of time and the money billed to my insurance, so eventually I had surgery to re-position it. I'll be honest with you, that surgery was very painful because of all the scar tissue my surgeon had to deal with. I guess you have to consider the alternative? What's your co-pay for fills in the radiology department? Are you willing to go through that every time you need a fill or unfill for the rest of your life? BTW, we don't know why my port flipped. It could be that my workouts pulled a suture loose, or my original surgeon didn't suture it in well enough, or dumb luck. My current surgeon said that the possiblity of a flipped port is not a good excuse for avoiding exercise!

Is your brother, or your brother's doctor, a bariatric medical professional? If no, don't take their advice. Most non-bariatric physicians I've encountered know next to nothing about bariatric surgery, and what they do claim to know is ass-backwards.

Will they still do a revision on you? Depends on who you mean by "they". A surgeon will do a revision if the patient is having complications or issues with their band. They may even do it if the patient isn't having complications but wants a revision. Whether the patient's insurance company approves the revision depends on the individual policy. Some policies allow for only one WLS in a patient's lifetime. My insurance company approved my band removal and revision to sleeve despite my normal BMI because my surgeon provided evidence that the revision was medically necessary.

I can't remember where, but the other day I read that scar tissue usually softens as time goes on.

Scar tissue forms during the process of healing after an injury or surgery. When you fall and scrape your knee, the scab that forms is the initial part of the healing process. The same thing happens internally as a result of surgery. The body is trying to mend and reconnect the tissues that were cut apart. the collagen and other Proteins that the body uses to do this tend to connect in a different way than undamaged tissue does, so the scar tissue becomes thicker and more rigid than normal tissue. How much scar tissue forms as a result of band (or other) surgery depends on the individual. Scar tissue formation is not abnormal, but it can be difficult for a surgeon to deal with when performing surgical procedures (such as band removal) later on. If the patient has had several abdominal surgeries in her/his lifetime, there will probably be more scar tissue to complicate things. For example, my bariatric surgeon says that I'm a challenge to work on because I no longer have a "virgin belly". I have scar tissue from band placement, a port revision, band removal, and (further south) a hysterectomy. If a patient has a lot of scar tissue, a surgical procedure will take longer to perform, and the surgeon may decide that the patient's body needs time to heal (and, unfortunately, form more scar tissue!) before another bariatric procedure can be done safely.

They denied it because they said my co-morbidities weren't bad enough to make the surgery a "medical necessity". In my appeal, I told them how much they'd have to pay to treat my co-morbidities (high cholesterol, sleep apnea, etc.) until I'm of Medicare age. I guess that convinced them! But that was back in 2007. Anthem seems to have loosened up a bit about WLS since then.

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!

You have whatever Anthem insurance is printed on your subscriber ID card. If you're confused about it, just call them and ask. It doesn't really matter where they're located as long as you have coverage with providers in your area. I live in TN and have Anthem BC/BS of CT because my husband is retired from the state of CT. Providers submit claims for our medical care through BC/BS of TN, who then recover the money from Anthem BC/BS of CT. Your WLS coverage and approval will depend on the terms of your particular policy. Anthem could have 1000 different policies for 1000 different organizations or individuals (probably more!). Anthem took 2 weeks to deny my band surgery and another 2 weeks to approve it after I appealed it. My BMI was 39.9 and I had several co-morbidities.

Congratulations and good luck!

You might see it after losing a lot of weight. Mine looked like a round bump under the skin, but it wasn't weird looking and I don't think anyone would have noticed it if I'd gone out in public wearing a bikini (which I assure you, I have no plans to do ever again in my entire life).

I haven't gotten all the records yet, and it's 100% covered by my insurance, but so far it's $1600 for the anesthetist, $46,875 for the hospital (for an overnight stay), and $3057 for the pre-admission testing. My surgeon's fee will probably be $5000+.