Jean McMillan

Nope. I could feel my port as a hard mass that sometimes felt like it got in the way when I used my abdominal muscles to bend over, but I couldn't feel my band around my stomach. It's my understanding that the nerves in the GI tract don't react to stimulation the way nerves do elsewhere in the body. For example, when you stimulate your thumb buy pricking it with a pin, the nerves in your thumb immediately say, "Pain!" But when an organ or structure in your GI tract is stimulated, the nerves send the pain signal elsewhere in the body.

that's a very interesting question. I believe I was a very compliant and conservative patient as a new post-op, and after my first fill I realized how important it is to fill the band gradually, because it took a lot of effort for me to adjust my eating to the new level of restriction. I also felt that I NEEDED every single fill I got, but several times I asked for small unfills because eating had become too difficult. So I think it all balanced out OK for me.

I've never been sent home from any surgery with antibiotics. I hate that this is happening to you, but it really is best to remove your band and port now. As your doctor said, infection at the port site is often due to bacteria traveling down the tubing from the band to the port, and that may be due to band erosion. If that turns out to be the case with you, I wouldn't have another band placed. I'd consider revising to a different surgery after your stomach has healed from the band removal.

If the port site is also hot to touch, you could have an infection there. It's good that you're going to the doc tomorrow. I'm not a stomach sleeper, so I can't help you there!

Sam, That's a lot of questions! I could write a book in response to them. Oh, wait. I did write a book. Everybody's experience of surgery (anesthesia, pain, recovery) is different; surgeons' protocols for pre and post-op diets vary greatly; weight loss varies; exercise varies...so there's no one-size-fits-all answer for you. I suggest that you cruise the forums here to get an idea of other bandsters' experiences. As for preparing for surgery: you need to be doing whatever your surgeon and/or dietitian told you to do in preparationg, but other than that, I'd say the #1 thing is to start adjusting your expectations. Success at weight loss surgery of any type requires a lot of work - in making good food choices, controlling portions, resisting the urge to eat for non-hunger reasons (like stress, boredom, comfort), exercising (at whatever keeps you from getting bored), etc. Average weight loss with the band is 1-2 lbs/week. That's an average that includes people who lost a lot more quickly as well as people who lost nothing or gained weight.

Protein bullets are a flavored, gelatinous protein supplement packaged in small bullet-shaped (or test-tube shaped) packages. They give you a big whallop of protein in a very concentrated form. I think they're disgusting - I'm not sure if it's the flavor or the gelatinous texture. You can get them in health food stores.

I'm so glad to hear you're feeling better. I was very hungry too starting the day after my surgery. I think it may be easier for you to tolerate when you have work to do to keep your mind off it. Hang in there!

I have to tell you a funny fill story. During one of my first few fills, I was lying on the exam table chatting with my surgeon (my original surgeon, who didn't use lidocaine to numb the injection site). I couldn't see much of what was going on. I said, "So, how much are you going to put in this time?" and he laughed and said, "We're done already! I put in .5 cc." I hadn't felt a thing!

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.

That's the spirit!

Lots of questions! I'm going to insert my answers and comments into your text, below.

You're not alone! My dietitian told me I wouldn't be hungry after my surgery, but she was wrong. I was hungry starting on day 2, and clear liquids didn't do much to help. But there are some very good reasons for following the liquid diet, and I've just posted an LBT Magazine article about how to survive the liquid diet that might help you. Check it out here: http://www.lapbandtalk.com/page/index.html/_/healthy-living/food-nutrition/how-to-survive-your-liquid-diet-r69 Hang in there!

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.

What happens at your pre-op appointment depends on your surgeon's protocol. As I recall, my pre-op appointment I spent some time with my surgeon (last-minute questions), his nurse (going over what was going to happen at the hospital before and after surgery, and my post-op instructions), and the dietitian (going over the pre-op and post-op eating plans). I also had to sign release papers.

So a revision request never got submitted to your insurance? You might want to ask about that again, because my revision was approved when my BMI was only 26.6. Apparently my insurance company decided that since my band removal was due to medical problems, and they'd already made an investment in my bariatric health back in 2007, they were willing to OK the sleeve. It'll depend on the insurance policy, but it doesn't hurt to ask.

I had my band completely emptied in February removed in April because of esophageal problems apparently caused by reflux. I had hoped to revise tot he sleeve but my surgeon wasn't able to do it because of a stricture we didn't know I had. I've re-gained 24 lbs since my unfill. I know a few other people who had their band removed for various reasons, and unfortunately they've all regained some weight. I regained weight so quickly at first that I was shocked, because I wasn't pigging out, just eating bigger quantities of healthy foods. My gastro-enterologist said that was my body's response to what it had perceived as long-term starvation/deprivation. Now that I can eat easily, my body seems to be holding on to every freaking calorie I eat. I still plan to revise to the sleeve. If I were you, I'd want some sort of revision, but not until your doctors have a better explanation (and treatment)for those pre-cancerous cells in your stomach. Good luck!

Since you'll have justed started eating a normal diet, my #1 advice is don't take chances. Don't order foods that you haven't yet eaten as a post-op. When in doubt, order Soup. If you'll be traveling by air, airline food is only an issue on long flights, on which you may be able to order a special diet meal (vegetarian, etc.). Bring non-perishable Snacks with you (Protein bars; granola bars; jerky; single-serving applesauce, fruit, or dry cereal; packets of protein powder). Most full-service restaurants serve things like oatmeal, yogurt, soup, smoothies, juice and milk, and hotel shops often have a refrigerated case stocked witgh juiced, iced tea, milk (ignore the soda), though their packaged snacks (chips, crackers, cookies) are best ignored. Restaurant eating tips: order an appetizer or a half-size entree; avoid buffets; order a child's meal (if there's a healthy-looking choice on the menu); order an extra vegetable instead of potatoes, rice, Pasta or other starch; order salad dressing, sauce, or condiments on the side so you can control the portion size; put a napkin or bread plate over your beverage glass so the server won't fill it; avoid alcohol; always locate the restroom before you start to eat, just in case you have to leave the table in a hurry. Who was it that asked if you have any special food needs? Is it someone you've met before, or are likely to meet in the future? Does this person reasonably have control over all the foods you'll be offered during the trip? Will you be seeing anyone you've previously met, or will it be strangers who know nothing about you? You don't owe anybody, stranger or not, any explanation about anything unrelated to the business at hand. In social situations, there are dozens of things you can talk about that have nothing to do with your eating. You can not tell anyone you'll be traveling with or visiting that you've had bariatric surgery and just wing it, or you can tell them you're recovering from (unspecified) surgery and give them some guidelines (see above). I have an acquaintance who told her coworkers she was recovering from surgery to repair a hiatal hernia (which was part of the truth), and another (whose coworkers were mostly men) who explained she'd had surgery for "female trouble" (almost guaranteed to turn them off). You could also say you're recovering from oral surgery. The problem with telling those little white lies is that there's always a chance you'll run into someone who also had that kind of surgery and would love to talk about it in detail. My own approach is to not explain anything and not do anything to call attention to the way I eat. If coworkers get nosy about it, I change the subject or give myself an exit line (like, "Oh, there's Bob. I've got to ask him something before I forget, so excuse me.")

I've done a fair amount of business and other travel since being banded and might be able to give you some suggestions, but I need to know what post-op diet phase will you be in then? Purees? Soft foods? Solid foods?

Jessie Ahroni's book, Laparascopic Adjustable Gastric Banding, has an excellent section entitled, "How Can I Tell If I'm Perfectly Adjusted?" While I'm not sure there's such a thing as "perfect" adjustment (for me, "almost perfect" works very well), Jessie gives helpful lists of questions to ask yourself to determine if you need an eating adjustment, a behavior adjustment, an acitivity adjustment, an attitude adjustment, or a band adjustment. There are dozens of things that can affect your weight and though not all of them are within our control, quite a few of them are. I like re-reading Jessie's questions because she reminds me of things I'd overlooked or forgotten.

I haven't had that on the pre-op liquid diet, but on the post-op diet, yes. For me it's crampy diarrhea from consuming only liquids. Depending on what liquids you've been drinking, it could be related to lactose intolerance or an overload of artificial sweeteners. Hope you feel better soon.

Yes, an EGD or upper endoscopy involves putting a scope down your throat and into your stomach, while you're sedated, so not something you'd want to do while pregnant. You shouldn't have an upper GI while pregnant either. A common symptom of band erosion is an infection at the port site (from bacteria traveling along the tubing). The port site would be red, swollen, and hot to touch. Minor erosions are often "silent" (no symptoms). Other signs of erosion include fever, back pain, difficulty eating, complete loss of restriction. You really need to discuss this with your surgeon, and maybe have a complete unfill to reduce the amount of stress on your stomach and esophagus.

Yes, it could, but you might also need an EGD.

Your doctor should have told you what to do about taking time off work. For every EGD I've had, I was told not to drive, operate machinery, make important decisions, or sign any legal documents for 24 hours after the procedure, because of the sedation given. You'll need to bring an adult with you. The procedure itself is quick - maybe 5-10 minutes - but the prep (checking you in, putting in an IV, waiting for the doctor) and the recovery (waiting for you to wake up enough to get up, get dressed, and walk out. What to expect: check in, be put in a curtained cubicle, change into a johnny, lie on a gurney, have an IV put in, talk to the anesthetist, and wait for the procedure to start. Be wheeled into the procedure room, say hi to the doctor, be rolled over on your side (usually the left side), and lights out when they start the sedation. Wake up in your cubicle, talk to the nurses and doctor, get your discharge instructions, get dressed, go home. You might have a sore throat from the scope. Doing an EGD is a way for the doctor to get the lay of the land (so to speak) in your upper GI tract. He/she might find a hiatal hernia that needs to be repaired during your band placement. They'll look for any other structural abnormalities in your esophagus and stomach, and for signs of disease, like ulcers, that might need to be treated before your surgery. I've never heard of anyone being disqualified from band surgery because of the findings of an EGD, so you need to ask your doctor about that. Edited to add: Also, don't drink or eat anything after midnight the night before unless your doctor says it's OK to take a medication (like blood pressure meds) with a tiny sip of Water.

Seems like everybody hits a weight loss plateau sooner or later. Soooo frustrating. I don't know enough about spinal stenosis to know what exercise is appropriate for you, but surely the doctor (orthopedic?) who monitors your spinal problem could recommend something? A physical therapist that I've worked with in the past has mentioned that Water exercise can be very helpful and my mom participated in a chair exercise program for a while. Also, I just wrote an article called Breaking a Weight Loss Plateau. You can read it here: http://www.lapbandtalk.com/page/index.html/_/plateaus-and-regain/breaking-a-weight-loss-plateau-r67

EAting solid protein is what satiety is all about!